Overview

The primary objective of the the trial is to establish one of three study arms, as future standard based on the comparison of the investigator-assessed failure-free survival.

Eligibility

Inclusion Criteria:

All patients must meet the following criteria:

• Histologically confirmed diagnosis of MCL according to WHO classification
• suitable for high-dose treatment including high-dose Ara-C
• Stage II-IV (Ann Arbor)
• Age ≥ 18 years and ≤ 65 years
• Previously untreated MCL
• At least 1 measurable lesion; in case of bone marrow infiltration only, bone marrow aspiration and biopsy is mandatory for all staging evaluations.
• ECOG/WHO performance status ≤ 2
• The following laboratory values at screening (unless related to MCL):
  • Absolute neutrophil count (ANC) ≥1000 cells/µL
  • Platelets ≥100,000 cells/µL
  • Transaminases (AST and ALT) ≤3 x upper limit of normal (ULN)
  • Total bilirubin ≤2 x ULN unless due to known Morbus Meulengracht [Gilbert-Meulengracht-Syndrome])
  • Creatinine ≤2 mg/dL or calculated creatinine clearance ≥ 50 mL/min
• Written informed consent form according to ICH/EU GCP and national regulations
• Sexually active men and women of child-bearing potential must agree to use highly effective contraceptives (eg, condoms, implants, injectables, combined oral contraceptives, intrauterine devices, sexual abstinence, or sterilized partner) while on study; this should be maintained for 90 days after the last dose of study drug.

Exclusion Criteria:

        Any potential subject who meets any of the following criteria will be excluded from
        participating in the study.
          -  Major surgery within 4 weeks prior to randomization.
          -  Requires anticoagulation with warfarin or equivalent vitamin K antagonists (eg
             phenprocoumon).
          -  History of stroke or intracranial hemorrhage within 6 months prior to randomization.
          -  Requires treatment with strong CYP3A4/5 inhibitors.
          -  Any life-threatening illness, medical condition, or organ system dysfunction which, in
             the investigator's opinion, could compromise the subject's safety, interfere with the
             absorption or metabolism of ibrutinib capsules, or put the study outcomes at undue
             risk.
          -  Vaccinated with live, attenuated vaccines within 4 weeks prior to randomization.
          -  Known CNS involvement of MCL
          -  Clinically significant hypersensitivity (eg, anaphylactic or anaphylactoid reactions
             to the compound of ibrutinib itself or to the excipients in its formulation)
          -  Known anti-murine antibody (HAMA) reactivity or known hypersensitivity to murine
             antibodies
          -  Previous lymphoma therapy with radiation, cytostatic drugs, anti-CD20 antibody or
             interferon except prephase therapy according to trial protocol
          -  Serious concomitant disease interfering with a regular therapy according to the study
             protocol:
               -  Cardiac (Clinically significant cardiovascular disease such as uncontrolled or
                  symptomatic arrhythmias, congestive heart failure, or myocardial infarction
                  within 6 months of Screening, or any Class 3 (moderate) or Class 4 (severe)
                  cardiac disease as defined by the New York Heart Association Functional
                  Classification or LVEF below LLN )
               -  Pulmonary (e.g. chronic lung disease with hypoxemia)
               -  Endocrinological (e.g. severe, not sufficiently controlled diabetes mellitus)
               -  Renal insufficiency (unless caused by the lymphoma): creatinine > 2x normal value
                  and/or creatinin clearance < 50 ml/min)
               -  Impairment of liver function (unless caused by the lymphoma): transaminases > 3x
                  normal or bilirubin > 2,0 mg/dl unless due to morbus Meulengracht
                  (Gilbert-Meulengracht-Syndrome)
          -  Patients with unresolved hepatitis B or C infection or known HIV positive infection
             (mandatory test)
          -  Prior organ, bone marrow or peripheral blood stem cell transplantation
          -  Concomitant or previous malignancies within the last 3 years other than basal cell
             skin cancer or in situ uterine cervix cancer
          -  Pregnancy or lactation
          -  Any psychological, familiar, sociological, or geographical condition potentially
             hampering compliance with the study protocol and follow up schedule
          -  Subjects not able to give consent
          -  Subjects without legal capacity who are unable to understand the nature, scope,
             significance and consequences of this clinical trial
          -  Participation in another clinical trial within 30 days before randomization in this
             study.