A Phase 2 interventional study of Bendamustine Hydrochloride and Bortezomib in Ann Arbor Stage III Grade 1 Follicular Lymphoma, Ann Arbor Stage III Grade 2 Follicular Lymphoma and Ann Arbor Stage III Grade 3 Follicular Lymphoma, sponsored by National Cancer Institute (NCI). Completed at 96 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-11-24.
Sponsored by National Cancer Institute (NCI) · Phase 2, Interventional, and Treatment
This randomized phase II trial studies how well ofatumumab and bendamustine hydrochloride with or without bortezomib works in treating patients with untreated follicular non-Hodgkin lymphoma. Monoclonal antibodies, such as ofatumumab, may block cancer growth in different ways by targeting certain cells. Drugs used in chemotherapy, such as bendamustine hydrochloride, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Bortezomib may also stop the growth of cancer cells by blocking blood flow to the tumor. It is not yet known whether ofatumumab and bendamustine hydrochloride are more effective with bortezomib in treating patients with follicular non-Hodgkin lymphoma.
PRIMARY OBJECTIVES:
I. To determine the complete response (CR) rate in newly diagnosed, untreated follicular lymphoma patients receiving 6 cycles of ofatumumab-bendamustine (bendamustine hydrochloride) (ARM A) and 6 cycles of ofatumumab, bortezomib, and bendamustine (ARM B) using International Harmonization Project Response Criteria.
SECONDARY OBJECTIVES:
I. To determine progression-free survival (PFS) of patients with untreated follicular lymphoma after 6 cycles of ofatumumab-bendamustine (ARM A) followed by maintenance ofatumumab and after 6 cycles of ofatumumab, bortezomib, and bendamustine followed by maintenance ofatumumab and bortezomib (ARM B).
II. To determine the toxicity profile of ofatumumab and bendamustine and ofatumumab, bortezomib, and bendamustine in patients with untreated high-risk follicular lymphoma.
III. To determine if changes in both qualitative and semi-quantitative fludeoxyglucose (FDG)-positron-emission tomography (PET) findings at baseline, after cycle 2 (day 32-35), and at end of therapy (6-8 weeks after the last cycle of induction chemotherapy but prior to maintenance therapy) with ofatumumab-bendamustine and ofatumumab, bortezomib, and bendamustine correlate with response and PFS in patients with high-risk follicular lymphoma.
IV. To assess if a combinatorial approach using both qualitative and semi-quantitative changes in FDG-PET and computed tomography (CT) or magnetic resonance imaging (MRI) studies at baseline, after cycle 2 (day 32-35), and at end of therapy (6-8 weeks after the last cycle of induction chemotherapy prior to maintenance therapy) would result in a higher predictive value for response and PFS in patients with high-risk follicular lymphoma.
V. To correlate all molecular parameters with FDG-PET parameters in determination of response and PFS.
VI. To correlate pre-treatment single nucleotide polymorphisms with response and PFS following ofatumumab-bendamustine and ofatumumab, bortezomib, and bendamustine therapy in patients with untreated high-risk follicular lymphoma.
VII. To correlate cluster of differentiation (CD)-68, B-cell chronic lymphocytic leukemia (CLL)/lymphoma (bcl)-2, marker of proliferation Ki-67 (Ki-67), forkhead box P3 (FOXP3), activated cytotoxic T-cells, lymphoma-associated macrophages (LAM), melanoma associated antigen (mutated) 1 (MUM1), CD10, nuclear v-rel avian reticuloendotheliosis viral oncogene homolog A (p65) and v-rel avian reticuloendotheliosis viral oncogene homolog C (cREL) subunits of nuclear factor of kappa light polypeptide gene enhancer in B-cells (NFkB), and selected genetic translocations by fluorescent in situ hybridization (FISH) analysis (such as Bcl-2 and Bcl-6) with response and PFS in patients receiving initial therapy for high-risk follicular lymphoma.
VIII. To determine whether immune gene signatures previously identified as prognostic factors in follicular lymphoma can be applied to paraffin-embedded tissues in ofatumumab and bendamustine or ofatumumab, bendamustine, and bortezomib treated patients; evaluate micro-ribonucleic acid (RNA) signatures associated with these gene signatures and outcome.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM A:
INDUCTION: Patients receive ofatumumab intravenously (IV) over 2-8 hours on day 1 and bendamustine hydrochloride IV over 30-60 minutes on days 1 and 2. Treatment repeats every 35 days for up to 6 courses. Patients without disease progression continue on to maintenance therapy.
