R-ICE Versus R-DHAP in Patients Aged 18-65 With Relapse Diffuse Large B-cell Lymphoma

This study has been completed.
Information provided by (Responsible Party):
Lymphoma Study Association
ClinicalTrials.gov Identifier:
First received: August 25, 2005
Last updated: September 1, 2015
Last verified: September 2015

The primary objective of this study is to evaluate the efficacy and safety of induction therapy R-ICE in comparison to R-DHAP after 3 cycles adjusted to successful mobilization of stem cells in patients with previously treated diffuse large B-cell lymphoma CD20.

The goal is to detect a difference in mobilization adjusted response rate of 15% between R-ICE and R-DHAP.

The other objective is to evaluate the efficacy and safety of MabThera maintenance therapy after transplantation as measured by the event free survival.

The goal is to obtain a 15% increase of event free survival at 2 years.

Condition Intervention Phase
Lymphoma, Large-Cell, Diffuse
Drug: Rituximab
Drug: Etoposide
Drug: Carboplatine
Drug: Ifosfamide + Mesna
Drug: Cisplatine
Drug: Cytosine Arabinoside
Drug: Dexamethasone
Procedure: Autologous Stem Cell Transplantation
Drug: BCNU
Drug: Cytarabine
Drug: Melphalan
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Randomized Study of ICE Plus RITUXIMAB Versus DHAP Plus Rituximab in Previously Treated Patients With Diffuse Large B-cell Lymphoma, Followed by Randomized Maintenance With Rituximab

Resource links provided by NLM:

Further study details as provided by Lymphoma Study Association:

Primary Outcome Measures:
  • MARR (mobilization adjusted response rate) [ Time Frame: 3 months ] [ Designated as safety issue: No ]
  • EFS (event free survival) [ Time Frame: 2 years post transplantation ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Progression rate [ Time Frame: 2 years post transplantation ] [ Designated as safety issue: No ]
  • Overall survival [ Time Frame: 2 years post transplantation ] [ Designated as safety issue: No ]
  • Duration of response [ Time Frame: 2 years post transplantation ] [ Designated as safety issue: No ]

Enrollment: 481
Study Start Date: June 2003
Study Completion Date: October 2008
Primary Completion Date: October 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: R-ICE
R-ICE + R-BEAM /ASCT Rituximab, Etoposide, Carboplatine, Ifosfamide + Mesna BCNU, Etoposide, Cytarabine, Melphalan Autologous Stem Cell Transplantation
Drug: Rituximab
375 mg/m² D-2/D1
Other Name: R
Drug: Etoposide
100 mg/m² D1-D2-D3
Drug: Carboplatine
max 800mg D2
Drug: Ifosfamide + Mesna
5 g/m² from D2 to D13
Procedure: Autologous Stem Cell Transplantation
Other Name: ASCT
Drug: BCNU
300mg/m² on D-6
Other Name: BICNU
Drug: Etoposide
200 mg/m² from D-6 to D-3
Drug: Cytarabine
100 mg/m² from D-6 to D-3
Drug: Melphalan
140 mg/m² on D-2
Experimental: R-DHAP
R-DHAP + R-BEAM /ASCT Rituximab, Cisplatine, Cytosine Arabinoside, Dexamethasone BCNU, Etoposide, Cytarabine, Melphalan Autologous Stem Cell Transplantation
Drug: Rituximab
375 mg/m² D-2/D1
Other Name: R
Drug: Cisplatine
100 mg/m² from D1 to D13
Drug: Cytosine Arabinoside
2000 mg/m²/12 h D2 D3
Drug: Dexamethasone
40 mg From D1 to D4
Procedure: Autologous Stem Cell Transplantation
Other Name: ASCT
Drug: BCNU
300mg/m² on D-6
Other Name: BICNU
Drug: Etoposide
200 mg/m² from D-6 to D-3
Drug: Cytarabine
100 mg/m² from D-6 to D-3
Drug: Melphalan
140 mg/m² on D-2

Detailed Description:

In vitro, the addition of rituximab to standard anticancer drugs increases cell lyses even in chemoresistant cell lines. This chemosensitization effect was also demonstrated in vivo by the results of the GELA trial in elderly patients with DLCL. Reported phase II study results on the RICE regimen for treatment of patients with relapsed DLCL and comparison with historical controls being treated with ICE suggests that this effect (15% improvement in response rate) is likely in relapsing DLCL and had led the SWOG to stop a randomized trial comparing ICE vs RICE in patients with relapsed aggressive lymphoma.

