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Trial details imported from ClinicalTrials.gov

For full trial details, please see the original record at https://clinicaltrials.gov/ct2/show/NCT01796171




Registration number
NCT01796171
Ethics application status
Date submitted
19/02/2013
Date registered
21/02/2013
Date last updated
10/01/2024

Titles & IDs
Public title
A Phase 1/2 Study of Betalutin for Treatment of Relapsed Non-Hodgkin Lymphoma
Scientific title
A Phase 1/2 Study of Lutetium (177Lu)-Lilotomab Satetraxetan (Betalutin®) Antibody-radionuclide-conjugate for Treatment of Relapsed Non-Hodgkin Lymphoma.
Secondary ID [1] 0 0
EudraCT: 2011-000033-36
Universal Trial Number (UTN)
Trial acronym
LYMRIT-37-01
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Non-Hodgkin Lymphoma 0 0
Follicular Lymphoma 0 0
Condition category
Condition code
Cancer 0 0 0 0
Lymphoma (non Hodgkin's lymphoma) - High grade lymphoma
Cancer 0 0 0 0
Lymphoma (non Hodgkin's lymphoma) - Low grade lymphoma

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Treatment: Drugs - 10 MBq/kg Betalutin
Treatment: Drugs - 15 MBq/kg Betalutin
Treatment: Drugs - 20 MBq/kg Betalutin
Treatment: Drugs - 40 mg lilotomab
Treatment: Drugs - 100 mg/m2 lilotomab
Treatment: Drugs - 60 mg/m2 lilotomab
Treatment: Drugs - Rituximab
Treatment: Drugs - 12.5 mBq/kg Betalutin

Experimental: Part A, Arm 1: 10 MBq/kg Betalutin with lower dose lilotomab pre-dosing - 10 MBq/kg (based on body weight) Betalutin with 40 mg lilotomab pre-dosing

Experimental: Part A, Arm 1: 15 MBq/kg Betalutin with lower dose lilotomab pre-dosing - 15 MBq/kg (based on body weight) Betalutin with 40 mg lilotomab pre-dosing

Experimental: Part A, Arm 1: 20 MBq/kg Betalutin with lower dose lilotomab pre-dosing - 20 MBq/kg (based on body weight) Betalutin with 40 mg lilotomab pre-dosing

Experimental: Part A, Arm 2: 10 MBq/kg Betalutin with no pre-dosing - 10 MBq/kg (based on body weight) Betalutin without pre-dosing

Experimental: Part A, Arm 2: 15 MBq/kg Betalutin with no pre-dosing - 15 MBq/kg (based on body weight) Betalutin without pre-dosing

Experimental: Part A, Arm 3: 15 MBq/kg Betalutin with rituximab pre-dosing - 15 MBq/kg (based on body weight) Betalutin with rituximab pre-dosing

Experimental: Part A, Arm 4: 15 MBq/kg Betalutin with higher dose lilotomab pre-dosing - 15 MBq/kg (based on body weight) Betalutin with 100 mg/m2 (based on body surface area) lilotomab pre-dosing

Experimental: Part A, Arm 4: 20 MBq/kg Betalutin with higher dose lilotomab pre-dosing - 20 MBq/kg (based on body weight) Betalutin with 100 mg/m2 (based on body surface area) lilotomab pre-dosing

Experimental: Part A, Arm 5: 20 MBq/kg Betalutin with intermediate dose lilotomab pre-dosing - 20 MBq/kg (based on body weight) Betalutin with 60 mg/m2 (based on body surface area) lilotomab pre-dosing

Experimental: Part B, Arm 1: 15 MBq/kg Betalutin with lower dose lilotomab pre-dosing - 15 MBq/kg (based on body weight) Betalutin with 40 mg lilotomab pre-dosing

Experimental: Part B, Arm 2: 20 MBq/kg Betalutin with higher dose lilotomab pre-dosing - 20 MBq/kg (based on body weight) Betalutin with 100 mg/m2 (based on body surface area) lilotomab pre-dosing

Experimental: Part B, Arm 3: 12.5 MBq/kg Betalutin with lower dose lilotomab pre-dosing - 12.5 MBq/kg (based on body weight) Betalutin with 40 mg lilotomab pre-dosing

Experimental: Part C: 15 MBq/kg Betalutin with lower dose lilotomab pre-dosing - 15 MBq/kg (based on body weight) Betalutin with 40 mg lilotomab pre-dosing


