ClinicalTrials.gg
Active, not recruitingNCT03620903Updated Dec 5, 2025

Efficacy of First Line B-RI for Treatment Naive Waldenström's Macroglobulinemia

A Phase 2 interventional study of Ibrutinib / Bortezomib / Rituximab in Waldenstrom Macroglobulinemia, sponsored by Christian Buske. Active, not recruiting at 12 sites in 2 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-12-05.

Sponsored by Christian Buske · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
53
Allocation
Not applicable
Ages
18 Years and older
Sex
All
01

Where this study stands

Counted across the records on this site · 2026-11-12

Among 25 studies testing ibrutinib in Waldenstrom Macroglobulinemia — 2 open to participants now, 7 under way, 2 of them phase 3. ibrutinib · Waldenstrom Macroglobulinemia.

Enrollment
12th of 25
53 · median 48
Started
2019
with 2 others
Phase 2
11 of 25
none open now
Registered
15th of 25
by date
Lead sponsor
2 of 25
Christian Buske

Among the 25 studies testing ibrutinib in Waldenstrom Macroglobulinemia, this one is the 12th largest by enrollment, is one of 3 that started in 2019, is one of 11 in phase 2, and was the 15th registered.

Waldenstrom Macroglobulinemia

524 studies on the registry are indexed under Waldenstrom Macroglobulinemia; 62 are open to participants now.

Browse Waldenstrom Macroglobulinemia studies →

Open to participants now

2 of the 25 studies testing ibrutinib in Waldenstrom Macroglobulinemia are open now, in 1 country. Recruiting first, the newest first:

By country, each count listing its studies:

All 2 open studies →

About ibrutinib

ibrutinib: first FDA approval 2013 (IMBRUVICA), first EMA approval 2014. What it is approved for, and how studies give it, is on its page →

Who these studies take

Of the 48 Waldenstrom Macroglobulinemia studies recruiting now, 44 (92%) set no upper age limit and 1 (2%) stop at 75 or younger; 2 take children under 18; 0 take healthy volunteers.

This study: 18 Years and older · all sexes · no healthy volunteers.

The full table on the hub →

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Watch this landscapeDownload CSVNarrow it in search →With an account: a weekly mail of what changed among 25 studies testing ibrutinib in Waldenstrom Macroglobulinemia, or all of them as a file.
02

Study summary

In Waldenström macroglobulinemia (WM) conventional chemotherapy induces only low complete remission (CR) rates and responses of short duration compared to other indolent lymphomas. Thus innovative approaches are needed which combine excellent activity and tolerability in patients with WM, who are mostly of advanced age. The immunochemotherapy DRC (dexamethasone, rituximab, cyclophosphamide) was shown to be highly effective in patients with WM without inducing major hematological toxicities. On the other hand the proteasome inhibitor bortezomib showed substantial activity as a single agent in WM with only very few side effects when given in a weekly schedule. Recent data confirmed high activity with low toxicity for ibrutinib in relapsed WM patients as single agent therapy. Based on these observations it is the aim of this study to investigate the efficacy and toxicity of the chemotherapy-free combination bortezomib, rituximab, ibrutinib (B-RI) in treatment naïve WM patient.

Read the detailed description

In Waldenström's macroglobulinemia (WM) conventional chemotherapy induces only low complete remission (CR) rates and responses of short duration compared to other indolent lymphomas. Thus innovative approaches are needed which combine excellent activity and tolerability in patients with WM, who are mostly of advanced age. Today, chemotherapy in combination with the anti-cluster of differentiation (CD) 20 antibody rituximab is still the backbone of treatment in patients with WM and is recommended as first line in national and international treatment guidelines. With the approval of Ibrutinib by the European Medicines Agency (EMA) 2015 for patients with relapsed WM or for patients not eligible for chemotherapy with treatment naïve WM treatment landscape has changed in this lymphoma subtype and there is an urgent need to evaluate to which extent chemotherapy-free approaches add clinical benefit to the patient. The treatment in the "European Consortium for Waldenström's Macroglobulinemia" (ECWM)-2 trial will test, whether the chemotherapy-free approach, which is given orally (ibrutinib) and subcutaneously (bortezomib and rituximab from cycle 2 onwards) (B-RI) will approach the efficacy of chemotherapy containing treatment concepts, but avoids chemotherapy associated toxicity. From the perspective of single agent ibrutinib, this regimen tests whether ibrutinib can be further optimized by adding rituximab and bortezomib. The combination of rituximab and ibrutinib was tested in comparison to rituximab/placebo in a large international phase III trial on behalf of the European Consortium for Waldenström's Macroglobulinemia in relapsed and first line WM, and results were recently published: in this trial no unexpected toxicity of the combination ibrutinib/rituximab was reported. Furthermore, ibrutinib/rituximab was significantly superior to rituximab/placebo with regard to response rates and PFS. From the perspective of the established rituximab/bortezomib regimen, the combination of B-RI will evaluate whether adding ibrutinib to this combination will add any benefit for the patient.

