Biological Insights of First Relapsed-refractory Patients With Mantle Cell Lymphoma: the MANTLE-FIRST BIO Study.

Mantle Cell Lymphoma Clinical Trial

Official title:

Biological Insights of First Relapsed-refractory Patients With Mantle Cell Lymphoma: the MANTLE-FIRST BIO Study.

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04882475
• Other study ID #: FIL_MANTLE-FIRST BIO
• Status: Recruiting
• Start date: February 8, 2023
• Est. completion date: December 2023

Study information

• Verified date: December 2023
• Source: Fondazione Italiana Linfomi - ETS
• Contact: Marina Cesaretti
• Phone: 0039 059 9769913
• Email: mcesaretti[@]filinf.it
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Retrospective observational study with a prospective biological evaluation of an historical cohort of first relapsed-refractory patients with mantle cell lymphoma who were relapsed or refractory to rituximab and chemotherapy containing induction regimens with curative intent.

Description:

Biological samples from 80 Mantle Cell Lymphoma (MCL) patients will be collected and analyzed in 30 Italian sites in 36 months. Patients will be identified and selected both on a clinical base and according to the availability of Formaline-fixed paraffin-embedded (FFPE) material, frozen material or viable cryopreserved cells at Mantle Cell Lymphoma (MCL) diagnosis. They will be analyzed in 4 subgroups, each with different clinical specificity: 1) refractory to Induction Chemoimmunotherapy (CIT); 2) refractory to Bruton Tyrosine kinase (BTK) inhibitors (BTKi); 3) sensitive to induction Induction Chemoimmunotherapy (CIT); 4) sensitive to BTK inhibitors (BTKi). Each group will undergo central pathology revision with other immunohistochemical studies (Verona, Dr. Parisi; Milano, Prof. Ponzoni; Vicenza, Dr. D'Amore; Brescia, Prof. Facchetti). Formaline-fixed paraffin-embedded (FFPE) diagnostic specimens of Mantle Cell Lymphoma (MCL) will be screened by immunohistochemistry for the expression of immunoglobulin (Ig) heavy chains to identify Mantle Cell Lymphoma (MCL) cases lacking Immunoglobulin (Ig) expression. Cytofluorimetric and molecular studies will be performed in the laboratories of the Verona University and at IFOM (Istituto FIRC di Oncologia Molecolare (FIRC = Fondazione Italiana per la Ricerca sul Cancro)). Specific methods will be used: Flow cytometry for the status of surface Ig expression and multiplexed phospho-specific flow cytometry, NGS (Next Generation Sequencing), Immunoglobulin (IgH/IgL V(D)J) profiling by BIOMED2 protocol-based, NGS (Next Generation Sequencing) technology in the relapsed-refractory mantle cell lymphoma (R/R MCL) cases, Chromatin accessibility studies by Assay for Transposase-Accessible Chromatin sequencing (ATAC-seq) (on viable cell suspensions or frozen pellets) and Gene Expression Profiling (GEP) by RNA-sequencing and RNA studies of the MALT1-MYC ((Mucosa-associated lymphoid tissue lymphoma translocation protein 1 - MYC) pathway.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 80
• Est. completion date: December 2023
• Est. primary completion date: December 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Patients with histologically documented diagnosis of Mantle Cell Lymphoma (MCL) as defined in the 2016 edition of the World Health Organization (WHO) classification, with available tissue for revision and additional studies;
• Diagnosis of Mantle Cell Lymphoma (MCL) between 1st of January 2008 and 30th of June 2020;
• Adults, 18-80 years at diagnosis;
• Relapsed or refractory disease after rituximab and chemotherapy containing induction regimens with curative intent.
• Treatment at relapse or progression on an intention-to-treat basis (ITT): at least one cycle of Chemo-immunotherapy (CIT), Bruton Tyrosine kinase inhibitors (BTKi), or alternative drugs combination;
• Subject understanding and voluntarily signing an informed consent form approved by an Independent Ethics Committee (IEC), prior to the initiation of any study-specific procedures.