Treatment: Drugs: 10 MBq/kg Betalutin


Treatment: Drugs: 15 MBq/kg Betalutin


Treatment: Drugs: 20 MBq/kg Betalutin


Treatment: Drugs: 40 mg lilotomab


Treatment: Drugs: 100 mg/m2 lilotomab


Treatment: Drugs: 60 mg/m2 lilotomab


Treatment: Drugs: Rituximab


Treatment: Drugs: 12.5 mBq/kg Betalutin
Intervention code [1] 0 0
Treatment: Drugs
Comparator / control treatment
Control group

Outcomes
Primary outcome [1] 0 0
Part A, Phase I
Timepoint [1] 0 0
12 weeks
Primary outcome [2] 0 0
Part A, Phase IIa
Timepoint [2] 0 0
5 years
Primary outcome [3] 0 0
Part B, Phase IIb
Timepoint [3] 0 0
up to 5 years

Eligibility
Key inclusion criteria
Part A and Part C:



1. Histologically confirmed (by World Health Organization [WHO] classification) relapsed
incurable non-Hodgkin B-cell lymphoma of following subtypes; follicular grade I-IIIA
(for Part C, this excludes patients meeting Part B criteria, who should enter Part B),
marginal zone, small lymphocytic, lymphoplasmacytic, mantle cell.

2. Age = 18 years.

3. Part A: A pre-study WHO performance status of 0-1; Part C: WHO performance status of
0-2.

4. Life expectancy should be =3 months.

5. <25% tumour cells in bone marrow biopsy (biopsy taken from a site not previously
irradiated).

6. Measurable disease by radiological methods.

7. Women of childbearing potential must:

1. understand that the study medication is expected to have teratogenic risk.

2. have a negative pregnancy test.

3. agree to use, and be able to comply with, effective contraception without
interruption, 4 weeks before starting study medication, throughout study
medication therapy and for 12 months after end of study medication therapy, even
if she has amenorrhoea.

8. Male patients must agree to use condoms during intercourse throughout study medication
therapy and the following 12 months.

9. Patients previously treated with native rituximab are eligible.

10. The patient is willing and able to comply with the protocol, and agrees to return to
the hospital for follow up visits and examination.

11. The patient has been fully informed about the study and has signed the informed
consent form.
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
Medical contraindications, including uncontrolled infection, severe cardiac, pulmonary,
neurologic, psychiatric or metabolic disease, uncontrolled asthma/allergy requiring
systemic steroids, known to be human immunodeficiency virus (HIV) positive.

2. Laboratory values within 15 days pre-registration:

1. Absolute neutrophil counts (ANC) =1.5×109/L.

2. Part A: Platelet count =150×109/L; Part C: Platelet count <150×109/L. For Part C,
criteria 2a and 2b must be satisfied within 72 hours of the administration of
rituximab

3. Total bilirubin =30 mmol/L (Part A only). Total bilirubin > 1.5×ULN (except patients
with documented Gilbert's syndrome [=3.0 mg/dL]) (Part C only).

4. Alkaline phosphatase (ALP) and alanine transaminase (ALT) =4×normal level (Part A
only).

Aspartate transaminase (AST), ALT or ALP >2.5×ULN (or >5.0×ULN with liver involvement
by primary disease). (Part C only).

5. Creatinine =115 µmol/L (men), 97 µmol/L (women) (Part A only). Serum creatinine
=1.5×ULN (Part C only).

6. Haemoglobin <9.0 g/dL (Part C only). 3. Known central nervous system (CNS) involvement
of lymphoma. 4. Previous total body irradiation. 5. Positive test for human
anti-murine antibody (HAMA) at screening. 6. Chemotherapy or immunotherapy received
within the last 4 weeks prior to start of study treatment. Pre treatment with
rituximab is allowed.

7. Pregnant or lactating women. 8. Previous hematopoietic stem cell transplantation
(autologous and allogenic). 9. Part A: Previous treatment with radioimmunotherapy.
Part C: Not applicable. 10. Actively participating in another study or received an IMP
within 4 weeks prior to enrolment.

11. Receipt of live-attenuated vaccine within 30 days prior to enrolment. 12. Part A
and Part C: Test positive for hepatitis B (HBsAg and anti-HBc). Part C only: Test
positive for hepatitis C and human immunodeficiency virus (HIV).

