Prophylactic Strategies for Mitigating Central Nervous System Relapse in Diffuse Large B-Cell Lymphoma

October 30, 2026 updated by: Cancer Institute and Hospital, Chinese Academy of Medical Sciences

Therapeutic Strategies for Preventing Central Nervous System Recurrence in Patients With Central High-risk Diffuse Large B-cell Lymphoma: A Prospective, Multicenter, Non-randomized Cohort Study

Background: The central nervous system (CNS) recurrence rate of patients with high-risk diffuse large B-cell lymphoma (DLBCL) is as high as 15% - 20%, and the prognosis is extremely poor once it occurs. Current intrathecal injection and high-dose methotrexate prophylaxis are ineffective and have significant toxicity. Lenalidomide, BTK inhibitors, and sidaribine all can penetrate the blood-brain barrier, and each has shown a signal of reducing the risk of CNS recurrence in previous studies, but there is still a lack of prospective concurrent comparative data.

Objective: To preliminarily evaluate the efficacy and safety of using these three oral drugs (lenalidomide, BTK inhibitors, and sidaribine) in combination with first-line immunotherapy chemotherapy for high-risk DLBCL patients to prevent CNS recurrence during the same period or after chemotherapy.

Method: This study is a phase II exploratory, open-label, non-randomized concurrent multi-cohort study, combined with historical external controls. A total of 87 patients with DLBCL diagnosed by histopathology and having at least one CNS high-risk factor (CNS-IPI ≥ 4 points, specific extranodal involvement (such as testis, breast, adrenal gland, kidney, uterus, bone marrow, bone), and extranodal invasion sites ≥ 2) are planned to be enrolled. Patients can choose to enter the lenalidomide group, BTK inhibitor group (ibrutinib, zanubrutinib, or obinutinib) or sidaribine group based on their disease characteristics and economic conditions, and the preventive treatment lasts for 1 year. The primary endpoint is the 2-year cumulative CNS recurrence rate (competitive risk model analysis), and the secondary endpoints include progression-free survival time, overall survival time, CNS disease-free survival time, and safety.

Significance: This study is the first to prospectively compare the CNS preventive value of these three drugs with different mechanisms in high-risk DLBCL patients, which is expected to provide key exploratory data for this field and lay the foundation for future confirmatory studies.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
87

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • China
      • Beijing, China
        • Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years to 80 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • 1. The diagnosis of diffuse large B-cell lymphoma, non-specific type or indolent lymphoma that has undergone large B-cell transformation, has been confirmed by histopathological examination; according to the 2016/2022 WHO classification, advanced B-cell lymphoma with dual expression/dual therapy is allowed; 2. Age between 18 and 80 years; 3. Proposed or currently receiving first-line standard immunotherapy, and planning to complete at least 6 cycles; 4. Baseline examination including brain-enhanced MR and cerebrospinal fluid cytology/flow cytometry by lumbar puncture was conducted to rule out CNS invasion; 5. Has at least one high-risk factor for CNS recurrence: CNS-IPI score ≥ 4 points; or involving specific extranodal sites (such as testis, breast, adrenal gland, kidney, uterus, bone marrow, high-risk bones); or extranodal invasion sites ≥ 2; 6. ECOG physical status score 0-2; 7. The subject can understand the study protocol and is willing to participate in this study, and signs a written informed consent.

Exclusion Criteria:

  • 1. Any evidence indicating the presence of CNS parenchymal, meningeal or intraocular lymphoma at the time of enrollment; 2. Having a history of myocardial infarction within 6 months prior to enrollment; suffering from New York Heart Association (NYHA) grade 3 or 4 congestive heart failure, or having a history of NYHA grade 3 or 4 congestive heart failure in the past, unless the left ventricular ejection fraction (LVEF) was ≥ 50% in the echocardiography (ECHO) screening conducted within 1 month before entering the study; 3. Pregnant or lactating women (baseline pregnancy test positive or not undergoing pregnancy test for women of childbearing age. Postmenopausal women must be at least 12 months post-menopause); 4. Having an uncontrollable infection; 5. Any other situation that the investigator deems the patient is not suitable to participate in this trial.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Patients with diffuse large B-cell lymphoma who meet the criteria for high-risk central nervous syst

