This is a phase II study to evaluate efficacy of Acalabrutinib as a maintenance therapy following blood or marrow transplant (BMT) in patients who have been diagnosed with mantle cell lymphoma.
Mantle cell lymphoma (MCL) is one of approximately 100 different types of non-Hodgkin's lymphoma (NHL). Due to the aggressive and heterogeneous nature of MCL, majority of patients are diagnosed with advanced stage disease that requires immediate, diverse and aggressive courses of therapy to improve the outcome of the disease. The addition of blood or bone marrow transplantation (BMT) to the chemotherapy regimens is a critical factor to prolong duration of response in patients, however, the benefit of combination chemotherapy followed by BMT is often temporary as patients experience disease progression and mortality and this underscores the need for novel therapies as well as additional maintenance therapy strategies to prevent relapse post-BMT. Acalabrutinib, a selective, irreversible small molecule inhibitor of Bruton's tyrosine kinase (BTK) is approved for the treatment of adult patients with MCL who have received at least 1 prior therapy This study is a single arm, multi-center, phase 2 study of participants who will receive acalabrutinib as maintenance therapy post-BMT. Participants will undergo a standard of care BMT with conditioning regimen determined by the treating physician per institutional guidelines.The BMT procedure is not considered part of this study. Following completion of the BMT, maintenance therapy with acalabrutinib will begin on Day 100 in 28-day cycles. Participants will self-administer 129 mg acalabrutinib twice daily (BID) until they reach 2 years post-BMT (approximately 22 cycles). Participants will be followed for up to 5 years post-BMT for Progression Free Survival.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
15
Acalabrutinib 129 mg will be self-administered orally twice daily (BID) starting from 100 day (+/- 7 days) Post-BMT on a 28-day schedule, with or without food, until the patient has reached approximately 2 years post-BMT.
Colorado Blood Cancer Institute
Denver, Colorado, United States
Tulane University, Office of Clinical Research
New Orleans, Louisiana, United States
HCA Midwest
Kansas City, Missouri, United States
Tennessee Oncology
Nashville, Tennessee, United States
Progression Free Survival Rate (PFS) at 2 Years Post-Blood or Marrow Transplant (BMT)
Progression Free Survival Rate is defined as the Kaplan-Meier estimate of the percentage of participants who are alive and free of disease progression according to Response Evaluation Criteria in Lymphoma (RECIL 2017) for up to 2 years post-BMT. According to RECIL, disease progression is defined as following criteria: \>20% increase in sum of longest diameters of target lesions, for small lymph nodes measuring \<15 mm post therapy, a minimum absolute increase of 5 mm and the longest diameter should exceed 15mm, or appearance of new lesions.
Time frame: 2 years after date of BMT procedure for each patient
Conversion Rate From Minimal Residual Disease Positive (MRD+) to Minimal Residual Disease Negative (MRD-)
Percentage of participants whose whole blood or bone marrow results transition from MRD positive before study treatment to MRD negative at 2 years post-BMT. An MRD negative status will be defined as all results from whole blood and bone marrow that are negative for the presence of residual clonal cells (with assay sensitivity of 10\^-6) per Adaptive Biotechnologies' reporting methods.
Time frame: Assessed at day 100 post-BMT procedure (prior to beginning maintenance treatment with study drug) and 2 years post-BMT
Minimal Residual Disease (MRD) Correlation With Progression Free Survival (PFS)
To compare the Kaplan-Meier estimated PFS rate for MRD negative population with MRD positive population. Progression-free survival is defined as the time from date of BMT procedure (day 0) until the date of objective radiological PD according to Response Evaluation Criteria in Lymphoma (RECIL 2017) or death. According to RECIL, disease progression is defined as following criteria: \>20% increase in sum of longest diameters of target lesions, for small lymph nodes measuring \<15 mm post therapy, a minimum absolute increase of 5 mm and the longest diameter should exceed 15mm, or appearance of new lesions. An MRD negative status will be defined as all results from whole blood and bone marrow that are negative for the presence of residual clonal cells (with assay sensitivity of 10\^-6) per Adaptive Biotechnologies' reporting methods.
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Time frame: 2 years after date of BMT procedure for each patient
Incidence of Grade 3 or Greater Treatment-Related Adverse Events
Number of participants with grade 3 or higher CTCAE Version 5.0 Adverse Events that are considered related to study drug
Time frame: Safety assessment will be done every cycle up to 2 years post-BMT