Phase I-II Study Combining Brentuximab Vedotin With Second Line Salvage Chemotherapy (R-DHAP) in CD30 Positive Diffuse Large B-cell Lymphoma Patients Refractory to First Line Chemotherapy or in First Relapse Who Are Eligible for High Dose Treatment Followed by Autologous Stem Cell Transplantation
Patients with CD30 positive DLBCL, primary refractory or in first relapse after R-CHOP or R-CHOP-like therapy will receive brentuximab vedotin in combination with R-DHAP, followed in responsive patients by high dose chemotherapy and ASCT.
• CD30 positive DLBCL, i.e. more than 1% of DLBCL cells CD30 positive(central pathology review results not required to enter patient into the study), according to the WHO classification 2008:
‣ CD30 positive DLBCL, including EBV positive DLBCL
⁃ CD30 positive primary mediastinal B-cell lymphoma
• Primary refractory to or in first relapse after first line therapy with R-CHOP or R-CHOP-like therapy
‣ Relapse is defined as biopsy confirmed CD30 positive DLBCL after a complete response. The relapse must be histologically confirmed. In case a surgical biopsy is not possible, at least confirmation by FNA biopsy is required
⁃ Refractory disease is defined as:
• progressive disease during first line therapy, In this case biopsy confirmation of CD30 positive DLBCL is preferred but not required
∙ stable disease after at least 3 cycles of first line therapy, In this case biopsy confirmation of CD30 positive DLBCL is preferred but not required
∙ PR after at least 6 cycles of first line therapy, or in the case of stage I-II disease after at least 3 cycles of therapy and definitive involved field radiotherapy. In this case refractory disease must be histologically confirmed
• Age ≥ 18 years (upper age limit for ASCT at the discretion of the participating center)
• Measurable disease: on CT scan at least 1 lesion/node with a long axis of \> 1.5 cm and at least one positive lesion on 18F-FDG PET scan
• WHO performance status 0-2, status 3 only if disease related (see appendix C)
• Adequate hepatic function: total bilirubin ≤ 1.5 times ULN (unless due to lymphoma involvement of the liver or a known history of Gilbert's syndrome as defined by \> 80% unconjugated bilirubin) and ALAT/ASAT ≤ 3 times ULN (unless due to lymphoma involvement of the liver; in that case ALAT/ASAT may be elevated up to 5 times ULN)
• Adequate renal function: GFR \> 60 ml/min as estimated by the Cockroft\&Gault formula at rehydration: CrCL = (140-age \[in years\] x weight \[kg\] (x 0.85 for females) / (0.815 x serum creatinine \[μmol/L\])
• Adequate bone marrow function: Absolute neutrophil count (ANC) ≥ 1.5x109/L and platelet count ≥ 100 x 109/L, unless caused by diffuse bone marrow infiltration by the NHL
• Hemoglobin must be ≥ 8 g/dL (5.0 mmol/L), transfusion is allowed
• Eligible for high-dose chemotherapy and ASCT
• Resolution of relevant toxicities from first-line therapy
• Life expectancy of \> 3 months with treatment
• Negative pregnancy test at study entry, if applicable
• Female patient is either post-menopausal for at least 1 year before screening visit or surgically sterile or if of childbearing potential, agrees to practice 2 effective methods of contraception, at the same time, or agrees to completely abstain from heterosexual intercourse, from the time of signing the informed consent through 12 months after the last dose of study drug
• Male patients, even if surgically sterilized, (i.e. status post vasectomy) agree to practice effective barrier contraception, or agrees to completely abstain from heterosexual intercourse, during the entire study period and through 12 months after the last dose of study drug
• Written informed consent
• Patient is capable of giving informed consent