Exclusion Criteria:

• Unavailability of the samples requested by the study;
• Any histology other than Mantle Cell Lymphoma (MCL);
• Patients treated with front line regimens containing only rituximab or with palliative therapy;
• Untreated patients; patients undergoing watchful waiting approach.

Related Conditions & MeSH terms

• Lymphoma
• Lymphoma, Mantle-Cell
• Mantle Cell Lymphoma

Locations

Country	Name	City	State
Italy	A.O. SS. Antonio e Biagio e Cesare Arrigo, SC Ematologia	Alessandria
Italy	AOU Ospedali Riuniti - Clinica di Ematologia	Ancona
Italy	Centro Riferimento Oncologico - S.O.C. Oncologia Medica A	Aviano
Italy	AOU Policlinico Consorziale - U.O. Ematologia con Trapianto	Bari
Italy	IRCCS Istituto Tumori Giovanni Paolo II - U.O.C Ematologia	Bari
Italy	ASST Spedali Civili di Brescia - Ematologia	Brescia
Italy	A.O. S. Croce e Carle	Cuneo
Italy	Azienda Ospedaliera Universitaria Careggi- Unità funzionale di ematologia	Firenze
Italy	Ospedale Vito Fazzi - Ematologia	Lecce
Italy	ASST Grande Ospedale Metropolitano Niguarda	Milano	MI
Italy	Istituto Scientifico San Raffaele - Unità Linfomi - Dipartimento Oncoematologia	Milano
Italy	Ospedale Maggiore Policlinico - Fondazione IRCCS Ca Granda - Ematologia	Milano
Italy	AOU Maggiore della Carità di Novara - SCDU Ematologia	Novara
Italy	AOU di Padova - Ematologia	Padova
Italy	IRCCS Policlinico S. Matteo di Pavia - Div. di Ematologia	Pavia
Italy	P.O. Spirito Santo di Pescara - UOS Dipartimentale - Centro di diagnosi e Terapia dei linfomi	Pescara	PE
Italy	Ospedale Guglielmo da Saliceto - U.O.Ematologia	Piacenza
Italy	Azienda Unit? Sanitaria Locale-IRCCS - Arcispedale Santa Maria Nuova - Ematologia - Ematologia	Reggio Emilia
Italy	Ospedale degli Infermi di Rimini - U.O. di Ematologia	Rimini
Italy	Policlinico Umberto I - Universit? "La Sapienza" - Istituto Ematologia -Dipartimento di Medicina Traslazionale e di Precisione	Roma
Italy	Universit? Cattolica S. Cuore - Ematologia	Roma
Italy	AOU Senese - U.O.C. Ematologia	Siena	SI
Italy	A.O.U. Citta della Salute e della Scienza di Torino - S.C.Ematologia	Torino
Italy	A.O.U. Citta della Salute e della Scienza di Torino- Ematologia Universitaria	Torino
Italy	Ospedale S. Chiara - S.S. di Ematologia	Trento
Italy	Ospedale Ca' Foncello - S.C di Ematologia	Treviso
Italy	Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) - SC Ematologia	Trieste
Italy	Azienda Sanitaria Universitaria Friuli Centrale (ASU FC) - SOC Clinica Ematologica	Udine
Italy	Ospedale di Circolo - U.O.C Ematologia	Varese
Italy	AOU Integrata di Verona - U.O. Ematologia	Verona
Italy	ULSS 8 Berica - Ospedale S. Bortolo - Ematologia	Vicenza

Sponsors (1)