MAINTENANCE: Beginning 8 weeks after the start of induction course 6, patients receive ofatumumab IV over 2-8 hours on day 1. Treatment repeats every 56 days for up to 4 courses.
ARM B:
INDUCTION: Patients receive ofatumumab IV over 2-8 hours on day 1, bendamustine hydrochloride IV over 30-60 minutes on days 1 and 2, and bortezomib IV over 3-5 seconds or subcutaneously (SC) on days 1, 8, 15, and 22. Treatment repeats every 35 days for up to 6 courses. Patients without disease progression continue on to maintenance therapy.
MAINTENANCE: Beginning 8 weeks after the start of induction course 6, patients receive ofatumumab IV over 2-8 hours on day 1 and bortezomib IV over 3-5 seconds or SC on days 1, 8, 15, and 22. Treatment repeats every 56 days for up to 4 courses.
After completion of study treatment, patients are followed up every 4 months for 2 years and then every 6 months for up to 10 years.
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Inclusion Criteria:
Histologically confirmed follicular non-Hodgkin lymphoma, World Health Organization (WHO) classification grade 1, 2, or 3a (> 15 centroblasts per high-power field with centrocytes present)
Patients must have at least one of the following indicators of poor risk disease:
Follicular Lymphoma International Prognostic Index (FLIPI score):
Lactate dehydrogenase (LDH) > upper limit of normal (ULN)
Measurable disease must be present either on physical examination or imaging studies; non-measurable disease alone is not acceptable; any tumor mass > 1 cm is acceptable; lesions that are considered non-measurable include the following:
INDUCTION: Patients receive ofatumumab IV over 2-8 hours on day 1 and bendamustine hydrochloride IV over 30-60 minutes on days 1 and 2. Treatment repeats every 35 days for up to 6 courses. Patients without disease progression continue on to maintenance therapy. MAINTENANCE: Beginning 8 weeks after the start of induction course 6, patients receive ofatumumab IV over 2-8 hours on day 1. Treatment repeats every 56 days for up to 4 courses.
Drug: Bendamustine Hydrochloride · Radiation: Fludeoxyglucose F-18 · Other: Laboratory Biomarker Analysis · Biological: Ofatumumab · Procedure: Positron Emission Tomography with Radiolabeled Targeting Agent
INDUCTION: Patients receive ofatumumab IV over 2-8 hours on day 1, bendamustine hydrochloride IV over 30-60 minutes on days 1 and 2, and bortezomib IV over 3-5 seconds or SC on days 1, 8, 15, and 22. Treatment repeats every 35 days for up to 6 courses. Patients without disease progression continue on to maintenance therapy. MAINTENANCE: Beginning 8 weeks after the start of induction course 6, patients receive ofatumumab IV over 2-8 hours on day 1 and bortezomib IV over 3-5 seconds or SC on days 1, 8, 15, and 22. Treatment repeats every 56 days for up to 4 courses.
Drug: Bendamustine Hydrochloride · Drug: Bortezomib · Radiation: Fludeoxyglucose F-18 · Other: Laboratory Biomarker Analysis · Biological: Ofatumumab · Procedure: Positron Emission Tomography with Radiolabeled Targeting Agent
Given IV
Also known as: Belrapzo, Bendamustin Hydrochloride, Bendeka, CEP 18083, CEP-18083, CEP18083, Cytostasan Hydrochloride, Levact, Ribomustin, SyB L-0501, Treakisym, Treanda, VIVIMUSTA
Given IV or SC
Also known as: [(1R)-3-Methyl-1-[[(2S)-1-oxo-3-phenyl-2-[(pyrazinylcarbonyl)amino]propyl]amino]butyl]boronic Acid, LDP 341, LDP-341, LDP341, MLN 341, MLN-341, MLN341, PS 341, PS-341, PS341, Velcade
Undergo FDG-PET
Also known as: 18FDG, FDG, Fludeoxyglucose (18F), fludeoxyglucose F 18, Fludeoxyglucose F18, Fluorine-18 2-Fluoro-2-deoxy-D-Glucose, Fluorodeoxyglucose F18
Correlative studies
Given IV
Also known as: Arzerra, GSK1841157, HuMax-CD20, HuMax-CD20, 2F2, Kesimpta
Undergo FDG-PET
Also known as: Positron Emission Tomography with Radiolabeled Targeting Agents
Complete Response Rate
A complete response was defined using International Harmonization Project Response Criteria as the complete disappearance of all detectable clinical evidence of disease and disease-related symptoms if present before therapy. If the bone marrow was involved by lymphoma before treatment, the infiltrate must have cleared on repeat bone marrow biopsy. The complete response (CR) rate was calculated in newly diagnosed untreated follicular lymphoma patients receiving 6 cycles of ofatumumab-bendamustine (ARM A) and 6 cycles of ofatumumab, bortezomib, and bendamustine (ARM B). The complete response rate was calculated as the number of patients with a complete response divided by the number of patients eligible for evaluation.
