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    Clinical Trial Results:
    GOAL trial: Rescue treatment with the monoclonal anti CD20-antibody Obinutuzumab (GA101) in combination with PixantrOne for the treatment of patients with relapsed Aggressive B-cell Lymphoma

    Summary
    EudraCT number
    2014-004780-21
    Trial protocol
    DE  
    Global end of trial date
    02 Jan 2022

    Results information
    Results version number
    v1(current)
    This version publication date
    22 Jun 2023
    First version publication date
    22 Jun 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    ETN-1-GOAL
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    University Medical Center of the Johannes Gutenberg
    Sponsor organisation address
    Langenbeckstr 2, Mainz, Germany, 55131
    Public contact
    Georg Hess, University Medical Center of the Johannes Gutenberg, 0049 6131175040, ruckes@izks-mainz.de
    Scientific contact
    Georg Hess, University Medical Center of the Johannes Gutenberg, 6131179919 6131175040, ruckes@izks-mainz.de
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    02 May 2022
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    31 May 2021
    Global end of trial reached?
    Yes
    Global end of trial date
    02 Jan 2022
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    - To evaluate the overall response rate (ORR) of the combination after completion or termination of trial treatment
    Protection of trial subjects
    Ethics approval, authority approval
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Jul 2015
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Germany: 70
    Worldwide total number of subjects
    70
    EEA total number of subjects
    70
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    19
    From 65 to 84 years
    50
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    70 patients were enrolled 68 patients were analyzed for efficacy and safety 60 patients were analyzed mITT (available tumor assessment) 42 patients were analyzed within GCB evaluation

    Pre-assignment
    Screening details
    -

    Pre-assignment period milestones
    Number of subjects started
    70
    Number of subjects completed
    68

    Pre-assignment subject non-completion reasons
    Reason: Number of subjects
    Did not receive stdy medication: 2
    Period 1
    Period 1 title
    Treatment Period (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    Not applicable, single-arm trial

    Arms
    Arm title
    Obinutuzumab+Pixantrone
    Arm description
    Patients received 1000 mg of Obinutuzumab on days 1, 8 and 15 (first cycle) or day 1 of any following cycle in combination with 50 mg/m2 Pixantrone on days 1, 8 and 15 of a 28-day cycle for up to six cycles.
    Arm type
    Experimental

    Investigational medicinal product name
    Obinutuzumab
    Investigational medicinal product code
    Other name
    Gazyvaro
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    1000 mg of Obinutuzumab on days 1, 8 and 15 (first cycle) or day 1 of any following cycle

    Investigational medicinal product name
    Pixantrone
    Investigational medicinal product code
    Other name
    Pixuvri
    Pharmaceutical forms
    Infusion
    Routes of administration
    Infusion
    Dosage and administration details
    50 mg/m2 Pixantrone on days 1, 8 and 15 of a 28-day cycle

    Number of subjects in period 1 [1]
    Obinutuzumab+Pixantrone
    Started
    68
    Completed
    20
    Not completed
    48
         Adverse event, serious fatal
    3
         Consent withdrawn by subject
    2
         Adverse event, non-fatal
    10
         Unspecified
    2
         Disease Progression
    31
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: Only the number of patients receiving study medication were analyzed.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Treatment Period
    Reporting group description
    -

