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NCT03418038 · Mayo Clinic

Ascorbic Acid and Chemotherapy for the Treatment of Relapsed or Refractory Lymphoma, CCUS, and Chronic Myelomonocytic Leukemia

What this study is about

This phase II trial studies the effect of ascorbic acid and combination chemotherapy in treating patients with lymphoma that has come back (recurrent) or does not respond to therapy (refractory), clonal cytopenia of undetermined significance and chronic myelomonocytic leukemia (CMML). Ascorbic acid may make cancer cells more sensitive to chemotherapy.

View original scientific description

This phase II trial studies the effect of ascorbic acid and combination chemotherapy in treating patients with lymphoma that has come back (recurrent) or does not respond to therapy (refractory), clonal cytopenia of undetermined significance and chronic myelomonocytic leukemia (CMML). Ascorbic acid may make cancer cells more sensitive to chemotherapy.

Interventions

DIETARY_SUPPLEMENT

Ascorbic Acid

Given IV

DRUG

Carboplatin

Given IV or PO

DRUG

Cisplatin

Given IV or PO

DRUG

Cytarabine

Given IV or PO

DRUG

Dexamethasone

Given IV or PO

DRUG

Etoposide

Given IV or PO

DRUG

Gemcitabine Hydrochloride

Given IV or PO

DRUG

Ifosfamide

Given IV or PO

OTHER

Laboratory Biomarker Analysis

Correlative studies

DRUG

Oxaliplatin

Given IV or PO

OTHER

Placebo Administration

Given normal saline IV

OTHER

Questionnaire Administration

Ancillary studies

BIOLOGICAL

Rituximab

Given IV

DRUG

Decitabine

Given IV

PROCEDURE

Biospecimen Collection

Undergo blood sample collection

PROCEDURE

Core Biopsy

Undergo core needle biopsy

PROCEDURE

Bone Marrow Aspiration

Undergo bone marrow aspiration and biopsy

PROCEDURE

Bone Marrow Biopsy

Undergo bone marrow aspiration and biopsy

PROCEDURE

Echocardiography

Undergo ECHO

PROCEDURE

Positron Emission Tomography

Undergo PET/CT

PROCEDURE

Magnetic Resonance Imaging

Undergo MRI

PROCEDURE

Central Venous Cannula Insertion

Undergo PICC placement

PROCEDURE

Portacath Placement

Undergo portacath placement

PROCEDURE

Computed Tomography

Undergo PET/CT

DRUG

Decitabine and Cedazuridine

Given PO

Primary outcome measures

Overall response rate (ORR) (Arms A and B)

Time frame: Up to 2 years

Defined as an objective status of complete response (CR) or partial response (PR) evaluated by Response Evaluation Criteria in Lymphoma (RECIL) criteria after 2 courses of treatment in all arms. Will be compared between the two arms. The proportion of successes will be estimated in each arm by the number of successes divided by the total number of evaluable patients. Exact binomial ninety-five percent confidence intervals for the true success proportion will be calculated in each arm. For the diffuse large B-cell lymphoma (DLBCL) arms, comparison of overall response rates between the two treatment groups will be performed using a one-sided chi-square test at significance level 0.10.

ORR (Arm C)

Time frame: Up to 2 years

Defined as an objective status of CR or PR evaluated by RECIL criteria after 2 cycles of treatment. The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. Exact binomial ninety-five percent confidence intervals for the true success proportion will be calculated in each arm.

Hematologic response (HI) rate (Arm D)

Time frame: At 20 weeks

Defined as an objective status of HI-E (minor or major response), HI-P, or HI-N evaluated by Myelodysplastic Syndrome International Working Group (IWIG) 2018 criteria at 20 weeks. Exact binomial ninety-five percent confidence intervals for the true success proportion will be calculated in each arm.

Overall Response Rate (ORR) in Arm E

Time frame: At completion of cycle 4 (each cycle is 21 days)

Defined as an objective status of complete remission, complete cytogenetic remission, partial remission, bone marrow response, or clinical benefit after 4 cycles of therapy as defined by the 2015 IWG myelodysplastic syndrome/ myeloproliferative neoplasm response criteria.

