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This is a prospective, open-label, multicenter, randomized controlled study in participants with previously untreated large B-cell lymphoma. Participants will be stratified into different risk groups using an AI-based multimodal model. Those classified as intermediate- or high-risk will be randomized in a 1:1 ratio to receive either an AI-guided treatment strategy or Pola-R-CHP. In the experimental arm, participants will receive either genotype-guided targeted agents in combination with Pola-R-CHP or Pola-R-CHP combined with glofitamab, according to their AI-defined risk group and molecular features. Participants in the control arm will receive Pola-R-CHP. The study will evaluate the efficacy and safety of the AI-guided treatment strategy compared with Pola-R-CHP.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Genotype-guided targeted agents or glofitamab in combination with Pola-R-CHP | Experimental | Participants will receive polatuzumab vedotin 1.8 milligrams per kilogram (mg/kg) intravenously (IV) on Day 2, rituximab 375 milligrams per square meter (mg/m²) IV on Day 1, cyclophosphamide 750 mg/m² IV on Day 2, doxorubicin 50 mg/m² IV on Day 2, and prednisone 100 milligrams per day (mg/day) orally (PO) on Days 2-6 of the first 21-day cycle. For the remaining five cycles, participants will receive standard Pola-R-CHP in combination with one of the following: zanubrutinib 160 mg BID PO on Days 1-21, lenalidomide 25 mg/day PO on Days 2-11, decitabine 10 mg/m²/day IV on Days -5 to -1, or glofitamab administered IV with step-up dosing of 2.5 mg on Cycle 2 Day 8, 10 mg on Cycle 2 Day 15, and 30 mg on Day 8 of Cycles 3-6. Each treatment cycle is 21 days. |
|
| Pola-R-CHP | Active Comparator | Participants will receive polatuzumab vedotin 1.8 milligrams per kilogram (mg/kg) intravenously (IV) on Day2, rituximab 375 milligrams per square meter (mg/m²) IV on Day 1, cyclophosphamide 750 mg/m² IV on Day 2, doxorubicin 50 mg/m² IV on Day 2, and prednisone 100 milligrams per day (mg/day) orally (PO) on Days 2-6 of every 21-day cycle for 6 cycles. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Polatuzumab Vedotin | Drug | Polatuzumab vedotin IV infusion will be administered as per the schedule specified in the respective arm. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Progression-free survival | PFS, defined as the time from randomization to the first occurrence of disease progression or relapse using the 2014 Lugano Response Criteria or death due to any cause, whichever occurs first. | From randomization to the first occurrence of disease progression or relapse, or death from any cause, whichever occurs earlier (up to 24 months) |
| Measure | Description | Time Frame |
|---|---|---|
| Event-free survival | EFS, defined as the time from date of randomization to the earliest occurrence of any of the following: Disease progression/relapse; Death due to any cause; The primary efficacy reason that leads to initiation of NALT (other than disease progression/relapse). If biopsy is obtained after treatment completion and is positive for residual disease regardless of whether NALT is initiated or not. |
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Inclusion Criteria:
Exclusion Criteria:
Prior solid organ transplantation or SCT
Significant or extensive history of cardiovascular disease such as New York Heart Association Class III or IV cardiac disease or Objective Assessment Class C or D, myocardial infarction within the last 6 months prior to the start of Cycle 1, unstable arrhythmias, or unstable angina
History or presence of an abnormal ECG that is clinically significant in the investigator's opinion
Any of the following abnormal laboratory values (unless any of these abnormalities are due to underlying lymphoma):
Any active infection within 7 days prior to Cycle 1 Day 1 that would impact participant safety
Positive test results for chronic hepatitis B infection (defined as positive hepatitis B surface antigen [HBsAg] serology):Participants with occult or prior hepatitis B infection (defined as positive total hepatitis B core antibody and negative HbsAg) may be included if hepatitis B virus (HBV) DNA is undetectable at the time of screening. Such participants must be willing to undergo HBV DNA testing every month and appropriate antiviral therapy as indicated
Positive test results for hepatitis C (hepatitis C virus [HCV] antibody serology testing):Participants positive for HCV antibody are eligible only if PCR is negative for HCV RNA
Participants with a history of progressive multifocal leukoencephalopathy
Pregnancy or breastfeeding, or intention of becoming pregnant during the study or within 12 months after final dose of treatment
Participants with uncontrolled coagulation disorders, connective tissue diseases, severe infectious diseases
