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    Clinical Trial Results:
    A phase 1/2 study of the combination of pixantrone, etoposide, bendamustine and, in CD-20 positive tumors, rituximab in patients with relapsed aggressive non-Hodgkin lymphomas of B- or T-cell phenotype - the P[R]EBEN study

    Summary
    EudraCT number
    2015-000758-39
    Trial protocol
    DK   SE   FI   NO   NL  
    Global end of trial date
    31 Jan 2025

    Results information
    Results version number
    v1(current)
    This version publication date
    07 Sep 2025
    First version publication date
    07 Sep 2025
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    PREBEN
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02678299
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Aarhus University Hospital
    Sponsor organisation address
    Palle Juul-Jensens Boulevard 35, Aarhus N, Denmark, 8200
    Public contact
    Clinical Trial Office, Department of Hematology, Aarhus University Hospital, 45 78455855, a-cto@auh.rm.dk
    Scientific contact
    Clinical Trial Office, Department of Hematology, Aarhus University Hospital, 45 78455855, a-cto@auh.rm.dk
    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
    08 May 2021
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    14 Jan 2021
    Global end of trial reached?
    Yes
    Global end of trial date
    31 Jan 2025
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Determine the MTD of pixantrone, rituximab (only in CD20 positive tumors), etoposide, and bendamustine in ‘fit' patients with rel aNHL of B- or T-cell phenotype. Evaluate the ORR and PFS using the combination of pixantrone, rituximab (only in CD20 positive tumors), etoposide, and bendamustine either at the identified MTD (P[R]EBEN-fit) in ‘fit’ patients or at the baseline dose level (P[R]EBEN-frail) in ‘frail’ patients with rel aNHL. Evaluate the CR, PR, duration of response, and OS using the combination of pixantrone, rituximab (only in CD20 positive tumors), etoposide, and bendamustine in patients with B- or T-cell NHL. Evaluate the safety and tolerability of combination therapy with pixantrone, rituximab (only in CD20 positive tumors), etoposide, and bendamustine in patients with aggressive B- or T-cell NHL.
    Protection of trial subjects
    The study was conducted according to the guidelines for Good Clinical Practice issued by the International Conference on Harmonisation of the Technical Requirements for the Registration of Pharmaceuticals for Human Use (ICH). The protocol was approved by the local, regional or national ethical review boards according to the existing natinal and local requirements. The study was conducted in agreement with the declaration of Helsinki and the laws and regulations of the respective countries.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    03 Jun 2016
    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
    Netherlands: 4
    Country: Number of subjects enrolled
    Norway: 4
    Country: Number of subjects enrolled
    Sweden: 3
    Country: Number of subjects enrolled
    Denmark: 34
    Country: Number of subjects enrolled
    Finland: 15
    Worldwide total number of subjects
    60
    EEA total number of subjects
    60
    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)
    11
    From 65 to 84 years
    49
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Overall 60 patients were included in the trial. The first patient was included on 03-Jun-2016 and the last patient was included on 21-Jul-2020

    Pre-assignment
    Screening details
    Patients were screened for the complete list of inclusion and exclusion criteria according to the protocol

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Treatment
    Arm description
    Single arm study. All patients received a maximum of 6 cycles of 3 weeks duration. Pixantrone, etoposide, bendamustine was given to all patients and rituximab was added for patients with CD20 positive tumors
    Arm type
    Experimental

    Investigational medicinal product name
    Pixantrone
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    50 mg/m2 i.v. day 1+8 in 6 cycles of 3 weeks

    Investigational medicinal product name
    etoposide
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    100 mg/m2 i.v. day 1 of 6 cycles of 3 weeks duration

    Investigational medicinal product name
    Bendamustine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    90 mg/m2 i.v. day 1 of 6 cycles of 3 weeks

    Investigational medicinal product name
    rituximab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    375 mg/m2 i.v. day 1 of 6 cycles of 3 weeks, only in patients with CD20 positive tumors

    Number of subjects in period 1
    Treatment
    Started
    60
    Completed
    46
    Not completed
    14
         Adverse event, serious fatal
    1
         Physician decision
    1
         Adverse event, non-fatal
    4
         Lack of efficacy
    6
         Protocol deviation
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    -