Who can participate

This study lists these criteria on ClinicalTrials.gov. A study coordinator reviews eligibility during screening — this page does not determine whether you qualify.

Inclusion criteria

  • Age \>= 18 years
  • Biopsy-proven relapsed or refractory lymphomas; relapsed is defined as a relapse that occurred after having a response to the last therapy that lasted \> 6 months; refractory is no response or relapse within 6 months; previous biopsies \< 6 months prior to treatment on this protocol will be acceptable
  • NOTE: Arms A/B - relapsed or refractory DLBCL within 24 months from the end of anthracycline-based therapy; no prior salvage therapy; patients can have received radiation therapy as part of initial treatment but not specifically for relapse
  • NOTE: Arm C patients include relapsed or refractory lymphoma patients of any type for which the recommended treatment includes one of the platinum-based regimens; of note, relapsed or refractory double-hit high grade lymphoma patients and relapsed or refractory Hodgkin lymphoma patients will be enrolled in Arm C; there is no limit on the number of prior therapies for Arm C patients; the patient must be eligible for a platinum-based regimen and must not have received the same regimen in the past without responding
  • Measurable or assessable disease: measurable disease is defined as measurable by computed tomography (CT) \[dedicated CT or the CT portion of a positron emission tomography (PET)/CT\] or magnetic resonance imaging (MRI): to be considered measurable, there must be at least one lesion that has a single diameter of \>= 1.5 cm
  • NOTE: Skin lesions can be used if the area is \>= 1.5 cm in at least one diameter and photographed with a ruler; patients with assessable disease by PET are also eligible as long as the assessable disease is biopsy proven lymphoma
  • Arms A/B - eligible for treatment with ifosfamide, carboplatin, and etoposide (+/- rituximab)
  • Arm C eligible for treatment with one of the following standard, every 3 week, platinum-based salvage regimens (with or without monoclonal antibody as appropriate for the disease):
  • Ifosfamide/carboplatin/etoposide (ICE) or rituximab/ifosfamide/carboplatin/etoposide (RICE);
  • Cisplatin, cytarabine (cytosine arabinoside), dexamethasone (DHAP) or RDHAP;
  • Gemcitabine hydrochloride (gemcitabine), dexamethasone, cisplatin (GDP) or rituximab, gemcitabine, dexamethasone, cisplatin (RGDP);
  • Gemcitabine and oxaliplatin (GemOx) or rituximab, gemcitabine and oxaliplatin (RGemOx);
  • Oxaliplatin, cytosine arabinoside, dexamethasone (OAD) or rituximab, oxaliplatin, cytosine arabinoside, dexamethasone (ROAD)
  • Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1 or 2
  • Hemoglobin \>= 8.0 g/dL (may transfuse to meet this requirement), obtained =\< 14 days prior to registration
  • Absolute neutrophil count (ANC) \>= 1500/mm\^3, obtained =\< 14 days prior to registration
  • Platelet count \>= 75000/mm\^3, obtained =\< 14 days prior to registration
  • Total bilirubin =\< 2 x upper limit of normal (ULN) (if \> 2 x ULN direct bilirubin is required and should be =\< 1.5 x ULN), obtained =\< 14 days prior to registration
  • Alanine aminotransferase (ALT) and aspartate transaminase (AST) =\< 3 x ULN (=\< 5 x ULN for patients with liver involvement), obtained =\< 14 days prior to registration
  • Creatinine =\< 1.6 mg/dL; if over 1.6 then the calculated creatinine clearance must be \>= 55 ml/min using the Cockcroft-Gault formula, obtained =\< 7 days prior to registration
