Zanubrutinib Plus Rituximab (Zanu -R) as Fixed Duration, Early Intervention Versus Observation for Patients With Indolent Mantle Cell Lymphoma: a Randomised Phase II Clinical Trial
Phase II, multicentre, randomised, open-label study to assess the benefit of early intervention with fixed duration, time-limited zanubrutinib-rituximab in indolent mantle cell lymphoma (MCL)
• 18 years of age or over.
• Life expectancy ≥ 6 months.
• Pathologically confirmed MCL, with documentation of monoclonal B cells that have a chromosome translocation t(11;14)(q13;q32) and/or overexpress cyclin D1, D2 or D3.
• Stage II-IV MCL measurable by CT imaging or by white cell count (WCC)/BM infiltration.
• 'Indolent' MCL, defined as 1 or more of the following:
‣ Observation with no treatment for a minimum of 6 months after the initial diagnosis
⁃ Leukaemic non-nodal variant (lymphocytosis/splenomegaly only without nodal involvement)
⁃ Low tumour volume (largest lymph node ≤ 3cm in maximal diameter), proliferation fraction (Ki67 or equivalent) ≤30% and classical morphology (non-blastoid/pleomorphic)
• Eastern Cooperative Oncology Group (ECOG) Performance Status 0-2.
• Absolute neutrophil count ≥1.0 x 109/L and platelets ≥75 x 109/L independent of growth factor support.
• AST and/or ALT ≤3 x upper limit of normal (ULN).
• Total Bilirubin ≤1.5 x ULN unless due to Gilberts syndrome or of non-hepatic origin unless directly attributable to the patient's MCL.
⁃ Calculated creatinine clearance ≥30 mL/min. Glomerular filtration rate (GFR) ≥30 mL/min directly measured with 24 hour urine collection, or creatinine clearance calculated according to the modified formula of Cockcroft and Gault (for men: GFR ≈ ((140 - age) x bodyweight)/ (72 x creatinine), for women x 0, 85).
⁃ Able to give voluntary written informed consent.
⁃ Willing and able to participate in all required evaluations and procedures in this study protocol including swallowing capsules without difficulty.
⁃ Negative serum or urine pregnancy test for women of childbearing potential (WOCBP).
⁃ Willing to comply with the contraceptive requirements of the trial.