To this end, the aim of the study is to assess the toxicity and efficacy of B-RI in an exploratory phase II trial.

03

Conditions studied

  • Waldenstrom Macroglobulinemia

Keywords

  • Waldenstrom Macroglobulinemia, Ibrutinib, Bortezomib
04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Clinicopathological diagnosis of WM as defined by consensus panel one of the Second International Workshop on WM, diagnosed by a reference pathology center. Pathological diagnosis has to occur before study inclusion. In addition, pathological specimens have to be sent to the national pathological reference center at study inclusion. The positivity for Cluster of Differentiation (CD) 20 can be assumed from any previous bone marrow immunohistochemistry or flow cytometry analysis performed up to 6 months prior to enrollment. Inclusion in the study will be based on morphological and immunological criteria. Immunophenotyping will be performed in each center and saved locally. Flow cytometry of bone marrow and blood cells will include at least one double staining and assess the expression of the following antigens: surface immunoglobulin, CD19, CD20, CD5, CD10 and CD23. Patients are eligible if tumor cells express the following antigens: CD19, CD20, and if they are negative for CD5, CD10 and CD23 expression. Patients with tumor cells positive for CD5 and/or CD23 and morphologically similar to WM cells may be included after ruling out other low-grade B-cell .
  • Presence of at least one criterion for initiation of therapy, according to the 2nd Workshop on WM:

    • Recurrent fever, night sweats, weight loss, fatigue (at least one of them)
    • Hyperviscosity
    • Lymphadenopathy which is either symptomatic or bulky (≥5 cm in maximum diameter)
    • Symptomatic hepatomegaly and/or splenomegaly
    • Symptomatic organomegaly and/or organ or tissue infiltration
    • Peripheral neuropathy due to WM
    • Symptomatic cryoglobulinemia
    • Cold agglutinin anemia
    • Immunoglobulin M (IgM) related immune hemolytic anemia and/or thrombocytopenia
    • Nephropathy related to WM
    • Amyloidosis related to WM
    • ≤10g/dL
    • count \<100x109/L
    • Serum monoclonal protein >5g/dL, even with no overt clinical symptoms
  • Low or absent IgG serum levels
  • World Health Organization (WHO)/Eastern Co-operative Oncology Group () performance status 0 to 2.
  • Other criteria:

    • Age ≥ than 18 years
    • >3 months.
    • Baseline platelet count >100x10exponential (E)9/L if not due to bone marrow (BM) involvement by the lymphoma, independent of any transfusions
    • >1x10E9/L independent of growth factor support.
    • Meet the following pretreatment laboratory criteria at the Screening visit conducted within 28 days of study enrollment:

      • (AST): \<3 times the upper limit of institutional laboratory normal value
      • alanine aminotransferase (ALAT): \<3 times the upper limit of institutional laboratory normal value
      • Total : \< 1.5 times the upper limit of institutional laboratory normal value, unless clearly related to the disease (except if due to Gilbert's syndrome)
      • Serum creatinine: ≤ 2 times the upper limit of institutional laboratory normal value or estimated (cockroft-gault ≥ 40 mL/min/1.73m2)
  • Premenopausal fertile females must agree to use a highly effective method of for the duration of the therapy up to 6 months after end of therapy. A highly effective method of birth control is defined as those which result in a low failure rate (i.e. less than 1% per year) when used consistently and correctly such as implants, injectables, combined oral contraceptives, some intrauterine devices (IUDs), sexual abstinence or vasectomised partner.
  • Men must agree not to father a child for the duration of therapy and 12 months after and must agree to advice a female partner to use a highly effective method of birth control.
  • Voluntary written before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care.
  • Affiliation to a social security scheme (relevant for France only)

Exclusion criteria

Exclusion Criteria:

