Study of Safety and Efficacy of Avadomide (CC-122) Combined With RCHOP for Newly-diagnosed DLBCL With Poor Risk Factors

This research study is for patients who have been newly diagnosed with diffuse large B-cell
lymphoma DLBCL and are receiving treatment for the first time.

This study will be conducted in two phases. Phase 1 will test the safety of increasing dose
levels of avadomide (CC-122) when given in combination with R-CHOP-21 therapy to identify an
appropriate dose and schedule for further evaluation in Phase 2. Phase 2 will evaluate the
rate of complete response when adding avadomide (CC-122) to the R-CHOP-21 regimen in
first-line treatment of patients with poor risk DLBCL.

This study is separated into three periods: the Screening period, the Treatment period and
the Follow-up period. Before the patient can receive the drug the doctor will perform test to
find out whether he/she can participate in the study. This is done during the Screening
period. If the patient and the treating physician determine that the patient is eligible to
participate in the study, the patient will be registered in the study and receive avadomide
(CC-122) combined with R-CHOP.

In the Treatment period the patient will receive treatment for up to 6 treatment cycles. Each
treatment cycle is 21 days long. The full length of the treatment period will be
approximately 4 months.

The follow-up period begins when the patient has completed treatment or is discontinued for
any reason. During the follow-up period the patient will have fewer exams, test and visits.
The first follow-up visit will be 28 days after treatment is completed or discontinued. After
that, the follow-up visits will be every 3 months during the first year, then every 6 months
until the study is closed.

Inclusion Criteria:

1. Subject is ≥ 18 years of age at the time of signing the informed consent form (ICF).

2. Subject has documented, histologically locally confirmed, previously untreated CD20+
DLBCL (NOS) and the following histologies; refer to the World Health Organization (WHO)
2016 classification (Appendix G):

1. DLBCL associated with chronic inflammation

2. Epstein-Barr virus positive (EBV+) of the elderly

3. T-cell/histiocyte-rich DLBCL 3. Subject is considered an appropriate candidate (per
Investigator assessment) for induction therapy with 6 cycles of R-CHOP-21
immunochemotherapy.

4. Subject has a performance status (PS) of 0-2 according to the Eastern Cooperative
Oncology Group (ECOG) scale. Subjects with ECOG PS of 3 may be included if decreased
PS is secondary to DLBCL only, and not to comorbidities.

5. Subject has poor-risk disease defined as International Prognostic Index (IPI) score
≥ 3 (high-intermediate or high-risk classification) and has an age-adjusted IPI
defined as ≤ 60 age-adjusted IPI score of 2 with elevated LDH are eligible.

6. Subject has measurable disease on cross-sectional imaging by computed tomography
(CT) with at least one (post-biopsy) measurable lesion ≥ 2.0 cm in its longest
dimension.

7. Subject must appropriately be able to complete Screening assessments before
beginning treatment for DLBCL, in the judgement of the Investigator.

For subjects with bulky disease, B-symptoms, compressive disease, elevated bilirubin
due to lymphoma, rapidly progressing adenopathies, or worsening performance status,
pre-phase treatment with up to 100 mg/day prednisone, or equivalent, for a maximum of
10 days is permitted prior to beginning the treatment period, at the discretion of the
Investigator. A washout period is not required, however, the Screening positron
emission tomography (PET), CT, tumor biopsy (if needed), and bone marrow biopsy (if
needed) should be completed before initiating corticosteroids.

8. Subject's central laboratory values must fulfill the following requirements during
Screening: Blood product transfusions and hematopoietic growth factors may not be used
to meet eligibility criteria. Screening samples should not be collected within 14 days
after subject receives a blood product transfusion or growth factors.

If treatment needs to be urgently started and screening central laboratory results are
not available then local laboratory results may be used to confirm eligibility. In
these cases, the Celgene medical monitor must be consulted prior to beginning
treatment. The investigator must still ensure that samples for the central laboratory
are drawn before investigational product is administered and sent to the central
laboratory.

1. Absolute neutrophil count (ANC) ≥ 1,500 cells/mm3 (1.5 x 109/L) unless secondary to
extensive bone marrow involvement by lymphoma (ie, ≥ 50%) as demonstrated by
unilateral bone marrow core biopsy performed during Screening or within 3 months prior
to signing the ICF. In the case of documented extensive bone marrow involvement an ANC
≥ 1,000 cells/mm3 (1.0 x 109/L) is required.

2. Platelet count ≥ 100,000/mm3 (100 x 109/L) unless secondary to extensive bone
marrow involvement by lymphoma (ie, ≥ 50%) as demonstrated by unilateral bone marrow
core biopsy performed during Screening or within 3 months prior to signing the ICF. In
the case of documented extensive bone marrow involvement, a platelet count of ≥
75,000/ mm3 (75 x 109/L) is required.

3. Serum aspartate transaminase (AST/SGOT) or alanine transaminase (ALT/SGPT) ≤ 3.0 x
upper limit of normal (ULN). In the case of documented liver involvement by lymphoma,
ALT/SGPT and AST/SGOT must be ≤ 5.0 x ULN.

4. Serum total bilirubin ≤ 2.0 mg/dL (34 μmol/L). In the case of Gilbert's syndrome,
or documented liver or pancreatic involvement by lymphoma, serum total bilirubin must
be ≤ 5.0 mg/dL (86 μmol/L).