    Reporting group values
    Treatment Period Total
    Number of subjects
    68 68
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    0
        Newborns (0-27 days)
    0
        Infants and toddlers (28 days-23 months)
    0
        Children (2-11 years)
    0
        Adolescents (12-17 years)
    0
        Adults (18-64 years)
    0
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    70.49 ± 11.67 -
    Gender categorical
    Units: Subjects
        Female
    37 37
        Male
    31 31
    Current Lymphoma Stage
    Units: Subjects
        Stage I
    8 8
        Stage II
    13 13
        Stage III
    14 14
        Stage IV
    32 32
        Missing
    1 1
    Histologically proven type of lymphoma
    Units: Subjects
        Diffuse large B-cell lymphoma
    49 49
        Follicular lymphoma grade IIIB
    1 1
        Follicular lymphoma grade IIIA
    3 3
        Follicular lymphoma grade II
    3 3
        Follicular lymphoma grade I
    4 4
        Other
    8 8
    Histologically proven type of lymphoma
    Histologically proven type of lymphoma at screening
    Units: Subjects
        Diffeuse large B-cell lymphoma
    52 52
        Follicular lymphoma grade IIIB
    2 2
        Transformed to DLBCL
    8 8
        Transformed to FL3B
    1 1
        Transformed to burkitt-like lymphoma
    1 1
        Other
    4 4
    Prior lymphoma treatment - chemotherapies
    Units: Subjects
        =1
    19 19
        =2
    27 27
        =3
    13 13
        >3
    9 9
    Prior lymphoma treatment - antibodies
    Units: Subjects
        =1
    16 16
        =2
    17 17
        >2
    35 35
    Prior lymphoma treatment - novel agents
    Units: Subjects
        None
    64 64
        =1
    4 4
    Prior lymphoma treatment - consolidation
    Units: Subjects
        None
    56 56
        =1
    11 11
        =2
    1 1
    Best response to most recent prior therapy
    Units: Subjects
        CR
    14 14
        CRu
    1 1
        PR
    14 14
        SD
    3 3
        PD
    31 31
        Discontinued
    2 2
        Unknown
    3 3

    End points

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    End points reporting groups
    Reporting group title
    Obinutuzumab+Pixantrone
    Reporting group description
    Patients received 1000 mg of Obinutuzumab on days 1, 8 and 15 (first cycle) or day 1 of any following cycle in combination with 50 mg/m2 Pixantrone on days 1, 8 and 15 of a 28-day cycle for up to six cycles.

    Subject analysis set title
    GEP-profiling
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    Subjects who took part in the gene expression profiling (GEP). Recent gene expression profiling studies supported the view that DLBCL is heterogeneous, as two major molecular DLBCL subtypes, termed germinal center B-cell-like (GCB) DLBCL and activated B-cell-like (ABC) DLBCL, could be distinguished.

    Primary: Objective Response Rate

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    End point title
    Objective Response Rate [1]
    End point description
    End point type
    Primary
    End point timeframe
    44 weeks
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: This is only a single arm trial.
    End point values
    Obinutuzumab+Pixantrone GEP-profiling
    Number of subjects analysed
    68
    42
    Units: Patients
        Response
    24
    13
        Non-response
    36
    29
        Not recorded
    8
    0
    No statistical analyses for this end point

    Secondary: Progression-free survival

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    End point title
    Progression-free survival
    End point description
    Time from first medication intake to first documentation of objective tumor progression or to death due to any cause, whichever occurs first.
    End point type
    Secondary
    End point timeframe
    44 months
    End point values
    Obinutuzumab+Pixantrone
    Number of subjects analysed
    68
    Units: months
        median (confidence interval 95%)
    2.8 (2.0 to 6.6)
    No statistical analyses for this end point

    Secondary: Overall Survival

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    End point title
    Overall Survival
    End point description
    End point type
    Secondary
    End point timeframe
    44 months
    End point values
    Obinutuzumab+Pixantrone
    Number of subjects analysed
    68
    Units: months
        median (confidence interval 95%)
    8.0 (4.8 to 12.3)
    No statistical analyses for this end point

    Secondary: Progression-free survival GCB

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    End point title
    Progression-free survival GCB
    End point description
    Progression-free survival for the GCB cohort
    End point type
    Secondary
    End point timeframe
    44 months
    End point values
    GEP-profiling
    Number of subjects analysed
    22
    Units: month
        median (confidence interval 95%)
    1.8 (1.0 to 6.8)
    No statistical analyses for this end point

    Secondary: Progression-free survival non-GCB

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    End point title
    Progression-free survival non-GCB
    End point description
    End point type
    Secondary
    End point timeframe
    44 months
    End point values
    GEP-profiling
    Number of subjects analysed
    20
    Units: month
        median (confidence interval 95%)
    6.5 (2.3 to 999)
    No statistical analyses for this end point

    Secondary: Overall Survival GCB

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    End point title
    Overall Survival GCB
    End point description
    End point type
    Secondary
    End point timeframe
    44 months
    End point values
    GEP-profiling
    Number of subjects analysed
    22
    Units: month
        median (confidence interval 95%)
    5.2 (1.8 to 10.0)
    No statistical analyses for this end point