13. A known hypersensitivity to rituximab, lilotomab, Betalutin or murine proteins or
any excipient used in rituximab, lilotomab, or Betalutin.

Part B:

Inclusion Criteria:

Histologically confirmed (by WHO classification) relapsed non-Hodgkin B-cell FL (grade
I IIIA).

2. Male or female aged =18 years. 3. Received at least 2 prior systemic
anti-neoplastic or immunotherapy-based regimens (maintenance therapy following a CR/PR
is not considered to be a separate line of therapy). Systemic regimens including
agents such as idelalisib or other PI3K inhibitors qualify as a prior line of therapy.

4. Prior therapy must have included a rituximab/anti-CD20 agent and an alkylating
agent - which may be been administered in separate regimens.

5. Patients must be refractory to any at least one previous regimen that contained
rituximab or an anti CD20 agent, with refractoriness defined as:

i. no response (no CR or PR) during therapy, or ii. a response (CR/PR) lasting less than 6
months after the completion of a regimen including rituximab/anti-CD20 therapy (including
occurrence of progressive disease (PD) during rituximab/anti-CD20 maintenance therapy, or
within 6 months of completion of maintenance therapy).

6. WHO performance status of 0-2. 7. Life expectancy of =3 months. 8. Bone marrow tumour
infiltration <25% (in biopsy taken from a site not previously irradiated).

9. Measurable disease by CT or MRI: longest diameter (LDi) >1.5 cm for nodal lesion, LDi
>1.0 cm for extra nodal lesion on an assessment performed during the screening period.

Criteria 10 and 11 must be satisfied within 72 hours of the administration of rituximab:

10. ANC =1.5×109/L. 11. Platelet count =100×109/L.

Criteria 12 to 15 must be verified at time of eligibility review within 2 weeks prior to
rituximab administration:

12. Haemoglobin =9.0 g/dL. 13. Total bilirubin =1.5×upper limit of normal (ULN) (except
patients with documented Gilbert's syndrome [<3.0 mg/dL]).

14. Liver enzymes: AST; ALT or ALP =2.5×ULN (or =5.0×ULN with liver involvement by primary
disease).

15. Adequate renal function as demonstrated by a serum creatinine <1.5×ULN. 16. Women of
childbearing potential must:

1. understand that the study medication is expected to have teratogenic risk.

2. have a negative serum beta human-chorionic gonadotropin (ß-HCG) pregnancy test at
screening.

3. commit to continued abstinence from heterosexual intercourse (excluding periodic
abstinence or the withdrawal method) or begin a highly effective method of birth
control with a Pearl-Index <1%, without interruption, from 4 weeks before starting
study medication, throughout study medication therapy and for 12 months after end of
study medication therapy, even if she has amenorrhoea. Apart from abstinence, highly
effective methods of birth control are: i. Combined (oestrogen and progestogen
containing) hormonal contraception associated with inhibition of ovulation (oral,
intravaginal, transdermal).

ii. Progestogen-only hormonal contraception associated with inhibition of ovulation (oral,
injectable, implantable) iii. Intrauterine device (IUD). iv. Intrauterine hormone-releasing
system (IUS). v. Bilateral tubal occlusion. vi. Vasectomised partner. 17. Male patients
must agree to use condoms during intercourse throughout study treatment administration and
for 12 months following administration of Betalutin.

18. The patient is willing and able to comply with the protocol, and agrees to return to
the hospital for follow up visits and examination.

19. The patient has been fully informed about the study and has signed the informed consent
form.

20. Negative HAMA test at screening. 21. Negative test at screening for Hepatitis B
(negative HBsAg and anti-HBc), Hepatitis C and HIV.

Exclusion Criteria

1. Prior hematopoietic allogenic stem cell transplantation.

2. Patients with a prior autologous SCT are excluded unless at least two years have
elapsed since transplantation.

3. Evidence of histological transformation from FL to diffuse large B-cell lymphoma
(DLBCL) at time of screening (transformation to grade IIIB that was successfully
treated with recurrence of grade I-IIIA initial clone is accepted).

4. Previous total body irradiation.

5. Prior anti-lymphoma therapy (chemotherapy, immunotherapy or other systemic agent
including any investigational agent) within 4 weeks prior to start of study treatment
(corticosteroid treatment at doses of = 20 mg/day, topical or inhaled corticosteroids,
granulocyte colony-stimulating factor [G-CSF] or granulocyte-macrophage
colony-stimulating factor [GM-CSF] are permitted up to 2 weeks prior to start of
rituximab)..

