Rituximab With or Without Stem Cell Transplant in Treating Patients With Minimal Residual Disease-Negative Mantle Cell Lymphoma in First Complete Remission
Rituximab With or Without Stem Cell Transplant in Treating Patients With Minimal Residual Disease-Negative Mantle Cell Lymphoma in First Complete Remission
This randomized phase III trial studies rituximab after stem cell transplant and to see how
 well it works compared with rituximab alone in treating patients with in minimal residual
 disease-negative mantle cell lymphoma in first complete remission. Monoclonal antibodies,
 such as rituximab, may interfere with the ability of cancer cells to grow and spread. Giving
 chemotherapy before a stem cell transplant helps kill any cancer cells that are in the body
 and helps make room in the patient's bone marrow for new blood-forming cells (stem cells) to
 grow. After treatment, stem cells are collected from the patient's blood and stored. More
 chemotherapy is then given to prepare the bone marrow for the stem cell transplant. The stem
 cells are then returned to the patient to replace the blood-forming cells that were destroyed
 by the chemotherapy. Giving rituximab with or without stem cell transplant may work better in
 treating patients with mantle cell lymphoma.
PRIMARY OBJECTIVES:

 I. To compare overall survival in mantle cell lymphoma (MCL) patients in minimal residual
 disease (MRD)-negative first remission who undergo autologous hematopoietic stem cell
 transplantation (auto-HCT) followed by maintenance rituximab versus (vs.) maintenance
 rituximab alone (without auto-HCT).

 SECONDARY OBJECTIVES:

 I. To compare progression-free survival in MCL patients in MRD-negative first remission who
 undergo auto-HCT followed by maintenance rituximab vs. maintenance rituximab alone.

 II. To define the overall survival and progression-free survival at 2 and 5 years of
 chemosensitive but MRD-positive (or MRD-indeterminate) patients who undergo auto-HCT followed
 by 2 years of maintenance rituximab.

 III. To describe the rate of complications (serious infection, hospitalization, need for
 intravenous immune globulin) in MCL patients undergoing maintenance rituximab following
 auto-HCT.

 IV. To determine the prognostic impact of MRD status at day 100, in MCL patients who were
 MRD-positive prior to auto-HCT.

 OUTLINE: Patients are randomized to 1 of 2 groups.

 GROUP I: Patients receive standard of care preparative chemotherapy and undergo auto-HCT.
 Beginning 60-120 days after transplant, patients receive rituximab intravenously (IV) once
 every 8 weeks for up to 12 courses in the absence of disease progression or unacceptable
 toxicity.

 GROUP II: Patients receive standard of care induction chemotherapy. Beginning 40-120 days
 after completion of chemotherapy, patients receive rituximab as in Group I.

 After completion of study treatment, patients are followed up every 3 and 6 months for 10
 years.
Inclusion Criteria:

 -  INCLUSION CRITERIA FOR SCREENING (STEP 0 - PREREGISTRATION)

 -  Patients must have histologically confirmed mantle cell lymphoma, with documented
 cluster of differentiation (CD19) or CD20 expression and cyclin D1 (BCL1) by
 immunohistochemical stains and/or t(11;14) by cytogenetics or fluorescence in situ
 hybridization (FISH); the diagnosis must be confirmed by formal hematopathology review
 at the enrolling center, including assessment of Ki-67 proliferation index (=< 30%
 versus > 30% versus ?indeterminate? Ki-67 index)

 -  Patients should be deemed to be potentially eligible and willing candidates for
 auto-HCT by the enrolling physician

 -  Patient may be receiving or have completed induction therapy within 60 days prior to
 preregistration to step 0; no more than 300 days may have passed between the first day
 of induction therapy and preregistration to step 0

 -  For patients who have completed induction therapy, restaging evaluation must show
 status of partial (PR) or complete response (CR); patients preregistered
 post-induction with evidence of clinical disease progression are not eligible for
 preregistration

 -  Up to two regimens of chemotherapy are allowed as long as a continuous response
 was ongoing throughout therapy

