Rituximab Plus Venetoclax in Front Line Marginal Zone Lymphoma

A Phase II Study Using Rituximab Plus Venetoclax in the Front Line Treatment of Marginal Zone Lymphoma

The purpose of this study is to see if the combination of rituximab and venetoclax is effective in treating participants with untreated Marginal Zone Lymphoma (MZL).

The names of the study drugs involved in this study are:

• Venetoclax (a type of inhibitor)
• Rituximab (a type of antibody)

Study Overview

• Status: Recruiting
• Conditions: Lymphoma; Marginal Zone Lymphoma; MZL
• Intervention / Treatment: Drug: Venetoclax; Drug: Rituximab

Detailed Description

This is a phase II study of rituximab plus venetoclax in participants with MZL who have not had prior chemotherapy. The purpose of this study is to see if the combination of rituximab and venetoclax is effective in treating Marginal Zone Lymphoma.

The U.S. Food and Drug Administration (FDA) has not approved venetoclax for MZL but it has been approved for other uses.

The FDA has approved rituximab as a treatment option for MZL.

The research study procedures include screening for eligibility, study treatment visits, Computerized Tomography (CT) scans, Magnetic Resonance Imaging (MRI) scans, Positron Emission Tomography (PET) scans, blood tests, bone marrow and tumor biopsies, and electrocardiograms.

Participants will receive study treatment for up to 24 months and will be followed for 1 year after discontinuation of the study drugs.

It is expected that about 33 people will take part in this research study.

Abbvie, Inc. is funding this research study by providing venetoclax.

• Study Type: Interventional
• Enrollment (Estimated): 33
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Gottfried von Keudell, MD, PhD; Phone Number: 617-667-9920; Email: gkeudell@bidmc.harvard.edu
• Study Contact Backup: Name: Dea Hunsicker, PhD; Phone Number: 617-975-7425; Email: dhunsick@bidmc.harvard.edu

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02215
      • Recruiting
      • Beth Israel Deaconess Medical Center
      • Contact: Gottfried von Keudell, MD, PhD; Phone Number: 617-667-9920; Email: gkeudell@bidmc.harvard.edu
      • Principal Investigator: Gottfried von Keudell, MD, PhD
      • Contact: Dea Hunsicker, PhD; Email: dhunsick@bidmc.harvard.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Participants must have histologically confirmed Marginal Zone Lymphoma
• Patients must have measurable disease as defined by at least one lymph node ≥1.5 cm or spleen > 13 cm
• Patients with intestinal MALT lymphoma must have disease that is detectable by EGD or colonoscopy with biopsy
• Patients with gastric MALT lymphoma must be h. pylori negative. Patients who are h. pylori positive are allowed if they have failed a trial of h. pylori eradication
• Patients with gastric MALT lymphoma who are h. pylori negative or who relapsed/refractory disease after h. pylori eradication must be ineligible form have refused or failed gastric radiation therapy
• Age ≥18 years
• ECOG performance status ≤1
• Life expectancy of greater than 2 years

• Participants must meet the following organ and marrow function as defined below:

  • Hemoglobin ≥8.0 g/dL
  • absolute neutrophil count ≥1,000 cells/mcL (In the event of documented bone marrow involvement, ANC must be ≥1500 cells/mcL)
  • platelets ≥50,000 cells/mm3
  • total bilirubin < 1.5 x institutional upper limit of normal (ULN) (In patients with Gilberts disease or documented liver involvement, total bilirubin < 3 X ULN will be allowed)
  • AST(SGOT)/ALT(SGPT) < 3 × institutional ULN unless elevation is caused by liver involvement with MZL
  • Creatinine within institutional ULN OR creatinine clearance >60mL/min for patients with creatinine levels above institutional normal (by Cockcroft-Gault estimate or 12-24h creatinine clearance measurements)
• Ability to understand and the willingness to sign a written informed consent document
• Patient must be able to swallow pills
• HIV-positive patients on combination antiretroviral therapy are eligible if their HIV is under adequate control with an antiretroviral regimen that has been stable for > 4 weeks, as long as the CD4 count is >300. Appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated
• Patients with Hepatitis B surface antibody serum positivity due to poor immunization, as well as those with Hepatitis B core antibody positivity with negative PCR on antiviral therapy will be eligible

Exclusion Criteria:

• Patients who had prior systemic therapy including rituximab

• Patients who have had prior radiation therapy, with the following exceptions:

