TrAVeRse: This study is evaluating how effective treatment with a combination of targeted therapies is for people with mantle cell lymphoma who have not had prior treatmentA Multicentre, Phase II, Randomised, Open-label Study to Evaluate the Efficacy of Acalabrutinib in Combination With Venetoclax and Rituximab in Participants With Treatment Naïve Mantle Cell Lymphoma

Exclusion

Medical Conditions

1. Active CNS involvement by lymphoma or leptomeningeal disease

2. Current or previous active malignancies requiring anticancer therapy except:

   - adequately treated basal cell or squamous cell skin cancer

   - in situ cancer

   - history of cancer with no evidence of recurrence for ≥ 2 years before enrolment

   - local radiotherapy field that does not overlap with sites of MCL disease and the participant had recovered from any toxicity.

   - anti-hormonal therapies are permitted after discussion with the sponsor's medical monitor

3. Participants for whom the goal of therapy is tumour debulking before ASCT
4. Any severe or life-threatening illness, medical condition (e.g., uncontrolled hypertension, bleeding diathesis), or organ system dysfunction which, in the investigator' opinion, could compromise the participant safety, interfere with the absorption or metabolism of study intervention (acalabrutinib, rituximab, venetoclax) or put the study outcomes at undue risk
5. Clinically significant cardiovascular disease such as uncontrolled or untreated symptomatic arrhythmias, congestive heart failure, or myocardial infarction within 6 months of screening, or any Class 3 (moderate) or Class 4 (severe) cardiac disease as defined by the New York Heart Association Functional Classification, or QTc > 480 msec at screening. Exception: Participants with controlled, asymptomatic atrial fibrillation during screening may enroll.
6. Any active uncontrolled infection (bacterial, viral, fungal, or other infection), defined as exhibiting ongoing signs/symptoms related to the infection and without improvement, despite appropriate antibiotics or other treatment, which in the investigator's opinion makes it undesirable or pose a safety risk for the participant to participate in the study.

7. HIV infection. As per standard of care, results of HIV serology should be known prior to start of study intervention. In the acute situation, registration may occur without the results of the HIV serology but must be available prior to start of study intervention

   Excluded Participants: Participants with active HIV infection (i.e., with detectable viral load by PCR) are excluded.

   Included Participants: HIV-positive participants receiving anti-retroviral treatment with undetectable viral load by PCR may be enroled following discussion with the participant's HIV physician and the sponsor medical monitor. Potential interactions between anti-retroviral medications and study interventions should be considered.

8. Serologic status reflecting active hepatitis B or C. As per standard of care, results of hepatitis serology should be known prior to start of study intervention. In the acute situation, enrolment may occur without the results of the hepatitis serology but must be available prior to start of study intervention.

   (a) Participants who are HBsAg positive or hepatitis B PCR positive will not be eligible.Participants who are anti-HBc antibody positive and who are HBsAg negative will need to have a negative PCR result before enrolment. Participants who have protective titres of HBsAb after vaccination will be eligible.

   (b) Participants who are hepatitis C antibody positive and are HCV-PCR positive will not be eligible.

9. History or ongoing confirmed progressive multifocal leukoencephalopathy.
10. History of stroke or intracranial haemorrhage within 6 months prior to the first dose of study intervention (Cycle 1 Day 1).
11. Uncontrolled autoimmune haemolytic anaemia or idiopathic thrombocytopenic purpura.
12. Active bleeding from a gastrointestinal ulcer, except incidental finding identified on endoscopy that is attributable to MCL
13. Participants with a known hypersensitivity to acalabrutinib, venetoclax, or rituximab or any of the excipients of the product.
14. Known allergy to uric acid lowering agents (e.g., xanthine oxidase inhibitors or rasburicase)
15. Severe prior reactions to monoclonal antibodies
16. Known glucose-6-phosphate dehydrogenase deficiency
17. Malabsorption syndrome, disease significantly affecting gastrointestinal function, resection of the stomach, extensive small bowel resection that is likely to affect absorption, symptomatic inflammatory bowel disease, partial or complete bowel obstruction, or gastric restrictions and bariatric surgery, such as gastric bypass or inability to swallow the formulated product (tablets).

18. Currently pregnant (confirmed with positive pregnancy test) or breast feeding

    Prior/Concomitant Therapy

19. Any prior therapies for the treatment of MCL
20. Requiring continued treatment with a strong CYP3A4 inhibitor/inducer or its use within 7 days prior to the first dose (Cycle 1 Day 1) of acalabrutinib or venetoclax 21 Requiring continued anticoagulation with warfarin or equivalent vitamin K antagonists (e.g., phenprocoumon). Exceptions are DOACs rivaroxaban, apixaban, edoxaban and dabigatran

22 Requiring ongoing immunosuppressive therapy, including systemic or enteric corticosteroids except:

• Topical or inhaled corticosteroids or low-dose oral steroids (≤ 20 mg of prednisone or equivalent per day) as a therapy for comorbid conditions
• Short courses of glucocorticoids in excess of 20 mg prednisone for no more than 14 days for comorbid conditions.

• Systemic use of corticosteroids as a prephase to control MCL manifestations

  23 Received major surgery (excluding placement of vascular access or for diagnosis) within 28 days of first dose of study intervention (Cycle 1 Day 1) 24 Receipt of live, attenuated vaccine within 28 days before the first dose of study intervention (Cycle 1 Day 1) (except COVID-19 vaccine).

See Section 6.9, for lists of prohibited (Table 15) and restricted (Table 16) concomitant medications.

Prior/Concurrent Clinical Study Experience 25 Concurrent participation in another clinical study

Other Exclusions 26 Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site).

27 Judgment by the investigator that the participant should not participate in the study if the participant is unlikely to comply with study procedures, restrictions, and requirements.

28 Previous enrolment in the present study.