Acalabrutinib, Umbralisib, and Ublituximab for the Treatment of Previously Untreated Mantle Cell Lymphoma

PRIMARY OBJECTIVE: I. Evaluate the anti-tumor activity of acalabrutinib, umbralisib and ublituximab (AU2) regimen as induction therapy in patients with treatment-naïve mantle cell lymphoma (MCL), as assessed by the complete response (CR) rate. SECONDARY OBJECTIVES: I. Evaluate the overall response rate (ORR) to AU2 in treatment-naive MCL. II. Evaluate the progression-free survival (PFS), overall survival (OS) and duration of response (DOR) in patients with treatment-naïve MCL who received AU2. III. Evaluate the safety and tolerability of AU2 in patients with treatment-naive MCL. EXPLORATORY OBJECTIVES: I. Examine the T-cell populations and functionality in patients treated with AU2. II. Explore the predictive value of minimal residual disease (MRD) in MCL. III. Explore the mechanisms of resistance to AU2 therapy. OUTLINE: INDUCTION: Patients receive ublituximab intravenously (IV) over 90 minutes-4 hours on days 1, 8, and 15 of cycle 1 and days 1 of cycles 2-6. Patients also receive acalabrutinib orally (PO) twice daily (BID) and umbralisib PO once daily (QD) on days 1-28. Treatment repeats every 28 days for 6 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE: Patients receive ublituximab IV on day 1 on cycles 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30. Patients also receive acalabrutinib Po BID and umbralisib PO QD on day 1-28. Treatment repeats every 28 days for 24 cycles in the absence of disease progression of unacceptable toxicity. After completion of study treatment, patients are followed up for 30 days and then every 6 months for 2 years.