  • Negative pregnancy test done =\< 7 days prior to registration, for persons of childbearing potential only
  • NOTE: If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
  • Human immunodeficiency virus (HIV) test done =\< 14 days prior to registration
  • If positive, the CD4 count must be \> 400
  • Provide written informed consent
  • Willingness to have a central venous line \[peripherally inserted central catheter (PICC) or PORT\]
  • Willingness to provide mandatory blood specimens for correlative research
  • Willingness to provide mandatory tissue specimens for correlative research
  • Willingness to return to enrolling institution for follow-up (during the active monitoring phase of the study)
  • Willingness to follow the requirements of the intravenous ascorbic acid program schedule
  • ARM D: Patients who had a diagnosis of CCUS with one or more TET2 mutations or TET2 mutations with concurrent splicing genes mutations (SRSF2, U2AF1, SF3B1, and ZRSR2) or epigenetic regulator mutations (DNMT3A, EZH2, IDH1, IDH2). CCUS diagnosis being defined based on the absence of definitive morphologic evidence of hematologic neoplasms from bone marrow biopsy evaluation combined with evidence of pathogenic myeloid somatic mutation with a variant allele frequency (VAF) of at least 2% using our institution's next generation sequencing (NGS) panel (OncoHeme, Mayo Clinic)
  • ARM D: ECOG performance status (PS) 0, 1 or 2
  • ARM D: Patients must meet at least 1 of these 3 laboratory criteria to be enrolled:
  • Hemoglobin =\< 10g/dL (obtained =\< 7 days prior to registration)
  • Absolute neutrophil count (ANC) =\< 1000/mm\^3 (obtained =\< 7 days prior to registration)
  • Platelet count =\< 100,000/mm\^ 3 (obtained =\< 7 days prior to registration)
  • ARM D: Total bilirubin =\< 2 x ULN (if \> 2 x ULN direct bilirubin is required and should be =\< 1.5 x ULN) (obtained =\<7 days prior to registration)
  • ARM D: Alanine aminotransferase (ALT) and aspartate transaminase (AST) =\< 3 x ULN (=\< 5 x ULN for patients with liver involvement) (obtained =\<7 days prior to registration)
  • ARM D: Creatinine =\< 1.6 mg/dL (obtained =\<7 days prior to registration). If \> 1.6, then the Calculated creatinine clearance must be \>= 55 ml/min using the Cockcroft-Gault formula
  • ARM D: Negative pregnancy test, for persons of childbearing potential only (obtained =\< 7 days prior to registration). NOTE: If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
  • ARM D: Provide written informed consent
  • ARM D: Willingness to have a central venous line (PICC or PORT)
  • ARM D: Willingness to provide mandatory blood specimens for correlative research
  • ARM D: Willingness to return to enrolling institution (MCR) for follow-up (during the active monitoring phase of the study)
  • ARM D: Willingness to follow the requirements of the intravenous ascorbic acid program schedule
  • ARM E PRE-REGISTRATION: Age ≥ 18 years
  • ARM E PRE-REGISTRATION: New or an established diagnosis of 2016 World Health Organization (WHO) defined chronic myelomonocytic leukemia with a somatic TET2, IDH1, or IDH2 mutation requiring treatment with DNA methyltransferase inhibitors/hypomethylating agents
  • ARM E PRE-REGISTRATION: No prior CMML directed therapy.
  • Exception: Received ≤ 1 cycle of azacitidine, decitabine, erythropoiesis stimulating agent therapy (ESA), or oral decitabine and cedazuridine. NOTE: Prior exposure to hydroxyurea is allowed. Continuation beyond the first cycle must be discussed with the principal investigator (PI)