Time frame: From date of randomization until patient stops treatment for any reason, up to 484 days post-randomization
Progression-free Survival (PFS)
Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions. PFS rates (percentages) at 1, 2, ,3 and 4 years are defined as the percentage of patients who are alive and progression-free at the respective time points. The p-values of the log-rank test will be calculated to compare PFS between the two arms.
Time frame: Up to 4 years
The Number of Patients Who Experienced Grade 3+ Hematologic and Non-hematologic Adverse Events at Least Possibly Related to Treatment
The number of patients who experienced grade 3+ hematologic and non-hematologic adverse events at least possibly related to treatment assessed according to National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0
Time frame: From date of randomization until patient stops treatment for any reason, up to 484 days post-randomization
Pre-treatment Single Nucleotide Polymorphisms (SNP)
The PFS will be compared among the three genotype groups of each SNP using the log-rank tests. A maxtype test will be used by taking the maximum value of the log-rank tests under dominant, recessive, and proportional hazard model. The critical value (or p-value) of the max test will be obtained by a permutation method. No multiple testing adjustment may be applied because of the small sample size.
Time frame: Up to 10 years
Immunohistochemical (IHC) Markers
The IHC markers will be correlated with response (using the two-sample t-test) and PFS (using the Cox regression method) data. No multiple testing adjustment will be applied because of the small sample size.
Time frame: Up to 10 years
Predictive Value of Fludeoxyglucose-positron-emission Tomography
The ratio will be correlated with response (using the two-sample t-test) and PFS (using the Cox regression method) data.
Time frame: Up to 36-38 weeks (6-8 weeks after course 6, day 1 after last course of induction chemotherapy)
| Milestone | Arm A (Ofatumumab, Bendamustine Hydrochloride) | Arm B (Ofatumumab, Bendamustine Hydrochloride, Bortezomib) |
|---|---|---|
| Started | 67 | 65 |
| Completed | 66 | 62 |
| Not completed | 1 | 3 |
| Withdrew: Ineligible after beginning treatment | 1 | 3 |
A complete response was defined using International Harmonization Project Response Criteria as the complete disappearance of all detectable clinical evidence of disease and disease-related symptoms if present before therapy. If the bone marrow was involved by lymphoma before treatment, the infiltrate must have cleared on repeat bone marrow biopsy. The complete response (CR) rate was calculated in newly diagnosed untreated follicular lymphoma patients receiving 6 cycles of ofatumumab-bendamustine (ARM A) and 6 cycles of ofatumumab, bortezomib, and bendamustine (ARM B). The complete response rate was calculated as the number of patients with a complete response divided by the number of patients eligible for evaluation.
| proportion of patients | Arm A (Ofatumumab, Bendamustine Hydrochloride) | Arm B (Ofatumumab, Bendamustine Hydrochloride, Bortezomib) |
|---|---|---|
| Complete Response Rate | .621 | .597 |
Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions. PFS rates (percentages) at 1, 2, ,3 and 4 years are defined as the percentage of patients who are alive and progression-free at the respective time points. The p-values of the log-rank test will be calculated to compare PFS between the two arms.
| percentage of patients | Arm A (Ofatumumab, Bendamustine Hydrochloride) | Arm B (Ofatumumab, Bendamustine Hydrochloride, Bortezomib) |
|---|---|---|
| PFS at 1 year | 93.8 (88.2 to 99.9) | 84.8 (76.2 to 94.5) |
| PFS at 2 years | 80.3 (70.8 to 91.0) | 75.6 (65.2 to 87.7) |
| PFS at 3 years | 65.9 (53.9 to 80.7) | 67.1 (55.5 to 81.0) |
| PFS at 4 years | 57.3 (43.2 to 75.9) | 64.7 (52.8 to 79.2) |
The number of patients who experienced grade 3+ hematologic and non-hematologic adverse events at least possibly related to treatment assessed according to National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0
| Participants | Arm A (Ofatumumab, Bendamustine Hydrochloride) | Arm B (Ofatumumab, Bendamustine Hydrochloride, Bortezomib) |
|---|---|---|
| Hematologic | 45 | 41 |
| Non-Hematologic | 17 | 33 |
The PFS will be compared among the three genotype groups of each SNP using the log-rank tests. A maxtype test will be used by taking the maximum value of the log-rank tests under dominant, recessive, and proportional hazard model. The critical value (or p-value) of the max test will be obtained by a permutation method. No multiple testing adjustment may be applied because of the small sample size.