6. Patients who are receiving any other investigational medicinal products.

7. Patients with known or suspected CNS involvement of lymphoma.

8. History of malignancy other than FL within 5 years prior to screening( i.e. patients
with cancer diagnosed within 5 years prior to screening or who were diagnosed prior to
5 years and were not in CR or were on treatment within 5 years prior to screening),
with the exception of malignancies with a negligible risk of metastasis or death (e.g.
5-year OS rate >90%), such as adequately treated carcinoma in situ of the cervix,
non-melanoma skin carcinoma, localised prostate cancer, ductal carcinoma in situ, or
Stage I uterine cancer.

.9. Pregnant or breastfeeding women. 10. Exposure to another CD37 targeting drug. 11. A
known hypersensitivity to rituximab, lilotomab, Betalutin or murine proteins or any
excipient used in rituximab, lilotomab, or Betalutin.

12. Has received a live-attenuated vaccine within 30 days prior to enrolment. 13. Evidence
of severe or uncontrolled systemic diseases:

1. Uncontrolled infection including evidence of ongoing systemic bacterial, fungal, or
viral infection (excluding viral upper respiratory tract infections) at the time of
initiation of study treatment.

2. Pulmonary conditions e.g. unstable or uncompensated respiratory disease.

3. Hepatic, renal, neurological, or metabolic conditions - which in the opinion of the
investigator would compromise the protocol objectives.

4. Psychiatric conditions e.g. patients unlikely to comply with the protocol, e.g. mental
condition rendering the patient unable to understand the nature, scope, and possible
consequences of participating in the study.

5. History of erythema multiforme, toxic epidermal necrolysis, or Stevens-Johnson
syndrome.

6. Cardiac conditions in the previous 24 weeks (before date of consent), including

i. history of acute coronary syndromes (including unstable angina). ii. class II, III, or
IV heart failure as defined by the New York Heart Association (NYHA) functional
classification system.

iii. known uncontrolled arrhythmias (except sinus arrhythmia).

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Other
Other design features
Phase
Phase 1/Phase 2
Type of endpoint/s
Statistical methods / analysis

Recruitment
Recruitment status
Completed
Data analysis
Reason for early stopping/withdrawal
Other reasons
Date of first participant enrolment
Anticipated
Actual
1/12/2012
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
27/10/2022
Sample size
Target
Accrual to date
Final
191
Recruitment in Australia
Recruitment state(s)
Recruitment hospital [1] 0 0
Royal Hobart Hospital - Hobart
Recruitment postcode(s) [1] 0 0
7000 - Hobart
Recruitment outside Australia
Country [1] 0 0
United States of America
State/province [1] 0 0
Arkansas
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United States of America
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California
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United States of America
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Florida
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United States of America
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Illinois
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United States of America
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Kentucky
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United States of America
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Louisiana
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United States of America
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New York
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United States of America
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North Carolina
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United States of America
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Oregon
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United States of America
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Pennsylvania
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United States of America
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Texas
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Austria
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Innsbruck
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Austria
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Wien
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Belgium
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Gent
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Belgium
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La Louvière
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Belgium
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Leuven
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Canada
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London
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Canada
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Sault Ste Marie
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Canada
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Toronto
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Croatia
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Zagreb
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Czechia
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Olomouc
Country [22] 0 0
Czechia
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Ostrava-Poruba
Country [23] 0 0
Denmark
State/province [23] 0 0
Aarhus
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Denmark
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Odense
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Helsinki
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Finland
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Jyväskylä
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France
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Bordeaux
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France
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Grenoble
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France
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Paris
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France
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Pierre-Bénite
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France
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Tours
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Hungary
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Budapest
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Ireland
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Dublin
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Ireland
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Galway
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Israel
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Afula
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Israel
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Be'er Ya'aqov
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Israel
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Haifa
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Israel
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Jerusalem
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Israel
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Tel Aviv
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Italy
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Alessandria
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Italy
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Bologna
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Italy
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Firenze
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Italy
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Meldola
Country [44] 0 0
Italy
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Milano
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Italy
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Napoli
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Italy
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Reggio Emilia
Country [47] 0 0
Italy
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Torino
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Korea, Republic of
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Jeonju
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Korea, Republic of
State/province [49] 0 0
Seoul
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Korea, Republic of
State/province [50] 0 0
Ulsan
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Netherlands
State/province [51] 0 0
Groningen
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Norway
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Bergen
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Norway
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Oslo
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Norway
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Trondheim
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Poland
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Gdynia
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Poland
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Krakow
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Poland
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Warszawa
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Singapore
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Singapore
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Spain
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Barcelona
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Spain
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Cadiz
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Spain
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Majadahonda
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Spain
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Ourense
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Spain
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Pamplona
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Spain
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Salamanca
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Spain
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Seville
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Spain
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Valencia
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Sweden
State/province [67] 0 0
Umeå
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Switzerland
State/province [68] 0 0
Chur
Country [69] 0 0
Turkey
State/province [69] 0 0
Adana
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Turkey
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Ankara
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Turkey
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Eskisehir
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Turkey
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Fatih
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Turkey
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Izmir
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Turkey
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Manisa
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Turkey
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Samsun
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Turkey
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Sehitkamil
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United Kingdom
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Dorset
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United Kingdom
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Bristol
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United Kingdom
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Edinburgh
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United Kingdom
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Glasgow
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United Kingdom
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London
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United Kingdom
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Manchester
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United Kingdom
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Plymouth
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United Kingdom
State/province [84] 0 0
Sutton

