Ofatumumab and Bendamustine Combination Therapy Compared With Bendamustine Monotherapy in Indolent B-cell Non-Hodgkin's Lymphoma (NHL) Unresponsive to Rituximab or a Rituximab-Containing Regimen

Ofatumumab is an anti-CD20 monoclonal antibody shown to have monotherapy activity in patients
with follicular lymphoma that has relapsed following rituximab-containing therapy.
Bendamustine was approved by FDA for the treatment of in patients with indolent B-cell
Non-Hodgkin's Lymphoma (NHL) that did not respond to rituximab or a rituximab-containing
regimen during or within 6 months of the last rituximab treatment.

Biologics have demonstrated enhanced efficacy when added to chemotherapeutic combinations in
the frontline treatment for indolent NHL. The combination of ofatumumab and bendamustine may
provide additional clinical benefit and efficacy to those who no longer respond to rituximab
or rituximab-containing regimens.

The objective of this study is to determine the effect of ofatumumab and bendamustine
combination therapy in patients with indolent B-cell NHL that did not respond to rituximab or
a rituximab-containing regimen during or within 6 months of the last rituximab treatment.

Inclusion Criteria:

- Indolent lymphoma including Grades 1-3a follicular, small lymphocytic,
lymphoplasmacytic, and marginal zone lymphoma; Stages III-IV, or bulky disease, Stage
II. Tumor verified CD20+ and CT imaging done at screening verifying disease

- Indolent B-cell NHL that remains stable or unresponsive during or within 6 months of
treatment with rituximab or a rituximab-containing regimen

- Indolent lymphoma including grades 1-3a follicular, small lymphocytic,
lymphoplasmacytic, and marginal zone lymphoma; stages III-IV, or bulky disease stage
II (i.e. as any single mass > 5 cm in any direction)

- ECOG Performance Status of 0, 1, or 2

- Life expectancy of at least 6 months

- 18 years or older

- Signed, written informed consent

Exclusion Criteria:

- Grade 3b follicular lymphoma or evidence that the indolent lymphoma has transformed to
aggressive lymphoma

- Previous allogeneic stem cell transplant

- Previous autologous stem cell transplant, fludarabine therapy, or radioimmunotherapy
in the past 12 months

- Previous external beam radiation therapy to the pelvis. Previous external beam
radiation therapy for bony disease to the cranium, mediastinum, and axilla, or to two
or to more than 3 vertebral bodies

- High dose steroids greater to or equal to 60 mg prednisone/day (or equivalent) within
3 months of randomization. No more than 10 mg prednisone (or equivalent) daily at the
time of randomization

- Prior bendamustine treatment within 1 year of randomization not resulting in a CR or
PR for at least 6 months

- Treatment with anti-CD20 monoclonal antibody within 3 months of randomization

- Known CNS involvement of indolent lymphoma

- Other past or current malignancy. Subjects free of malignancy for at least 5 years or
have history of definitively treated non-melanoma skin cancer, or successfully treated
in situ carcinoma, are eligible

- Chronic or current active infectious disease requiring systemic antibiotics,
antifungal, or antiviral treatment

- Clinically significant cardiac disease

- History of significant cerebrovascular disease or event with significant symptoms

- Positive serology for Hepatitis B

- Current active liver or biliary disease (except Gibler's syndrome or asymptomatic
gallstones, liver metastases, or otherwise stable chronic liver disease)

- Known HIV positive

- Abnormal/inadequate blood values, liver and kidney function

- Current participation in other clinical study

- Inability to comply with the protocol activities

- Lactating or pregnant women or female patients of child-bearing potential (or male
patients with such partners) not willing to use adequate contraception