  • ARM E PRE-REGISTRATION: Creatinine ≤ 1.6 mg/dL. If \> 1.6, then the Calculated creatinine clearance must be ≥ 55 ml/min using the Cockcroft-Gault formula
  • ARM E PRE-REGISTRATION: Willingness to provide mandatory research bone marrow sample for correlative research
  • ARM E PRE-REGISTRATION: ECOG performance status (PS) 0, 1, or 2
  • ARM E PRE-REGISTRATION: Provide written informed consent
  • ARM E REGISTRATION: Willingness to provide mandatory blood specimens for correlative research
  • ARM E REGISTRATION: Willingness to return to enrolling institution (MCR) for follow-up (during the active monitoring phase of the study)
  • ARM E REGISTRATION: Recovered to grade 1 or baseline or established as sequelae from all toxic effects of previous therapy except alopecia
  • ARM E REGISTRATION: Absolute neutrophil count (ANC) ≥ 500/mm\^3 (obtained ≤ 7 days prior to registration)
  • ARM E REGISTRATION: Platelet count ≥ 20,000/mm\^3 (obtained ≤ 7 days prior to registration)
  • ARM E REGISTRATION: Total bilirubin ≤ 1.5 x ULN ( ≤ 3 x ULN for patients with Gilbert's syndrome) (obtained ≤ 7 days prior to registration)
  • ARM E REGISTRATION: Alanine aminotransferase (ALT) and aspartate transaminase (AST) ≤ 3 x ULN (obtained ≤ 7 days prior to registration)
  • ARM E REGISTRATION: Ability to complete questionnaire by themselves or with assistance
  • ARM E REGISTRATION: For a person of child-bearing potential (WOCBP): Must agree to use contraception or take measures to avoid pregnancy during the study. Adequate contraception is defined as follows:
  • Complete true abstinence
  • Consistent and correct use of one of the following methods of birth control:
  • Male partner who is sterile prior to the female patient's entry into the study and is the sole sexual partner for that female patient
  • Implants of levonorgestrel
  • Injectable progestogen
  • Intrauterine device (IUD) with a documented failure rate of less than 1% per year
  • Oral contraceptive pill (either combined or progesterone only)
  • Barrier method, for example: diaphragm with spermicide or condom with spermicide in combination with either implants of levonorgestrel or injectable progestogen
  • ARM E REGISTRATION: WOCBP must have a negative serum or urine pregnancy test ≤ 7 days prior to registration. NOTE: WOCBP include any person who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or is not postmenopausal (defined as amenorrhea \> 12 consecutive months); or women on hormone replacement therapy with documented serum follicle stimulating hormone (FSH) level \> 35 mIU/mL. Even women who are using oral, implanted, or injectable contraceptive hormones or mechanical products such as an IUD or barrier methods (diaphragm, condoms, spermicides) to prevent pregnancy or practicing abstinence or where partner is sterile (e.g., vasectomy), must be considered to be of child-bearing potential. NOTE: If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
  • ARM E REGISTRATION: Persons who are able to father a child must use contraception during the study and for 3 months after the last treatment dose.
  • Complete true abstinence
  • Latex condom with a spermicidal agent
  • Diaphragm with spermicide
  • ARM E REGISTRATION: Willingness to have a central venous line (PICC or PORT)
  • ARM E REGISTRATION: Willingness to follow the requirements of the intravenous ascorbic acid program schedule