In the setting of relapsed DLCL, high dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) remains the standard to improve survival in highly selected chemosensitive patients. In the Parma study, only 58% of the patients with relapsed aggressive NHL were good responders after DHAP and 24% were in complete remission. Moreover, the quality of response depended on prognostic factors such as IPI and relapse > 12 months after treatment, and only patients responding to salvage therapy benefited from HDT + ASCT. As shown in the PARMA study. The goal in relapsed DLCL is to improve complete response rates before transplantation as it is the main parameter for eligibility for HDT + ASCT and the main prognostic factor. Unlike first line treatment with CHOP, no standard chemotherapy exists for relapsing patients. DHAP has been the most frequently used regimen for decades but incorporates only two drugs, and has dose-limiting renal toxicity. The ICE regimen was developed at several dosages and studies consistently produced CR rates that were 10-15% superior to DHAP. It is expected that this difference will remain the same with the addition of rituximab to both regimens. Recent phase II data in patients with relapsed DLCL not previously treated with rituximab showed that RICE produced a response rate of 78% with a complete remission rate of 58% and was active in primary refractory disease as well as in intermediate-high risk patients (IPI 2-3). Association of DHAP to Rituximab, R-DHAP has been done on small series of patients by investigators, including patients relapsing after autotransplant. Despite numerous phase II studies, no randomized study has been performed comparing the two regimens (DHAP/ICE) or others in relapsing DLCL. Treatment of first line DLCL has been changed in the past 10 years with more intensive regimens, often followed by ASCT, and very recently with the addition of rituximab to chemotherapy and therefore the population of relapsing patients might be different from the one in the initial PARMA study. A large lymphoma intergroup study working on a large prospective data base might help to find the best salvage regimen and to assess the role of retreatment with monoclonal antibodies in these patients. Finally, the role of rituximab maintenance therapy after HDT + ASCT in prolonging second complete response should be evaluated.


Ages Eligible for Study:   18 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients with CD20-positive diffuse large B-cell lymphoma. Disease must be histologically proven in case of relapse or partial response.
  • Aged 18 to 65 years
  • First relapse after complete remission (CR), less than partial remission (PR) or partial response to first line treatment not achieving documented or confirmed complete remission.
  • Eligible for transplant
  • Previously treated with chemotherapy regimen containing anthracyclines with or without rituximab.
  • ECOG performance status 0 to 2.
  • Minimum life expectancy of 3 months.
  • Signed written informed consent prior to randomization.

Exclusion Criteria:

  • Burkitt, mantle-cell and T-cell lymphoma.
  • CD20-negative diffuse large cell lymphoma
  • Documented infection with HIV and hepatitis B virus [HBV] (in the absence of vaccination)
  • Central nervous system or meningeal involvement by lymphoma.
  • Not previously treated with anthracycline-containing regimens
  • Prior transplantation
  • Contra-indication to any drug contained in the chemotherapy regimens.
  • Any serious active disease or co-morbid condition (according to the investigator's decision and information provided in the Investigational Drug Brochure [IDB]).
  • Poor renal function (creatinine level > 150µmol/l or 1.5-2.0 x upper limit of normal [ULN]); poor hepatic function (total bilirubin level > 30mmol/l [> 1.5 x ULN], transaminases > 2.5 maximum normal level) unless these abnormalities are related to the lymphoma; poor bone marrow reserve as defined by neutrophils < 1.5G/l or platelets < 100G/l, unless related to bone marrow infiltration.
  • Any history of cancer during the last 5 years with the exception of non-melanoma skin tumors or stage 0 (in situ) cervical carcinoma.
  • Treatment with any investigational drug within 30 days before planned first cycle of chemotherapy and during the study.
  • Pregnant women
  • Adult patients unable to provide informed consent because of intellectual impairment.
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Please refer to this study by its ClinicalTrials.gov identifier: NCT00137995

United States, New York
Memorial Sloan Kettering Cancer Center
New York, New York, United States, 10021
Australian leukemia and lymphoma group
Sydney, Australia
Groupe d'atude des lymphome de l'adulte
Yvoir, Belgium
Czech Republic
Czech Lymphoma study group
Praha, Czech Republic
Hospital district of south west Finland
Turku, Finland
German high grade non hodgkin's lymphoma group
Hamburg, Germany
Israel Society of Hematology
Tel-Hashomer, Israel
Nordic center
Uppsala, Sweden
Schweirische Arbeitsgruppe fur klinische Krebsforschung
Lausanne, Switzerland
United Kingdom
National cancer research institute
London, United Kingdom
Sponsors and Collaborators
Lymphoma Study Association
Principal Investigator: Christian Gisselbrecht Lymphoma Study Association
  More Information

Additional Information:
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Lymphoma Study Association
ClinicalTrials.gov Identifier: NCT00137995     History of Changes
Obsolete Identifiers: NCT00081146
Other Study ID Numbers: CORAL
Study First Received: August 25, 2005
Last Updated: September 1, 2015
Health Authority: France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis)

Keywords provided by Lymphoma Study Association:

Additional relevant MeSH terms:
Lymphoma, B-Cell
Lymphoma, Large B-Cell, Diffuse
Immune System Diseases
Immunoproliferative Disorders
Lymphatic Diseases
Lymphoma, Non-Hodgkin
Lymphoproliferative Disorders
Neoplasms by Histologic Type
Etoposide phosphate
Alkylating Agents
Anti-Infective Agents
Anti-Inflammatory Agents
Antimetabolites, Antineoplastic
Antineoplastic Agents
Antineoplastic Agents, Alkylating
Antineoplastic Agents, Hormonal
Antineoplastic Agents, Phytogenic
Antirheumatic Agents
Antiviral Agents
Autonomic Agents

ClinicalTrials.gov processed this record on October 07, 2015