Ibrutinib, Bortezomib and Rituximab-CHOP for the Treatment of Elderly Patients With CD20+ DLBCL, IPI ≥ 2

Prior treatment

• Prior therapy for DLBCL
• CNS involvement by lymphoma or any evidence of spinal cord compression. Brain CT/MRI is only mandatory (within 4 weeks prior to study entrance) in case of clinical suspicion of CNS involvement by lymphoma
• Major surgery within 4 weeks of study entrance
• History of stroke or intracranial hemorrhage within 6 months prior to study entrance
• treatment with strong CYP3A inhibitors
• Vaccination with live, attenuated vaccines within 3 weeks of study entrance
• Current or recent (within the last 30 days prior to enrollment) treatment with another investigational drug or participation in another clinical trial

Other illness

• Clinically significant cardiovascular disease such as uncontrolled or symptomatic arrhythmias, congestive heart failure or myocardial infarction within 6 months of Screening or any class 3 or 4 cardiac disease as defined by NYHA
• Known history of human immunodeficiency virus HIV or active Hepatitis C virus or active Hepatitis B virus infection or any uncontrolled active systemic infection requiring intravenous iv antibiotics
• History of solid organ transplantation
• Prior malignancy (except adequately treated basal cell carcinoma and squamous cell carcinoma of the skin, cervical cancer in situ, or any other cancer for which the patient has been in remission for at least 5 years)
• Known hypersensitivity or contraindication to any of the study drugs, its ingredients or recombinant human antibodies and contrast agents
• Severe chronic obstructive pulmonary disease with hypoxemia
• Any life-threatening illness, medical condition, or organ system dysfunction which, in the investigators opinion, could compromise the subjects safety, interfere with the absorption or metabolism of ibrutinib capsules or put the study outcomes at undue risk
• Any co-existing medical or psychological condition that would compromise the ability to give informed consent
• Lack of willingness to storage and disclosure of pseudonymous disease data in the context of the clinical trial

Lab values

• Evidence of any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates use of an investigational drug, or patient at high risk from treatment complications

Other

• Unable to sign informed consent
• Secondary transformed B-NHL or types of NHL other than DLBCL and its subtypes according to WHO classification
• Known central nervous system lymphoma
• Anticoagulation with Warfarin or equivalent vitamin K antagonists (e.g, Phenprocoumon)
• Pregnant or nursing females
• Pre-existing polyneuropathy of any kind \> grade I
• Subjects who are legally detained in an official institution
• Subjects who may be dependent on the sponsor, the investigator or the trial sites, have to be exclude from the trial

• Written informed consent indicating that they understand the purpose of and procedures required for the study, including biomarkers and are willing to participate in the study
• Age ≥ 61 years and ≤ 80 years
• CD20-positive diffuse large B-cell lymphoma (DLBCL); including T-cell-rich large B-cell lymphoma, anaplastic large B-cell lymphoma, plasmablastic lymphoma; follicular lymphoma grade 3b or primary transformed follicular lymphoma at initial diagnosis or highgrade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements or high-grade B-cell lymphoma NOS
• Lymphoma biopsy native, fresh-frozen for genome-wide transcriptome array or RNA-Seq analyses (gene expression profiling \[GEP\]) for molecular subtype diagnosis
• Willingness to consent to a re-biopsy in C1/day d2, and - in case of a residual lesion by interim CT - in C3/d2 if it can be obtained without inadequate risk
• Unfavorable risk profile according to the IPI score (IPI ≥ 2)
• Performance status (ECOG) 0-2
• Bi-dimensionally measurable disease (measurable by CT scan or MRI)
• Cardiac ejection fraction ≥ 50 % without clinically significant abnormalities
• Adequate hematological function: hemoglobin ≥ 9 g/dL absolute neutrophil count ≥ 1,00/μL independent of growth factor support and platelet count ≥ 100,000/μL or ≥ 50,000/μL if bone marrow involvement independent of transfusion support in either situation
• Adequate renal function as documented by serum creatinine level \< 2 x ULN or estimated GFR ≥ 40 ml/min/1,73m²
• Adequate hepatic function (total bilirubin ≤ 1,5 x ULN unless bilirubin rise is due to Gilbert's syndrome or of non-hepatic origin, alanine aminotransferase ALT and aspartate aminotransferase AST ≤ 3 x ULN)
• Life expectancy \> 6 months
• Women of childbearing potential must have a negative serum (beta-human chorionic gonadotropin \[ß-hCG\]) or urine pregnancy test at screening. Women who are pregnant or breastfeeding are ineligible for this study.
• Women of childbearing potential and men who are sexually active must be practicing a highly effective method of birth control during and after the study consistent with local regulations regarding the use of birth control methods for subjects participating in clinical trials. Men must agree to not donate sperm during and after the study. For females, These restrictions apply for 1 month after the last dose of study drug. For males, these restrictions apply for 3 month after the last dose of study drug.