    Secondary: Overall Survival non-GCB

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    End point title
    Overall Survival non-GCB
    End point description
    End point type
    Secondary
    End point timeframe
    44 months
    End point values
    GEP-profiling
    Number of subjects analysed
    20
    Units: month
        median (confidence interval 95%)
    99 (7.2 to 999)
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    24 weeks (6 treatment cycles)
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    20.0
    Reporting groups
    Reporting group title
    Obinutuzumab+Pixantrone
    Reporting group description
    -

    Serious adverse events
    Obinutuzumab+Pixantrone
    Total subjects affected by serious adverse events
         subjects affected / exposed
    58 / 68 (85.29%)
         number of deaths (all causes)
    45
         number of deaths resulting from adverse events
    16
    Investigations
    Amylase decreased
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Lipase increased
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Neutrophil count decreased
         subjects affected / exposed
    2 / 68 (2.94%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Platelet count decreased
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    White blood cell count decreased
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Acute myeloid leukaemia
         subjects affected / exposed
    2 / 68 (2.94%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    1 / 1
    Lung neoplasm malignant
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Non-Hodgkin's lymphoma
         subjects affected / exposed
    7 / 68 (10.29%)
         occurrences causally related to treatment / all
    0 / 7
         deaths causally related to treatment / all
    0 / 7
    Injury, poisoning and procedural complications
    Ulna fracture
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Acute myocardial infarction
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Bicytopenia
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Febrile neutropenia
         subjects affected / exposed
    3 / 68 (4.41%)
         occurrences causally related to treatment / all
    1 / 4
         deaths causally related to treatment / all
    0 / 0
    Granulocytopenia
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Leukopenia
         subjects affected / exposed
    22 / 68 (32.35%)
         occurrences causally related to treatment / all
    1 / 29
         deaths causally related to treatment / all
    0 / 0
    Neutropenia
         subjects affected / exposed
    31 / 68 (45.59%)
         occurrences causally related to treatment / all
    1 / 37
         deaths causally related to treatment / all
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    8 / 68 (11.76%)
         occurrences causally related to treatment / all
    1 / 12
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Disease progression
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 4
    Fatigue
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General physical health deterioration
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Malaise
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pain
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    Pyrexia
         subjects affected / exposed
    3 / 68 (4.41%)
         occurrences causally related to treatment / all
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Lower gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nausea
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Subileus
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Cholestasis
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Erysipelas
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Escherichia sepsis
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Infection
         subjects affected / exposed
    3 / 68 (4.41%)
         occurrences causally related to treatment / all
    1 / 3
         deaths causally related to treatment / all
    0 / 1
    Influenza
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Peritonitis
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pharyngitis
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
         subjects affected / exposed
    6 / 68 (8.82%)
         occurrences causally related to treatment / all
    1 / 6
         deaths causally related to treatment / all
    0 / 1
    Sepsis
         subjects affected / exposed
    2 / 68 (2.94%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 1
    Urinary tract infection
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Urosepsis
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Metabolism and nutrition disorders
    Dehydration
         subjects affected / exposed
    1 / 68 (1.47%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Obinutuzumab+Pixantrone
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    68 / 68 (100.00%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Non-Hodgkin's lymphoma
         subjects affected / exposed
    7 / 68 (10.29%)
         occurrences all number
    7
    Vascular disorders
    Hypertension
         subjects affected / exposed
    5 / 68 (7.35%)
         occurrences all number
    5
    Hypotension
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    4
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    19 / 68 (27.94%)
         occurrences all number
    22
    General physical health deterioration
         subjects affected / exposed
    5 / 68 (7.35%)
         occurrences all number
    5
    Oedema peripheral
         subjects affected / exposed
    9 / 68 (13.24%)
         occurrences all number