  • Prior systemic treatment of the WM (plasmapheresis and short - term administration of \< 4 weeks administered at a dose equivalent to \< 20 mg/day prednisone is allowed)
  • Patient with to Bortezomib
  • Patient with hypersensitivity to MabThera
  • Patient with hypersensitivity to Ibrutinib
  • Serious medical or psychiatric illness likely to interfere with participation in this clinical study.
  • Uncontrolled viral infection
  • Known history of (HIV) or active Virus or active Virus infection or any uncontrolled active systemic infection requiring intravenous (IV) antibiotics.
  • Congenital or acquired severe immunodeficiency not attributed to lymphoma (clinical appearance: recurrent infections, necessity of immunoglobulin substitution therapy, patients after transplantation)
  • Known interstitial lung disease
  • Prior allergic reaction or severe anaphylactic reaction related to humanized or murine monoclonal antibody.
  • Central Nervous System involvement by lymphoma
  • Prior history of unless the subject has been free of the disease for ≥ 5 years. Exceptions include the following:
  • Basal cell carcinoma of the skin,
  • Squamous cell carcinoma of the skin,
  • Carcinoma in situ of the cervix,
  • Carcinoma in situ of the breast,
  • Incidental histologic finding of prostate cancer (TNM stage of T1a or T1b).
  • Uncontrolled illness including, but not limited to:
  • Uncontrolled diabetes mellitus (as indicated by metabolic derangements and/or severe diabetes mellitus related uncontrolled organ complications)
  • Chronic symptomatic congestive heart failure (Class (NYHA) III or IV).
  • Unstable angina pectoris, angioplasty, stenting, or myocardial infarction within 6 months
  • cardiac arrhythmia that is symptomatic or requires treatment, or asymptomatic sustained ventricular tachycardia.
  • Known pericardial disease
  • acute diffuse infiltrative pulmonary and pericardial disease
  • Subjects with ≥ Grade 2 neuropathy.
  • Recent major surgery (within 4 weeks prior to study inclusion)
  • History of stroke or intracranial haemorrhage within 6 months prior to study inclusion
  • Women who are pregnant as well as women who are breast-feeding and do not consent to discontinue breast-feeding.
  • Participation in another clinical trial within four weeks prior to study inclusion
  • No consent for registration, storage and processing of the individual disease-characteristics and course as well as information of the family physician about study participation
  • St. John's Wort with Ibrutinib
  • Requires anticoagulation with warfarin or equivalent vitamin K antagonists (eg, phenprocoumon).
  • Requires treatment with strong cytochrome P (CYP) 3A inhibitors.
  • Vaccinated with live, attenuated vaccines within 4 weeks prior to study inclusion.
  • Person of legal age who is incapable of comprehending the nature, significance and implications of the clinical trial and of determining his/her will in the light of these facts
Terms in these criteria, in plain language(18)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Life expectancy

The study doctor’s estimate of how long someone is likely to live. Criteria use it so that people can stay in the study long enough for it to answer its question.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

GFR and eGFR (kidney filtering)

GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².

Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

Clinically significant

Judged by the study doctor to matter for your health or for the study. It is a doctor’s decision, so ask the study team if you are unsure whether something counts.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
53 participants (actual)

Study arms

  • Experimental
    Bortezomib-Rituximab-Ibrutinib

    Cycle 1: Rituximab: 375 mg/m2 intravenously (i.v) day 1; Bortezomib:1.6 mg/ m2 subcutanously (SC) day 1,8,15; Ibrutinib: 420 mg orally (p.o.) day 1-28; Cycle 2-6 Rituximab: 1400 mg absolute SC day 1; Bortezomib:1.6 mg/ m2 SC day 1,8,15; Ibrutinib: 420 mg p.o. day 1-28; Maintenance I (1 cycle = 56 days): Ibrutinib 420 mg p.o. daily, until evidence of progressive disease or no longer tolerated by the subject (for a maximum of 10 years); Rituximab 1400 mg absolute SC day 1, every second month for 24 months (month 7-30); Maintenance II (1 cycle = 84 days): Ibrutinib 420 mg p.o. daily, until evidence of progressive disease or no longer tolerated by the subject (for a maximum of 10 years);

    Drug: Ibrutinib / Bortezomib / Rituximab

Interventions

  • DrugIbrutinib / Bortezomib / Rituximab

    Drug pages: Ibrutinib · Bortezomib · Rituximab

    Induction (Rituximab / Bortezomib / Ibrutinib), Maintenance I (Ibrutinib / Rituximab), Maintenance II (Ibrutinib)

    Also known as: Imbruvica / Velcade / Mabthera

06

What researchers measure

Primary outcomes

  1. 1 year progression free survival

    The primary endpoint is the rate of 1 year progression free survival (1YPFS).