5. Calculated creatinine clearance (CrCl) of ≥ 50 mL/min by the Cockcroft-Gault
formula.

9. Subject must understand and voluntarily sign an Informed Consent Form (ICF) prior
to any study-specific assessments/procedures being conducted.

10. Subject is willing and able to adhere to the study visit schedule and other
protocol requirements.

11. Sufficient tissue from diagnostic tumor/ lymph node biopsy (from within 2 months
prior to ICF signature) must be available for translational research purposes or
subject is willing to undergo core needle or incisional/ excisional biopsy during
Screening.

12. Females of childbearing potential (FCBP)1 must:

1. Agree to use two reliable forms of contraception simultaneously or to practice
complete abstinence (True abstinence is acceptable when this is in line with the
preferred and usual lifestyle of the subject. Periodic abstinence [eg calendar,
ovulation, symptothermal or post-ovulation methods] and withdrawal are not
acceptable methods of contraception.) from heterosexual contact during the
following time periods related to this study: 1) for at least 28 days before
starting avadomide (CC-122); 2) while taking avadomide (CC-122); 3) during dose
interruptions; and 4) for at least 28 days after the last dose of avadomide
(CC-122) as specified in the Pregnancy Prevention and Risk Management Plan
(PPRMP)

2. Have a negative result confirmed for a medically supervised urine (or serum)
pregnancy test (with a sensitivity of at least 25 mIU/mL) 10-14 days prior to the
first dose of IP. A second pregnancy test performed within 24 hours prior to the
first dose of IP must also be confirmed to be negative prior to IP
administration.

- If urgent treatment is needed and requires a shorter window of screening,
please immediately contact the medical monitor

13. Avoid conceiving for at least 12 months after the last dose of rituximab, or
according to the local rituximab Prescribing Information or Summary of Product
characteristics (SmPC); at least 28 days after the last dose of any other study drug.

1. Agree to ongoing pregnancy testing during the course of the study as outlined in
the PPRMP.

14. Male subjects must:

1. Practice complete abstinence (True abstinence is acceptable when this is in line
with the preferred and usual lifestyle of the subject. Periodic abstinence [eg
calendar, ovulation, symptothermal or post-ovulation methods] and withdrawal are
not acceptable methods of contraception.) or agree to use a condom during sexual
contact with a pregnant female or a FCBP for at least 12 months after the last
dose of rituximab.

2. Agree to not donate semen or sperm for at least 12 months following the last dose
of rituximab.

15. All subjects must:

1. Understand that avadomide (CC-122) could have a potential teratogenic risk.

2. Agree to abstain from donating blood while taking IP and for at least 28 days
following discontinuation of IP.

3. Agree not to share IP with another person

4. Be counseled about pregnancy precautions and risks of fetal exposure and agree to
requirements of the Pregnancy Prevention and Risk Management Plan (PPRMP)

16. Subject is able to swallow pills.

Exclusion Criteria:

1. Subject is seropositive for or has active viral infection with hepatitis B virus
(HBV):

1. HBV surface antigen (HBsAg) positive

2. HBV surface antigen (HBsAg) negative, HBV surface ant ibody (ant i-HBs) posit ive
and/or HBV core antibody (ant i-HBc) positive, and detectable viral DNA Subjects
who are seropositive because of prior HBV vaccination are eligible (anti- HBs
positive, anti-HBc negative, and HBsAg negative).

2. Subject is known to be seropositive for, or have an active infection with,
hepatitis C virus (HCV).

3. Subject is known to be seropositive for, or have an active infection with, human
immunodeficiency virus (HIV).

4. Subject has any neuropathy > Grade 1. 5. Subject has impaired cardiac function or
clinically significant cardiac diseases, including any of the following:

1. Left ventricular ejection fraction (LVEF) < 45% as determined by multi-gated
acquisition scan (MUGA) or echocardiogram (ECHO).

2. Complete left bundle branch or bifascicular block.

3. Persistent or clinically meaningful ventricular arrhythmias.

4. Unstable angina pectoris or myocardial infarction ≤ 3 months prior to starting
treatment in the study.

5. Troponin-T value > 0.4 ng/mL or B-type natriuretic protein (BNP) > 300 pg/mL by
central laboratory assessment Subjects with baseline troponin-T > ULN or BNP >
100 pg/mL are eligible but must have a cardiologist evaluation prior to
enrollment in the trial for baseline assessment and optimization of
cardioprotective therapy.

If troponin-T is not usually tested by local laboratory then troponin-I may be
used to confirm subject meets the Screening eligibility criteria. The central
laboratory sample must still be collected prior to first dose and sent to central
laboratory. Elevated cut-off value for troponin I will depend on the assay used
at the site. If baseline troponin I >ULN, the subject must have a cardiologist
consultation prior to enrollment and optimization of cardioprotective therapy.

In case of discrepancy between both troponin-I and troponin-T test, the
troponin-T test will be repeated.

6. Subject has confirmed central nervous system (CNS) involvement by DLBCL. Subjects
at risk for CNS involvement per Investigator assessment must receive prophylaxis.
For subjects at risk, or with any neurological symptoms, testing for CNS
involvement is required at Screening.

7. Subject has any significant medical condition, laboratory abnormality, or
psychiatric illness that would prevent the subject from participating in the
study.

8. Subject has any condition including the presence of laboratory abnormalities,
which places the subject at unacceptable risk if he/she were to participate in
the study.

9. Subject has any condition that confounds the ability to interpret data from the
study.