Lead Sponsor	Collaborator
Fondazione Italiana Linfomi - ETS

Country where clinical trial is conducted

Italy, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Histopathological characterization of patients with Mantle Cell Lymphoma (MCL)	Histopathological characterization of patients with mantle cell lymphoma (MCL) who were relapsed or refractory to rituximab and chemotherapy containing induction regimens with curative intent. 80 Mantel Cell Lymphoma (MCL) patients stratified according to Chemo-immunotherapy (CIT) or Bruton Tyrosine kinase inhibitors (BTKi) resistance (20 for each of the groups previously identified) will undergo central pathology revision with assessment of Immunoglobulin (Ig) expression and other histopathological studies.	The endpoint will be evaluated from the beginning to the end of the study (up to 36 months)
Secondary	Mutational analysis of Mantle Cell Lymphoma (MCL) driver genes	Performed on formalin-fixed paraffin-embedded (FFPE) tissue sections as well as, when available, on frozen material or viable cryopreserved cells at Mantle Cell Lymphoma (MCL) diagnosis. The aim is to perform a mutational analysis for Mantle Cell Lymphoma (MCL) driver genes: Next Generation Sequencing (NGS) on approximately 80 cases of Mantle Cell Lymphoma (MCL), including 20 cases Relapsed/Refractory (R/R) to Bruton Tyrosine kinase inhibitors (BTKi)	The endpoint will be evaluated from the beginning to the end of the study (up to 36 months)
Secondary	Functional study of the B-Cell Receptor (BCR) activity by flow cytometry in Mantle Cell Lymphoma (MCL) cell samples	Performed on formalin-fixed paraffin-embedded (FFPE) tissue sections as well as, when available, on frozen material or viable cryopreserved cells at Mantle Cell Lymphoma (MCL) diagnosis. The aim is to perform a functional study of the B-Cell Receptor (BCR) activity: multiplexed phospho-specific flow cytometry on 10-20 Relapsed/Refractory (R/R) Mantle Cell Lymphoma cases.	The endpoint will be evaluated from the beginning to the end of the study (up to 36 months)
Secondary	To understand the mechanisms of evasion from B-Cell Receptor (BCR) requirement, with particular focus on Mantle Cell Lymphoma (MCL) cases that are resistant to Chemo-immunotherapy (CIT) and/or Bruton Tyrosine kinase (BTK) inhibition	Performed on formalin-fixed paraffin-embedded (FFPE) tissue sections as well as, when available, on frozen material or viable cryopreserved cells at Mantle Cell Lymphoma (MCL) diagnosis. The aim is to understand the mechanisms of evasion from B-Cell Receptor (BCR) requirement as follow: Immunoglobulin (IgH/IgL V(D)J) profiling by Next Generation Sequencing (NGS) on 80 mantle cell lymphoma (MCL) cases; Chromatin accessibility studies (Assay for Transposase-Accessible Chromatin sequencing, ATAC-seq) on approximately 20 cases among the Immunoglobulin (Ig)-negative identified cases or Bruton Tyrosine kinase inhibitors (BTKi) refractory cases, irrespective of their B-Cell Receptor (BCR) status, and on other 20 cases, from the group of patients sensitive to Bruton Tyrosine kinase inhibitors (BTKi); Gene Expression Profiling (GEP) by RNA-seq, on about 20 cases selected on the basis of results of the Assay for Transposase-Accessible Chromatin sequencing (ATAC-Seq) analysis;	The endpoint will be evaluated from the beginning to the end of the study (up to 36 months)
Secondary	Unveil the role of the MALT1-MYC (Mucosa-associated lymphoid tissue lymphoma translocation protein 1 - MYC) pathway in Mantle Cell Lymphoma (MCL) cases expressing or not the BCR (B-Cell Receptor)	Performed on formalin-fixed paraffin-embedded (FFPE) tissue sections as well as, when available, on frozen material or viable cryopreserved cells at Mantle Cell Lymphoma (MCL) diagnosis. The aim is to perform RNA studies on 20 cases	The endpoint will be evaluated from the beginning to the end of the study (up to 36 months)
Secondary	To correlate results of biologic studies with clinical characteristics of patients	About 80 cases of Relapsed/Refractory (R/R) Mantle Cell Lymphoma (MCL) with available tissue samples will be considered for correlation between biological studies with clinical characteristics of patients, response to treatment and conventional outcomes (Progression Free Survival, Progression Free Survival at 2 years, Overall Survival, Overall Survival at 2 years)	The endpoint will be evaluated from the beginning to the end of the study (up to 36 months)