At least one of the following high-risk factors for CNS recurrence must be present: CNS-IPI score ≥ 4; or involving specific extranodal sites (such as testis, breast, adrenal gland, kidney, uterus, bone marrow, high-risk bones); or having ≥ 2 extranodal invasion sites.
Drug: Lenalidomide

The dosage of lenalidomide is 25mg each time, once daily, taken with food or on an empty stomach. It is administered continuously from day 1 to day 21, with each 28-day period as one cycle. For elderly patients (aged > 75 years) or those with reduced renal function (creatinine clearance rate < 60 ml/min), the starting dose is reduced to 15mg. During the lenalidomide treatment, aspirin 100mg once daily or low molecular weight heparin is used to prevent thrombosis. The preventive drugs can be initiated simultaneously with chemotherapy or started 4-6 weeks after the completion of chemotherapy for continuous prevention, which is determined by the investigator. After the chemotherapy, it enters the single-agent maintenance stage, with the total prevention medication duration of 1 year (counting from the first administration), or until disease progression, intolerable toxicity occurs, or informed consent is withdrawn.

Drug: Bruton's tyrosine kinase inhibitor

The BTK inhibitor group includes drugs such as Zanubrutinib, Obinutinib, and Ibrutinib. Their specific usage is as follows: Zanubrutinib, 160mg each time, taken twice daily before or after meals; Ibrutinib, 560mg each time, once daily, taken before or after meals; Obinutinib, 150mg each time, once daily, taken before or after meals. Preventive drugs can be initiated simultaneously with chemotherapy or started 4-6 weeks after the completion of chemotherapy, depending on the decision of the researchers. After the completion of chemotherapy, it enters the single-agent maintenance stage. The total preventive medication duration is 1 year (counting from the first administration), or until disease progression, intolerable toxicity occurs, or informed consent is withdrawn.

Drug: Chidamide

Chidamide is administered at a dose of 20mg every 21 days. The medication is taken on days 1, 4, 8, and 11 of each cycle, 30 minutes after meals. The preventive medication can be initiated simultaneously with chemotherapy or started 4-6 weeks after the completion of chemotherapy, depending on the decision of the investigator. After the chemotherapy is completed, it enters the single-agent maintenance phase. The total preventive medication duration is 1 year (counting from the first administration), or until disease progression, intolerable toxicity occurs, or informed consent is withdrawn.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Two-year cumulative recurrence rate of CNS
Time Frame: The cumulative proportion of patients who experienced central nervous system recurrence within 2 years after starting the trial drug treatment.

The cumulative proportion of patients who experienced central nervous system recurrence within 2 years after starting the trial drug treatment.
The cumulative proportion of patients who experienced central nervous system recurrence within 2 years after starting the trial drug treatment.

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Progression-Free Survival (PFS)
Time Frame: From enrollment to the end of treatment until 2 years

From the time the experimental drug was administered until the date of the first recorded disease progression (in the central nervous system or systemically), recurrence, or death for any reason.
From enrollment to the end of treatment until 2 years
Overall survival (OS)
Time Frame: From enrollment to the end of treatment until 1 years

OS was defined as the time from cytarabine and thalidomide initiation to death or last follow-up.
From enrollment to the end of treatment until 1 years

Other Outcome Measures

Other Outcome Measures

For clinical trials, a planned measurement described in the protocol that is used to determine the effect of an intervention/treatment on participants. For observational studies, a measurement or observation that is used to describe patterns of diseases or traits, or associations with exposures, risk factors, or treatment. Types of outcome measures include primary outcome measure and secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
FACT-G (Functional Assessment of Cancer Therapy-General)
Time Frame: From enrollment to the end of treatment until 3 years

Score of FACT-G (Functional Assessment of Cancer Therapy-General)
From enrollment to the end of treatment until 3 years
Correlation between circulating free DNA (cfDNA) and efficacy
Time Frame: From enrollment to the end of treatment until 3 years

Correlation between circulating free DNA (cfDNA) and efficacy
From enrollment to the end of treatment until 3 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Cancer Institute and Hospital, Chinese Academy of Medical Sciences

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
November 1, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
October 31, 2028

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
November 1, 2028

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
October 30, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 30, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
November 4, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
November 4, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
October 30, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
October 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 26/174-0500

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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