  • Palliative radiotherapy (RT) is allowed, but must be completed at least 1 week prior to treatment on this study, and prior to any baseline imaging studies or biopsies. Patients must meet criteria for measurable/assessable disease as outlined above after completion of RT.
  • Prior RT for gastric MALT is allowed, but must be completed at least 1 week prior to treatment on this study, and prior to any baseline imaging studies or biopsies. Patients must meet criteria for measurable/assessable disease as outlined above after completion of RT.
• Prior treatment with ibrutinib or other BTK inhibitor
• Patients with h. pylori-associated gastric MALT or stage I/II MZL will be excluded unless they are deemed to be unfit for radiation therapy with curative intent.
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• Patients with uncontrolled hepatitis B or C or HIV infection are ineligible defined as patients with positive serologies and a detectable viral load by PCR.
• Patients with Hep B core ab positivity are allowed provided Hep B PCR is undetectable
• Pregnant women or participants unwilling to adhere to institutional guidelines for highly effective contraception for 12 months after the last dose of rituximab are excluded from this study because of documented risks of rituximab on fetal immunologic development and unknown effects of venetoclax on embryonic development. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with venetoclax, breastfeeding should be discontinued.
• Received moderate or strong CYP3A inhibitors (such as fluconazole, ketoconazole, and clarithromycin) within 7 days prior to the first dose of venetoclax.
• Received moderate or strong CYP3A inducers (such as rifampin, carbamazepine, phenytoin, St. John's Wort) within 7 days prior to the first dose of venetoclax.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Rituximab + Venetoclax; 33 participants will be enrolled and will complete study procedures as follows: Baseline visit with screening assessments, scans, and tumor and bone marrow biopsies.; Induction Period:CT/MRI scans at week 4.Weeks 1 - 4: Predetermined dose of Rituximab 1x weekly.Weeks 5 - 8: Predetermined dose of Venetoclax 1x daily.; Maintenance Period:CT/MRI scan on weeks 12, 36, 60, 84, and then every 6 months after week 96.Predetermined dose of Venetoclax 1x daily for up to week 96, then once every 6 months.Predetermined dose of Rituximab 1x weekly at weeks 12, 24, 36, and 48.; End of Treatment Visit: CT/MRI scan, tumor biopsy, and bone marrow biopsy.; Follow up: In-clinic visit at 1 year after finishing study drugs.

Drug: Venetoclax; B-cell lymphoma inhibitor, tablets taken orally per protocol.; Other Names: ABT-199; GDC-199; Drug: Rituximab; Anti-CD20 monoclonal antibody, 10mL or 50 mL single-use vials, via intravenous (into the vein) infusion per protocol.; Other Names: Rituxan; ABP 798; IDEC-C2B8; PF-05280586; Riabni; Ruxience; Truxima

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Complete Response Rate (CRR)	Complete Response (CR) rate is defined as the proportion of participants achieving CR during study treatment. CR is defined based on RECIL criteria.	Up to 24 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall response rate (ORR)	ORR will be measured as the proportion of participants that achieve a PR or CR per RECIL criteria.	Up to 24 months
Partial Remission (PR) Rate	Partial remission (PR) rate is defined as the proportion of participants achieving partial remission RECIL criteria.	Up to 24 months
Median Progression Free Survival (PFS)	PFS based on Kaplan-Meier methodology will be measured from the time the participant initiates treatment until the first occurrence of documented progression of disease or death from any cause, censored for participants alive without progression.	Up to 24 months
Median Overall Survival (OS)	OS based on Kaplan-Meier methodology will be measured from the time the participant initiates treatment until death from any cause, censored for participants alive.	Up to 36 months
Median Event Free Survival (EFS)	EFS will be measured from the time the participant initiates treatment until documented off therapy for any reason, censored for participants who remain on therapy.	Up to 24 months
Duration of Response (DOR)	DoR will be measured from the time of initial response until documented progression of disease, censored for participants who remain in response.	Up to 24 months

Collaborators and Investigators

• Sponsor: Gottfried von Keudell, MD PhD
• Collaborators: AbbVie
• Investigators: Principal Investigator: Gottfried von Keudell, MD, PhD, Beth Israel Deaconess Medical Center

Study record dates

Study Major Dates

• Study Start (Actual): February 11, 2026
• Primary Completion (Estimated): October 1, 2028
• Study Completion (Estimated): October 1, 2031

Study Registration Dates

• First Submitted: July 15, 2024
• First Submitted That Met QC Criteria: July 15, 2024
• First Posted (Actual): July 19, 2024

Study Record Updates

• Last Update Posted (Actual): March 13, 2026
• Last Update Submitted That Met QC Criteria: March 12, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Lymphoma; Marginal Zone Lymphoma; MZL
• Additional Relevant MeSH Terms: Neoplasms; Immune System Diseases; Neoplasms by Histologic Type; Lymphatic Diseases; Lymphoproliferative Disorders; Immunoproliferative Disorders; Lymphoma, Non-Hodgkin; Lymphoma, B-Cell; Hemic and Lymphatic Diseases; Lymphoma; Lymphoma, B-Cell, Marginal Zone; Amino Acids, Peptides, and Proteins; Proteins; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Serum Globulins; Globulins; Antibodies, Monoclonal, Murine-Derived; Rituximab; venetoclax
• Other Study ID Numbers: 23-711

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: [contact information for Sponsor Investigator or designee]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
• IPD Sharing Time Frame: Data can be shared no earlier than 1 year following the date of publication
• IPD Sharing Access Criteria: Contact the Beth Israel Deaconess Medical Center Technology Ventures Office at tvo@bidmc.harvard.edu
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No