Exclusion criteria

  • Any of the following:
  • Pregnant persons
  • Nursing persons
  • Persons of childbearing potential who are unwilling to employ adequate contraception
  • Any therapy =\< 2 weeks prior to registration; NOTE: Exception: patients on ibrutinib or corticosteroids (any dose) may continue therapy up until the new regimen has started at investigator discretion; corticosteroids can be tapered to lowest possible dose after start of treatment at investigator discretion. Exception: Palliative radiation is allowed
  • Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, pulmonary congestion or pulmonary edema, clinical dehydration, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • Receiving any other investigational agent which would be considered as a treatment for the lymphoma
  • Other active malignancy than lymphoma
  • NOTE: If there is a history of prior malignancy, they must not be receiving other specific treatment for their cancer that could interfere with this protocol therapy; patients on hormonal therapy for treated breast or prostate cancer are permitted if they meet other eligibility criteria; patients with non-melanotic skin cancer may enroll
  • History of myocardial infarction =\< 6 months, or current symptomatic congestive heart failure or left ventricular ejection fraction (LVEF) \< 40% or with \> grade 2 diastolic dysfunction, with no symptoms or signs of heart failure
  • Known G6PD (glucose-6-phosphate dehydrogenase) deficiency (below lower limit of normal)
  • Patients with active central nervous system (CNS) lymphoma or active cerebrospinal fluid (CSF) involvement with malignant cells requiring CNS-specific therapy with IV or intrathecal (IT) methotrexate (MTX); Note: Patients with any prior CNS lymphoma (parenchymal or leptomeningeal) MUST be in complete remission (CR) in those compartments without any maintenance therapy required
  • Patients with uncontrolled or symptomatic kidney stones
  • Known paroxysmal nocturnal hemoglobinuria (PNH)
  • ARM D: Bona-fide hematological neoplasm
  • ARM D: Any of the following because this study involves an agent that has known genotoxic, mutagenic and teratogenic effects:
  • Pregnant persons
  • Nursing persons
  • Persons of childbearing potential who are unwilling to employ adequate contraception
  • ARM D: Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
  • ARM D: Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, pulmonary congestion or pulmonary edema, clinical dehydration, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • ARM D: History of myocardial infarction =\< 6 months, or current symptomatic congestive heart failure or known LVEF \< 40% or with \> grade 2 diastolic dysfunction, with no symptoms or signs of heart failure
  • ARM D: Patients with uncontrolled or symptomatic kidney stones
  • ARM D: Known paroxysmal nocturnal hemoglobinuria (PNH)
  • ARM D: Known G6PD (glucose-6-phosphate dehydrogenase) deficiency (below lower limit of normal)
  • ARM E PRE-REGISTRATION: Myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN) overlap syndromes other than CMML
  • ARM E PRE-REGISTRATION: Active central nervous system disease
  • ARM E PRE-REGISTRATION: Any active disease condition that would render the protocol treatment dangerous or impair the ability of the patient to receive study drug
  • ARM E PRE-REGISTRATION: Concurrent active malignancy, except adequately treated nonmelanoma skin cancer. History of curatively treated in situ cancer of the cervix, curatively treated in situ cancer of the breast, or other solid tumors curatively treated is allowed as long as there is no evidence of disease for \> 2 years
  • ARM E PRE-REGISTRATION: Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
  • ARM E PRE-REGISTRATION: Disease requiring systemic treatment with systemic immunosuppression with steroid steroids at a dose of ≥ 20 mg/day prednisone (or equivalent). Exceptions: Intermittent use of bronchodilators or inhaled steroids, local steroid injections, topical steroids
  • ARM E PRE-REGISTRATION: Patients with uncontrolled or symptomatic kidney stones
  • ARM E REGISTRATION: New York Heart Association (NYHA) class III/IV heart failure or active angina/angina equivalents
  • ARM E REGISTRATION: History of myocardial infarction ≤ 6 months, or current symptomatic congestive heart failure or known LVEF \< 40% or with \> grade 2 diastolic dysfunction, with no symptoms or signs of heart failure
  • ARM E REGISTRATION: Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, clinically significant cardiac arrhythmia, unstable angina pectoris, clinically significant nonhealing or healing wounds, pulmonary congestion or pulmonary edema, significant pulmonary disease (shortness of breath at rest or mild exertion), uncontrolled infection, clinical dehydration, or psychiatric illness/social situations that would limit compliance with study requirements
  • ARM E REGISTRATION: Known G6PD (glucose-6-phosphate dehydrogenase) deficiency (below lower limit of normal)
  • ARM E REGISTRATION: Any of the following because this study involves an agent that has known genotoxic, mutagenic, and teratogenic effects:
  • Pregnant persons
  • Nursing persons
  • Persons of childbearing potential who are unwilling to employ adequate contraception

Where

  • Mankato, Minnesota
  • Rochester, Minnesota
  • Eau Claire, Wisconsin
  • La Crosse, Wisconsin

Collaborators

National Cancer Institute (NCI)

Related conditions & keywords

Clonal Cytopenia of Undetermined SignificanceHigh Grade B-Cell Lymphoma With MYC and BCL2 or BCL6 RearrangementsRecurrent Diffuse Large B-Cell LymphomaRecurrent Hodgkin LymphomaRecurrent LymphomaRefractory Diffuse Large B-Cell LymphomaRefractory LymphomaChronic Myelomonocytic Leukemia

Frequently asked questions

What is a clinical trial?