 -  NOTE: For example, a patient who started treatment with
 rituximab/bendamustine and was then switched to
 rituximab(R)-cyclophosphamide, doxorubicin hydrochloride, vincristine
 sulfate, and prednisone (CHOP) (due to insufficient response or excessive
 toxicity) would be counted as having received 2 regimens; however, R-CHOP
 alternating with R-dexamethasone, high-dose cytarabine, and cisplatin (DHAP)
 as a planned induction regimen would count as one regimen

 -  Patient does not have any documented history of central nervous system (CNS)
 involvement by mantle cell lymphoma; this includes no evidence of parenchymal brain,
 spinal cord, or cerebrospinal fluid involvement; radiculopathy symptoms from nerve
 root compression by lymphoma do not constitute CNS involvement

 -  Patient must have archived formalin-fixed paraffin-embedded (FFPE) tumor tissue
 specimen from the original diagnostic biopsy available for submission to Adaptive
 Biotechnologies for ClonoSEQ ID molecular marker identification of unique clonal
 immunoglobulin deoxyribonucleic acid (DNA) sequence

 -  NOTE: Patients for whom the molecular marker is identified will have peripheral
 blood collected after completion of induction (patient?s disease status is PR or
 CR) and submitted to Adaptive Biotechnologies for minimal residual disease (MRD)
 assessment

 -  INCLUSION CRITERIA FOR TREATMENT ASSIGNMENT (STEP 1)

 -  Patients must have met eligibility criteria for the screening step

 -  Institution has received results from Adaptive Biotechnologies as defined by one of
 the following criteria:

 -  Patients are ?MRD Indeterminate?: ClonoSEQ ID molecular marker assessment did not
 identify any unique clonal immunoglobulin DNA sequence OR

 -  ClonoSEQ ID molecular marker assessment identified unique clonal immunoglobulin
 DNA sequence and MRD assessment is completed

 -  Patients must have completed induction therapy within 120 days prior to
 preregistration to step 0, AND no more than 300 days may have elapsed from the first
 dose of induction chemotherapy (cycle 1 [C1] day 1 [D1]) given, until the last day of
 induction chemotherapy administered; for those assigned to Arms A, C, or D, the date
 of transplant (?day 0?) must not be greater than 365 days after the first dose of
 induction chemotherapy (C1D1) given

 -  Patient must have received at least four (4) cycles of induction therapy

 -  Up to two regimens of chemotherapy are allowed as long as a continuous response
 was ongoing throughout therapy

 -  NOTE: For example, a patient who started treatment with
 rituximab/bendamustine and was then switched to R-CHOP (due to insufficient
 response or excessive toxicity) would be counted as having received 2
 regimens; however, R-CHOP alternating with R-DHAP as a planned induction
 regimen would count as one regimen

 -  Patients must have achieved a radiologic complete or partial remission as defined by
 the Lugano criteria

 -  Patients must meet institutional eligibility requirements for stem cell transplant,
 including cardiac, renal, liver, and pulmonary requirements

 -  Patients have an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2

 -  Human immunodeficiency virus (HIV) positive patients are not excluded, but to enroll,
 must meet all of the below criteria:

 -  HIV is sensitive to antiretroviral therapy

 -  Must be willing to take effective antiretroviral therapy if indicated

 -  CD4 count at screening >= 300 cells/mm^3

 -  No history of acquired immune deficiency syndrome (AIDS)-defining conditions

 -  Patient must be disease-free >= 3 years of prior malignancies with the exception of
 adequately treated non-melanoma skin cancer, adequately treated in situ carcinoma, low
 grade prostate carcinoma (Gleason grade =< 6) managed with observation that has been
 stable for at least 6 months

 -  Women must not be pregnant or breast-feeding

 -  All females of childbearing potential must have a blood test or urine study
 within 2 weeks prior to registration to rule out pregnancy

 -  A female of childbearing potential is any woman, regardless of sexual orientation
 or whether they have undergone tubal ligation, who meets the following criteria:
 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been
 naturally postmenopausal for at least 24 consecutive months (i.e., has had menses
 at any time in the preceding 24 consecutive months)

 -  Women of childbearing potential and sexually active males must be strongly advised to
 use an accepted and effective method of contraception or to abstain from sexual
 intercourse for the duration of their participation in the study