    Reporting group values
    Overall trial Total
    Number of subjects
    60 60
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    11 11
        From 65-84 years
    49 49
        85 years and over
    0 0
    Gender categorical
    Units: Subjects
        Female
    26 26
        Male
    34 34

    End points

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    End points reporting groups
    Reporting group title
    Treatment
    Reporting group description
    Single arm study. All patients received a maximum of 6 cycles of 3 weeks duration. Pixantrone, etoposide, bendamustine was given to all patients and rituximab was added for patients with CD20 positive tumors

    Primary: Overall Response Rate

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    End point title
    Overall Response Rate [1]
    End point description
    End point type
    Primary
    End point timeframe
    Response at end of treatment
    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: The overall response rate is reported as number of subjects responding
    End point values
    Treatment
    Number of subjects analysed
    60
    Units: Subjects
    34
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events were reported from day 1 of cycle 1 to 6 months after last administration of study drugs.
    Adverse event reporting additional description
    Number of non-serious adverse events are reported only for anemia, neutropenia and thrombocytopenia
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    4.03
    Reporting groups
    Reporting group title
    Treatment
    Reporting group description
    All patients received a maximum of 6 cycles of 3 weeks duration. Pixantrone, etoposide, bendamustine was given to all patients and rituximab was added for patients with CD20 positive tumors

    Serious adverse events
    Treatment
    Total subjects affected by serious adverse events
         subjects affected / exposed
    38 / 60 (63.33%)
         number of deaths (all causes)
    44
         number of deaths resulting from adverse events
    3
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Adenocarcinoma
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Cardiac disorders
    Atrial fibrillation
         subjects affected / exposed
    2 / 60 (3.33%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Troponin C increased
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Tachycardia
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    heart failure
         subjects affected / exposed
    2 / 60 (3.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Coronary artery stenosis
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Left ventricular dysfunction
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Ataxia
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bone marrow disorder
    Additional description: Only observed in patients with PTCL of TFH type with probable pre-existing clonal haematopoieses (well-known to be frequently present in PTCL of TFH type)
         subjects affected / exposed
    2 / 60 (3.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Dehydration
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Fatigue
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Impaired general condition
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Death
         subjects affected / exposed
    5 / 60 (8.33%)
         occurrences causally related to treatment / all
    3 / 5
         deaths causally related to treatment / all
    3 / 5
    Gastrointestinal disorders
    Abdominal pain
         subjects affected / exposed
    3 / 60 (5.00%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    Diarrhoea
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    rectal bleeding
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Pleural effusion
         subjects affected / exposed
    3 / 60 (5.00%)
         occurrences causally related to treatment / all
    1 / 3
         deaths causally related to treatment / all
    0 / 0
    Dyspnoea
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Musculoskeletal and connective tissue disorders
    Arthritis
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Bronchitis
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Enterocolitis
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Febrile neutropenia
         subjects affected / exposed
    11 / 60 (18.33%)
         occurrences causally related to treatment / all
    14 / 14
         deaths causally related to treatment / all
    0 / 0
    fever
         subjects affected / exposed
    4 / 60 (6.67%)
         occurrences causally related to treatment / all
    5 / 5
         deaths causally related to treatment / all
    0 / 0
    Urosepsis
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    cytomegalovirus reactivation
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Influenza
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Herpes simplex
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Herpes zoster
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infection
         subjects affected / exposed
    2 / 60 (3.33%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
         subjects affected / exposed
    11 / 60 (18.33%)
         occurrences causally related to treatment / all
    11 / 11
         deaths causally related to treatment / all
    0 / 0
    Pneumonitis
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    2 / 60 (3.33%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    1 / 1
    Upper respiratory tract infection
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Urinary tract infection
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumocystis jirovecii pneumonia
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Erysipelas
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Hypercalcaemia
         subjects affected / exposed
    1 / 60 (1.67%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Treatment
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    60 / 60 (100.00%)
    Blood and lymphatic system disorders
    Neutropenia
         subjects affected / exposed
    30 / 60 (50.00%)
         occurrences all number
    30
    Thrombocytopenia
         subjects affected / exposed
    31 / 60 (51.67%)
         occurrences all number
    31
    Anaemia
         subjects affected / exposed
    39 / 60 (65.00%)
         occurrences all number
    39

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    17 Nov 2017
    End of the Phase 1 part, selection of the phase 2 dose schedule, sc rituximab administration allowed from cycle 2

    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
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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