Results for this outcome have not been posted.
The IHC markers will be correlated with response (using the two-sample t-test) and PFS (using the Cox regression method) data. No multiple testing adjustment will be applied because of the small sample size.
Results for this outcome have not been posted.
The ratio will be correlated with response (using the two-sample t-test) and PFS (using the Cox regression method) data.
Results for this outcome have not been posted.
Collected over Adverse events were collected systematically after each cycle, up to 10 cycles. Cycles 1-6 were up to 35 days and cycles 7-10 were up to 56 days.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Arm A (Ofatumumab, Bendamustine Hydrochloride) | 1/67 (1.5%) | 1/67 (1.5%) | 67/67 (100%) |
| Arm B (Ofatumumab, Bendamustine Hydrochloride, Bortezomib) | 4/65 (6.2%) | 4/65 (6.2%) | 65/65 (100%) |
| Event | Arm A (Ofatumumab, Bendamustine Hydrochloride) | Arm B (Ofatumumab, Bendamustine Hydrochloride, Bortezomib) |
|---|---|---|
| Death NOSGeneral disorders | 0/67 | 2/65 |
| Blood and lymphatic system disorders - Other, specifyBlood and lymphatic system disorders | 0/67 | 1/65 |
| SepsisInfections and infestations | 0/67 | 1/65 |
| Disseminated intravascular coagulationBlood and lymphatic system disorders | 1/67 | 0/65 |
| Event | Arm A (Ofatumumab, Bendamustine Hydrochloride) | Arm B (Ofatumumab, Bendamustine Hydrochloride, Bortezomib) |
|---|---|---|
| NauseaGastrointestinal disorders | 39/67 | 55/65 |
| FatigueGeneral disorders | 49/67 | 46/65 |
| Lymphocyte count decreasedInvestigations | 48/67 | 44/65 |
| White blood cell decreasedInvestigations | 37/67 | 43/65 |
| AnemiaBlood and lymphatic system disorders | 30/67 | 40/65 |
| DiarrheaGastrointestinal disorders | 22/67 | 39/65 |
| Neutrophil count decreasedInvestigations | 40/67 | 35/65 |
| Peripheral sensory neuropathyNervous system disorders | 16/67 | 36/65 |
| Platelet count decreasedInvestigations | 32/67 | 35/65 |
| ConstipationGastrointestinal disorders | 25/67 | 34/65 |
All patients that were eligible for endpoint analysis were included in the baseline characteristics.
| Age, Continuous(years) | Arm A (Ofatumumab, Bendamustine Hydrochloride) | Arm B (Ofatumumab, Bendamustine Hydrochloride, Bortezomib) | Total |
|---|---|---|---|
| Median | 61 (25 to 87) | 61.5 (31 to 81) | 61 (25 to 87) |
| Sex: Female, Male(Participants) | Arm A (Ofatumumab, Bendamustine Hydrochloride) | Arm B (Ofatumumab, Bendamustine Hydrochloride, Bortezomib) | Total |
|---|---|---|---|
| Female | 28 | 32 | 60 |
| Male | 38 | 30 | 68 |
| Ethnicity (NIH/OMB)(Participants) | Arm A (Ofatumumab, Bendamustine Hydrochloride) | Arm B (Ofatumumab, Bendamustine Hydrochloride, Bortezomib) | Total |
|---|---|---|---|
| Hispanic or Latino | 2 | 4 | 6 |
| Not Hispanic or Latino | 62 | 56 | 118 |
| Unknown or Not Reported | 2 | 2 | 4 |
| Race (NIH/OMB)(Participants) | Arm A (Ofatumumab, Bendamustine Hydrochloride) | Arm B (Ofatumumab, Bendamustine Hydrochloride, Bortezomib) | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 0 |
| White | 54 | 58 | 112 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 12 | 4 | 16 |
| Region of Enrollment(participants) | Arm A (Ofatumumab, Bendamustine Hydrochloride) | Arm B (Ofatumumab, Bendamustine Hydrochloride, Bortezomib) | Total |
|---|---|---|---|
| United States | 66 | 62 | 128 |
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