Cholecalciferol in Improving Survival in Patients With Newly Diagnosed Cancer With Vitamin D Insufficiency

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Mayo Clinic

Status

Enrolling

Conditions

Mature T-Cell and NK-Cell Non-Hodgkin Lymphoma
Mediastinal (Thymic) Large B-Cell Lymphoma
Small Lymphocytic Lymphoma
Anaplastic Large Cell Lymphoma
Primary Cutaneous Anaplastic Large Cell Lymphoma
Subcutaneous Panniculitis-Like T-Cell Lymphoma
Refractory Anaplastic Large Cell Lymphoma
Aggressive Non-Hodgkin Lymphoma
Angioimmunoblastic T-Cell Lymphoma
Hepatosplenic T-Cell Lymphoma
Enteropathy-Associated T-Cell Lymphoma
Diffuse Large B-Cell Lymphoma
Chronic Lymphocytic Leukemia
Nasal Type Extranodal NK/T-Cell Lymphoma
Peripheral T-Cell Lymphoma, Not Otherwise Specified

Treatments

Other: Laboratory Biomarker Analysis
Dietary Supplement: Cholecalciferol

Study type

Interventional

Funder types

Other
NIH

Identifiers

NCT01787409
12-007862 (Other Identifier)
NCI-2013-00037 (Registry Identifier)
P50CA097274 (U.S. NIH Grant/Contract)
LS1293 (Other Identifier)

Details and patient eligibility

About

This partially randomized clinical trial studies cholecalciferol in improving survival in patients with newly diagnosed cancer with vitamin D insufficiency. Vitamin D replacement may improve tumor response and survival and delay time to treatment in patients with cancer who are vitamin D insufficient.

Full description

PRIMARY OBJECTIVES: I. To determine if vitamin D replacement in vitamin D insufficient patients with newly diagnosed untreated diffuse large B-cell lymphoma (DLBCL) can improve event free survival at 12 months to be equivalent to that of a control population of vitamin D sufficient patients. (Study I) II. To assess the percentage of patients requiring treatment with conventional therapy at 36 in months in vitamin D insufficient patients with early stage chronic lymphocytic leukemia (CLL) being managed with observation who undergo vitamin D replacement. (Study II) SECONDARY OBJECTIVES: I. To assess the effect of vitamin D replacement in vitamin D insufficient patients with newly diagnosed untreated DLBCL on overall survival. (Study I) II. To assess the effect of vitamin D replacement in vitamin D insufficient patients with newly diagnosed untreated DLBCL on event free survival. (Study I) III. To assess the effect of vitamin D replacement in vitamin D insufficient patients with newly diagnosed untreated T cell lymphoma on event free and overall survival. (Study I) IV. To assess the effect of vitamin D replacement in vitamin D insufficient CLL patients on Bio-r response rate and overall response rate. (Study II) V. To assess time to treatment and overall survival in vitamin D insufficient CLL patients who received vitamin D replacement. (Study II) TERTIARY OBJECTIVES: I. To study immune effector cells (lymphocytes, monocytes), serum cytokines, and tumor cells from vitamin D deficient and sufficient patients to learn the effects of vitamin D on both tumor cells and the patient's immune system. (Study I-II) OUTLINE: Vitamin D sufficient patients receive no intervention. Vitamin D insufficient patients receive cholecalciferol orally (PO) once weekly for 12 weeks and then once monthly for a total of 36 months. After completion of study treatment, patients are followed up for 2 years.