    Time frame: 1 year

Secondary outcomes

  1. Response rate

    response rates (CR, VGPR, PR, MR) and overall response rate (CR, VGPR, PR, MR)

    Time frame: 6 months

  2. Best response

    At least achieving a MR

    Time frame: up to 10 years

  3. Time to best response

    time from the start of induction to best response the patient achieves (CR, VGPR, PR, MR).

    Time frame: up to 10 years

  4. Time to first response

    time from the start of induction to first response (MR, PR, VGPR or CR).

    Time frame: up to 10 years

  5. Time to Treatment failure (TTF)

    time of start of induction treatment to discontinuation of therapy for any reason including death from any cause, progression, toxicity or add-on of new anti-cancer therapy.

    Time frame: up to 10 years

  6. Remission duration (RD)

    patients with response (CR, VGPR, PR, MR) from the date of response to the date of progression, relapse or death from any cause.

    Time frame: up to 10 years

  7. Progression Free Survival (PFS)

    date of start of treatment to the following events: the date of progression and the date of death if it occurred earlier.

    Time frame: up to 10 years

  8. Cause specific survival (CSS)

    period from the start of induction treatment to death from lymphoma or lymphoma related cause

    Time frame: up to 10 years

  9. Overall survival (OS)

    period from the start of induction treatment to death from any cause.

    Time frame: up to 10 years

  10. Safety Analysis

    Safety including treatment associated adverse events.

    Time frame: up to 10 years

07

Study locations

12 sites
  • Studiengesellschaft Onkologie Bielefeld GbR
    Bielefeld, 33604, Germany
  • DIAKO Ev. Diakonie-Krankenhaus gGmbH, Med. Klinik II
    Bremen, 28239, Germany
  • Universitätsklinikum Halle, Klinik für Innere Medizin IV
    Halle, 06120, Germany
  • Universtätsmedizin Mannheim, III. Medizinische Klinik Studienzentrale im MCC
    Mannheim, 68167, Germany
  • Kliniken Maria Hilf GmbH (Krankenhaus St. Franziskus), Medizinische Klinik I (Klinik f. Hämatologie, Onkologie, Gastroentereologie)
    Mönchengladbach, 41063, Germany
  • Kliniken Ostalb Stauferklinikum Schwäbisch Gmünd, Zentrum für Innere Medizin
    Mutlangen, 73557, Germany
  • Hämato-Onkologische Gemeinschaftspraxis Pasing-Fürstenfeldbruck
    München, 81241, Germany
  • Klinikum der Universität München, Medizinische Klinik und Poliklinik III
    München, 83177, Germany
  • Universitätsklinikum Münster, Med. Klinik A
    Münster, 48149, Germany
  • Universitätsklinikum Ulm; Klinik für Innere Medizin Innere Medizin III
    Ulm, 89081, Germany
  • Gemeinschaftspraxis Dres. Rudolf Schlag, Björn Schöttker, Joachim Haas
    Würzburg, 97080, Germany
  • 'Alexandra' General Hospital of Athens
    Athens, 11528, Greece
08

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Ran from Sep 2019 to primary completion in Nov 2022, 38 months.

Of 55 non-industry phase 2 interventional studies under Waldenstrom Macroglobulinemia, half reached primary completion within 67 months of starting (the median), counting those still running; a quarter within 45 and three quarters within 103. This study's 38 months is below that.

Counting every sponsor, half of 66 studies reached it within 64 months; a quarter within 45 and three quarters within 103.

How these figures are worked out, and which studies are left out of them.

Registered
Aug 2, 2018
First posted
Aug 8, 2018
StartActual
Sep 11, 2019
Primary completionActual
Nov 14, 2022
CompletionEst.
Feb 2027
Last update
Dec 5, 2025
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Dec 5, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT03620903
Lead sponsor
Christian Buske
Collaborators
University of Ulm, ClinAssess GmbH, Zentrum für Klinische Studien Ulm, Hoffmann-La Roche, Johnson & Johnson
Responsible party
Christian Buske (Prof. Dr. med., University of Ulm) — Sponsor-investigator
First posted
Aug 8, 2018
Start date
Sep 11, 2019
Primary completion
Nov 14, 2022
Completion
Feb 2027 (estimated)
Last update
Dec 5, 2025

Study contacts

Christian Buske, MD
principal investigator · University of Ulm

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is active, not recruiting, as verified in Nov 2025. You cannot join it, but the record below documents what was studied.

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Discussion

Questions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.

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Studies of the drugs tested here: Ibrutinib · Bortezomib · Rituximab

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