Funding & Sponsors
Primary sponsor type
Commercial sector/Industry
Name
Nordic Nanovector
Address
Country
Other collaborator category [1] 0 0
Commercial sector/Industry
Name [1] 0 0
ICON Clinical Research
Address [1] 0 0
Country [1] 0 0

Ethics approval
Ethics application status

Summary
Brief summary
This study is a Phase 1/2 open-label three part study in patients with relapsed indolent
Non-Hodgkin's lymohoma (NHL) (Parts A and C) or relapsed/refractory follicular lymphoma (FL)
(Part B).
Trial website
https://clinicaltrials.gov/ct2/show/NCT01796171
Trial related presentations / publications
Dahle J, Repetto-Llamazares AH, Mollatt CS, Melhus KB, Bruland OS, Kolstad A, Larsen RH. Evaluating antigen targeting and anti-tumor activity of a new anti-CD37 radioimmunoconjugate against non-Hodgkin's lymphoma. Anticancer Res. 2013 Jan;33(1):85-95.
Repetto-Llamazares AH, Larsen RH, Mollatt C, Lassmann M, Dahle J. Biodistribution and dosimetry of (177)Lu-tetulomab, a new radioimmunoconjugate for treatment of non-Hodgkin lymphoma. Curr Radiopharm. 2013 Mar;6(1):20-7. doi: 10.2174/1874471011306010004.
Cheson BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L, Horning SJ, Coiffier B, Fisher RI, Hagenbeek A, Zucca E, Rosen ST, Stroobants S, Lister TA, Hoppe RT, Dreyling M, Tobinai K, Vose JM, Connors JM, Federico M, Diehl V; International Harmonization Project on Lymphoma. Revised response criteria for malignant lymphoma. J Clin Oncol. 2007 Feb 10;25(5):579-86. doi: 10.1200/JCO.2006.09.2403. Epub 2007 Jan 22.
Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, Lister TA; Alliance, Australasian Leukaemia and Lymphoma Group; Eastern Cooperative Oncology Group; European Mantle Cell Lymphoma Consortium; Italian Lymphoma Foundation; European Organisation for Research; Treatment of Cancer/Dutch Hemato-Oncology Group; Grupo Espanol de Medula Osea; German High-Grade Lymphoma Study Group; German Hodgkin's Study Group; Japanese Lymphorra Study Group; Lymphoma Study Association; NCIC Clinical Trials Group; Nordic Lymphoma Study Group; Southwest Oncology Group; United Kingdom National Cancer Research Institute. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014 Sep 20;32(27):3059-68. doi: 10.1200/JCO.2013.54.8800.
Public notes

Contacts
Principal investigator
Name 0 0
Chris Freitag
Address 0 0
Nordic Nanovector
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for public queries
Name 0 0
Address 0 0
Country 0 0
Phone 0 0
Fax 0 0
Email 0 0
Contact person for scientific queries



Summary Results

For IPD and results data, please see https://clinicaltrials.gov/ct2/show/NCT01796171