    14
    Pain
         subjects affected / exposed
    6 / 68 (8.82%)
         occurrences all number
    7
    Pyrexia
         subjects affected / exposed
    8 / 68 (11.76%)
         occurrences all number
    8
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    10 / 68 (14.71%)
         occurrences all number
    11
    Dysphonia
         subjects affected / exposed
    5 / 68 (7.35%)
         occurrences all number
    5
    Dyspnoea
         subjects affected / exposed
    12 / 68 (17.65%)
         occurrences all number
    14
    Oropharyngeal pain
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    4
    Pleural effusion
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    4
    Psychiatric disorders
    Insomnia
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    4
    Investigations
    Blood creatine increased
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    5
    Gamma-glutamyltransferase increased
         subjects affected / exposed
    5 / 68 (7.35%)
         occurrences all number
    11
    Neutrophil count decreased
         subjects affected / exposed
    14 / 68 (20.59%)
         occurrences all number
    45
    Platelet count decreased
         subjects affected / exposed
    6 / 68 (8.82%)
         occurrences all number
    11
    Troponin I increased
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    4
    Weight decreased
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    4
    White blood cell count decreased
         subjects affected / exposed
    13 / 68 (19.12%)
         occurrences all number
    48
    Cardiac disorders
    Tachycardia
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    5
    Nervous system disorders
    Polyneuropathy
         subjects affected / exposed
    5 / 68 (7.35%)
         occurrences all number
    6
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    17 / 68 (25.00%)
         occurrences all number
    29
    Leukopenia
         subjects affected / exposed
    46 / 68 (67.65%)
         occurrences all number
    86
    Neutropenia
         subjects affected / exposed
    46 / 68 (67.65%)
         occurrences all number
    93
    Thrombocytopenia
         subjects affected / exposed
    15 / 68 (22.06%)
         occurrences all number
    34
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    5
    Constipation
         subjects affected / exposed
    12 / 68 (17.65%)
         occurrences all number
    13
    Diarrhoea
         subjects affected / exposed
    15 / 68 (22.06%)
         occurrences all number
    15
    Nausea
         subjects affected / exposed
    14 / 68 (20.59%)
         occurrences all number
    24
    Stomatitis
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    6
    Vomiting
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    6
    Skin and subcutaneous tissue disorders
    Alopecia
         subjects affected / exposed
    12 / 68 (17.65%)
         occurrences all number
    12
    Pruritus
         subjects affected / exposed
    5 / 68 (7.35%)
         occurrences all number
    5
    Rash
         subjects affected / exposed
    7 / 68 (10.29%)
         occurrences all number
    9
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    5 / 68 (7.35%)
         occurrences all number
    5
    Muscle spasms
         subjects affected / exposed
    5 / 68 (7.35%)
         occurrences all number
    6
    Pain in extremity
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    4
    Infections and infestations
    Infection
         subjects affected / exposed
    6 / 68 (8.82%)
         occurrences all number
    6
    Nasopharyngitis
         subjects affected / exposed
    5 / 68 (7.35%)
         occurrences all number
    5
    Oral herpes
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    4
    Pneumonia
         subjects affected / exposed
    6 / 68 (8.82%)
         occurrences all number
    6
    Sinusitis
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    4
    Urinary tract infection
         subjects affected / exposed
    7 / 68 (10.29%)
         occurrences all number
    11
    Metabolism and nutrition disorders
    Decreased appetite
         subjects affected / exposed
    4 / 68 (5.88%)
         occurrences all number
    4
    Hypokalaemia
         subjects affected / exposed
    5 / 68 (7.35%)
         occurrences all number
    7

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    20 Jun 2016
    - Inclusion criteria: Removal of CD20 positive disease. - Inclusion criteria: Change from “LVEF>= 45% and normal serum troponin” to “- Adequate cardiac reserve: Serum Troponin level must be consistent with no significant acute or chronic myocardial damage and there should be no evidence of symptomatic”. - Clarification of reconstitution process of Pixantrone. - Addition of frequently observed adverse drug reactions of Obinutuzumab and Pixantrone. - Reference to IB-Addendum Number 1, March 2016 of Obinutuzumab concerning precautions for patients considered at risk for Tumor Lysis Syndrome was added. - Observation period for concomitant treatments and adverse events prolonged to 42 days after last administration of trial medication or until the start of a new antineoplastic therapy. - Minor typographic and editorial corrections or clarifications.
    06 Nov 2017
    - Change of manufacturer of Pixantrone. - Addition of frequently observed adverse drug reactions of Obinutuzumab and Pixantrone. - Addition of documentation and reporting of special situations. - Minor typographic and editorial corrections or clarifications.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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