Other concurrent and uncontrolled medical conditions that, in the opinion of the investigator, would affect the patient's participation in the study
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Weili Zhao | Contact | +862164370045 Ext. 610707 | zwl_trial@163.com | |
| Pengpeng Xu | Contact | +862164370045 Ext. 610707 | pengpeng_xu@126.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ruijin Hospital, Shanghai Jiao Tong University School of Medicine | Shanghai | Shanghai Municipality | 200020 | China |
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| ID | Term |
|---|---|
| C000600736 | polatuzumab vedotin |
| D000069283 | Rituximab |
| D003520 | Cyclophosphamide |
| D004317 | Doxorubicin |
| D011241 | Prednisone |
| C000629551 | zanubrutinib |
| D000077269 | Lenalidomide |
| D000077209 | Decitabine |
| C000720108 | glofitamab |
| ID | Term |
|---|---|
| D058846 | Antibodies, Monoclonal, Murine-Derived |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
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| rituximab | Drug | Rituximab IV infusion will be administered as per the schedule specified in the respective arm. |
|
| Cyclophosphamide | Drug | Cyclophosphamide IV infusion will be administered as per the schedule specified in the respective arm. |
|
| Doxorubicin | Drug | Doxorubicin IV infusion will be administered as per the schedule specified in the respective arm. |
|
| Prednisone | Drug | Prednisone PO will be administered as per the schedule specified in the respective arm. |
|
| Zanubrutinib | Drug | Zanubrutinib PO will be administered as per the schedule specified in the respective arm. |
|
| Lenalidomide | Drug | Lenalidomide PO will be administered as per the schedule specified in the respective arm. |
|
| Decitabine | Drug | Decitabine IV infusion will be administered as per the schedule specified in the respective arm. |
|
| Glofitamab | Drug | Glofitamab IV infusion will be administered as per the schedule specified in the respective arm. |
|
| Up to approximately 24 months |
| Complete response rate | CR rate at the end of treatment by FDG-PET defined as the proportion of participants with CR at the end of treatment according to the 2014 Lugano Response Criteria | End of treatment visit (6-8 weeks after last dose on Day 1 of Cycle 6 [Cycle length=21 days] ) |
| Objective response rate | ORR at treatment completion or discontinuation defined as the proportion of participants with partial response (PR) or CR at the end of treatment according to the 2014 Lugano Response Criteria | End of treatment visit (6-8 weeks after last dose on Day 1 of Cycle 6 [Cycle length=21 days] ) |
| Overall survival | OS defined as the time from randomization to death from any cause | Up to approximately 3 years |
| Duration of response | From documentation of CR/PR until relapse/progression or death due to any reason without documented relapse, whichever came first, assessed up to 3 years. |
| Duration of complete response | From documentation of CR until relapse/progression or death due to any reason without documented relapse, whichever came first, assessed up to 3 years. |
| Number of Participants With Treatment-Related Adverse Events as Assessed by CTCAE v6.0 | From enrollment to study completion, a maximum of 4 years |
| Patient reported outcome assessed by EORTC QLQ-C30 (Verison 3.0) | Day 1 of Cycles 1 and 4 (Cycle length=21 days); 30 days after treatment completion |
| Patient reported outcome assessed by EORTC QLQ-ELD14 | Day 1 of Cycles 1 and 4 (Cycle length=21 days); 30 days after treatment completion |
| Patient reported outcome assessed by FACT-Lym LymS | Day 1 of Cycles 1 and 4 (Cycle length=21 days); 30 days after treatment completion |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
| D010752 | Phosphoramide Mustards |
| D009588 | Nitrogen Mustard Compounds |
| D009150 | Mustard Compounds |
| D006846 | Hydrocarbons, Halogenated |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D063088 | Phosphoramides |
| D009943 | Organophosphorus Compounds |
| D003630 | Daunorubicin |
| D018943 | Anthracyclines |
| D009279 | Naphthacenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D011083 | Polycyclic Compounds |
| D000617 | Aminoglycosides |
| D006027 | Glycosides |
| D002241 | Carbohydrates |
| D011244 | Pregnadienediols |
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D010797 | Phthalimides |
| D010795 | Phthalic Acids |
| D000146 | Acids, Carbocyclic |
| D002264 | Carboxylic Acids |
| D010881 | Piperidones |
| D010880 | Piperidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D054833 | Isoindoles |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D001374 | Azacitidine |
| D001372 | Aza Compounds |
| D003562 | Cytidine |
| D011741 | Pyrimidine Nucleosides |
| D011743 | Pyrimidines |
| D009705 | Nucleosides |
| D009706 | Nucleic Acids, Nucleotides, and Nucleosides |
| D012263 | Ribonucleosides |