Enrollment

500 estimated patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria:

  • Newly diagnosed aggressive lymphoma or CLL/small lymphocytic lymphoma (SLL) that meets disease specific criteria below:

  • Study 1 - Aggressive lymphoma

    • Newly diagnosed de-novo DLBCL or primary mediastinal B-cell lymphoma that will be treated with an anthracycline-containing regimen (rituximab-cyclophosphamide, doxorubicin hydrochloride, prednisone [R-CHOP] or equivalent); patients with composite lymphomas can also be enrolled as long as they have large cell component and will be treated with an anthracycline; in addition, patients with "B cell lymphoma, unclassifiable, with features intermediate between diffuse large B cell lymphoma and Burkitt lymphoma" or post-transplant DLBCL are also eligible as long as they meet other criteria; patients with typical Burkitt lymphoma are not eligible

      • NOTE: patients can be enrolled up through day 1 of cycle 3 of therapy; the patient is permitted to participate in any other therapeutic therapy for their disease as long as it does not concern vitamin D; patients can begin their chemotherapy while awaiting vitamin D results and treatment arm assignment or
    • Newly diagnosed untreated peripheral T-cell non-Hodgkin lymphoma (NHL) that will be treated with chemotherapy; NOTE: patients can be enrolled up through day 1 of cycle 3 of therapy; this includes the following disease types:

      • Peripheral T cell lymphoma, unspecified
      • Anaplastic large cell lymphoma (T and null cell type)
      • Extranodal NK/T-cell lymphoma, nasal type
      • Enteropathy-type T-cell lymphoma
      • Hepatosplenic T-cell lymphoma
      • Subcutaneous panniculitis-like T-cell lymphoma
      • Angioimmunoblastic T-cell lymphoma
      • Anaplastic large cell lymphoma - primary cutaneous type and
    • Willing to provide tissue for correlative research purposes

  • Study 2 - CLL/SLL

    • Newly diagnosed (< 12 months from pre-registration on this study) CLL according to the National Cancer Institute (NCI) criteria or SLL according to the World Health Organization (WHO) criteria; this includes previous documentation of:

      • Biopsy-proven small lymphocytic lymphoma

      • Diagnosis of CLL according to NCI working group criteria as evidenced by all of the following:

        • Peripheral blood lymphocyte count of > 5,000/mm^3; if present, prolymphocytes should be < 55%

        • Immunophenotyping consistent with CLL defined as:

          • The predominant population of lymphocytes share both B-cell antigens (cluster of differentiation [CD]19, CD20, or CD23) as well as CD5 in the absence of other pan-T-cell markers (CD3, CD2, etc.)
          • Dim surface immunoglobulin expression
          • Restricted surface kappa or lambda light chain expression
        • Before diagnosing CLL or SLL, mantle cell lymphoma must be excluded by demonstrating a negative fluorescent in situ hybridization (FISH) analysis for t(11;14)(immunoglobulin H [IgH]/cyclin D 1 [CCND1]) on peripheral blood or tissue biopsy or negative immunohistochemical stains for cyclin D1 on involved tissue biopsy

    • Rai stage 0 or 1

    • Previously untreated

    • Asymptomatic with the plan for observation

    • Life expectancy of at least 24 months

    • Willing to provide tissue for correlative research purposes

  • Both Studies:

  • Capable of swallowing intact study medication capsules

  • Serum calcium < 11 mg/dL; note: patients with hypercalcemia can be enrolled after the calcium is corrected with standard of care treatments

  • Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study)

    • Note: During the Active Monitoring Phase of a study (i.e., active treatment and observation), participants must be willing to return to the consenting institution for follow-up
  • Willing to provide blood samples for correlative research purposes

  • Vitamin D level (25 hydroxy D2 + hydroxyl D3) confirmed by central laboratory review

Trial design

Primary purpose

Treatment

Allocation

N/A

Interventional model

Single Group Assignment

Masking

None (Open label)

500 participants in 1 patient group

Treatment (cholecalciferol)
Experimental group
Description:
Vitamin D sufficient patients receive no intervention. Vitamin D insufficient patients receive cholecalciferol PO once weekly for 12 weeks and then once monthly for a total of 36 months.
Treatment:
Dietary Supplement: Cholecalciferol
Other: Laboratory Biomarker Analysis

Trial contacts and locations

5

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Data sourced from clinicaltrials.gov

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