A clinical trial is a research study that tests new medical treatments, drugs, devices, or procedures to determine their safety and effectiveness. Trials are carefully designed and monitored to protect participants while advancing medical knowledge.

Is it safe to participate?

Clinical trials follow strict safety guidelines and ethical standards. Trials must be reviewed and approved, and participants are closely monitored by medical professionals throughout the study. You can withdraw at any time if you choose.

Will I be compensated?

Many clinical trials offer compensation for your time, travel expenses, and inconvenience. The specific compensation varies by study and will be discussed during the screening process. All study-related medical care is typically provided at no cost to participants.

Will I receive a placebo instead of treatment?

When effective treatment exists, participants typically receive either the standard treatment plus the study intervention, or the standard treatment plus placebo. You would not be denied effective care. Placebos are primarily used when no proven treatment is available, or in addition to standard care. Your trial consent form will clearly explain what treatments you may receive.

Can I leave a trial if I change my mind?

Absolutely. Participation in clinical trials is completely voluntary. You have the right to withdraw from the study at any time, for any reason, without penalty or loss of benefits to which you are otherwise entitled.

How long does a clinical trial last?

Trial duration varies widely depending on the study design and purpose. Some trials last just a few weeks, while others may continue for months or years. The study coordinator will provide specific timeline information during your screening call.

Data: ClinicalTrials.gov · synced Sep 28, 2026 · Source of record for eligibility and locations

📊
1 of 80 participants interested
1% interest

See if this study fits

A short prescreen based on this study's listed criteria. A coordinator confirms eligibility — this is not a medical assessment.

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Study locations

Choose your preferred location, or select flexible during enrollment.

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Mankato

Minnesota

Location available
RECRUITING

Rochester

Minnesota

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Eau Claire

Wisconsin

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La Crosse

Wisconsin

Location available

Express your interest

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What participation can include

  • Study-related care provided by the research team
  • Close monitoring by medical professionals
  • Possible compensation for time and travel*
  • The option to withdraw at any time
  • Contributing to medical research that may help future patients

*Compensation varies by study. Confirm details with coordinator.

Typical next steps

  1. 1.Submit this form
  2. 2.Phone screening
  3. 3.In-person assessment if eligible
  4. 4.Begin participation

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Looking for Lymphoma Treatment in Mankato?

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Lymphoma Treatment Options in Mankato, Minnesota

If you're searching for Lymphoma treatment in Mankato, participating in a clinical research study may provide access to innovative approaches under expert medical supervision. This study is actively recruiting participants in Mankato, Rochester, Eau Claire and surrounding areas.

Clinical trials offer participants the opportunity to receive cutting-edge treatments while contributing to medical research that may help future patients with Lymphoma. All study-related care is provided at no cost to participants.

Local Sites
3 locations in Minnesota
Now Enrolling
Up to 80 participants
Quick Start
Screening available now

Why Consider a Clinical Trial for Lymphoma?

Potential Benefits

  • ✓Access to new treatment approaches before public availability
  • ✓Close monitoring by experienced medical professionals
  • ✓Study-related care provided at no cost
  • ✓Contribute to medical research for Lymphoma

What to Expect

  • →Initial screening to determine eligibility
  • →Regular check-ups and monitoring visits
  • →Possible compensation for time and travel
  • →You can withdraw at any time

Frequently Asked Questions About This Lymphoma Study

Important Clinical Trial Information

This information is provided for educational purposes and does not constitute medical advice. Clinical trial participation involves potential risks and benefits. Eligibility requirements apply and will be assessed during the screening process.

Study identifier: NCT03418038. For complete study details, visit ClinicalTrials.gov. Always consult with your healthcare provider before making decisions about your medical care or participating in clinical research.