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This study is a multi-center, open-label, single-arm, non-randomized phase II clinical study in order to evaluate the safety and efficacy of zanubrutinib, lenalidomide plus R-CHOP (ZR2-CHOP) as the first-line therapy for treatment-naive high-risk diffuse large B-cell lymphoma patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Treatment-naive DLBCL | Experimental | Treatment-naive high-risk DLBCL patients will be enrolled. R/R2-CHOP were allowed in cycle 1 due to poor physical condition or liver and renal failure caused by lymphoma progression. Patients achieving Complete Remission (CR) or Partial Remission (PR) after 2 cycles will receive another 2 cycles. Patients achieving CR or PR after 4 cycles will finish 6 cycles. Patients achieving CR after 6 cycles with double-hit/triple-hit/double-expression/median to high risk aaIPI will undergo Autologous Stem Cell Transplantation (ASCT). Other patients will be administered rituximab for another 2 cycles and then turn to follow-up. After completion of study treatment, patients are followed up every 3 months for 2 years, and then every 6 months for another 3 years. Patients achieving Stable Disease (SD) or PD (Progression Disease) after 2 or 4 cycles will quit the study. After 6 cycles, patients achieving SD or PD will quit the study and patients achieving PR will receive second-line therapy. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Zanubrutinib | Drug | 160 mg capsules administered by mouth twice daily (21-day cycles). |
|
| Measure | Description | Time Frame |
|---|---|---|
| Complete response rate after six cycles of ZR2-CHOP | Complete response rate will be assessed by (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET/CT) according to 2014 Lugano Criteria. | at the end of 6 cycles(each cycle is 21 days) |
| Measure | Description | Time Frame |
|---|---|---|
| Progression-Free Survival (PFS) two years follow-up | PFS was defined as the duration from the date of randomization to the date of progression, relapse from CR, or death, whichever occurred first. Responses were based on 2014 Lugano Criteria. | At 2 years |
| Overall survival (OS) two years follow-up |
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Inclusion Criteria:
Exclusion Criteria:
Any serious medical condition including but not limited to uncontrolled hypertension, uncontrolled congestive heart failure within past 6 months prior to screening (class 3 [moderate] or class 4 [severe] cardiac disease as defined by the New York Heart Association Functional Classification), uncontrolled diabetes mellitus, active/symptomatic coronary artery disease, chronic obstructive pulmonary disease (COPD), left ventricular ejection fraction (LVEF) less than 55%, renal failure, active infection, history of invasive fungal infection, moderate to severe hepatic disease (Child Pugh class B or C), active hemorrhage, laboratory abnormality, or psychiatric illness that, in the investigators opinion places the patient at unacceptable risk and would prevent the subject from signing the informed consent form; patients with history of cardiac arrhythmias should have cardiac evaluation and clearance.
Pregnant or lactating females.
Known hypersensitivity to lenalidomide or thalidomide, Bruton's Tyrosine Kinase (BTK) inhibitor, rituximab, vincristine, doxorubicin, cyclophosphamide, or prednisone.
Patients with active hepatitis B infection (HBV-DNA detectable) and active hepatitis C infection; patients with other acquired or congenital immunodeficiency disease, including but not limited to human immunodeficiency virus (HIV) infection.
All patients with central nervous system involvement with lymphoma; patients with primary mediastinal large B cell lymphoma; patients with Richter Syndrome (aggressive DLBCL transformed from indolent CLL).
Patients diagnosed as other malignancy except lymphoma, not including:
Patients received curable treatment and no occurrence of active malignancy more than 5 years prior to study entry; successfully treated basal cell carcinoma without disease symptoms (except melanoma); successfully treated "in situ" cervix carcinoma.
Significant neuropathy (grade 2 or grade 1 with pain) within 14 days prior to enrollment.
Contraindication to any of the required concomitant drugs or supportive treatments or intolerance to hydration due to preexisting pulmonary or cardiac impairment including pleural effusion requiring thoracentesis or ascites requiring paracentesis not due to lymphoma.
Patients with active pulmonary embolism or deep vein thrombosis (diagnosed within 30 days of study enrollment).
Patients with severe bradycardia (heart rate < 40 beats per minute [bpm], hypotension, light-headedness, syncope).
Major surgery within 3 weeks of study entry, or wound that is not healed from prior surgery or trauma.
History of stroke or intracranial hemorrhage within 6 months prior to study entry.
Requires anticoagulation with warfarin or equivalent vitamin K antagonists.
Requires chronic treatment with strong cytochrome P450, family 3, subfamily A (CYP3A) inhibitors.
Vaccinated with live, attenuated vaccines within 4 weeks of study entry.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jianyong Li, Phd, MD | Contact | 025-83718836 | lijianyonglm@126.com |
| Name | Affiliation | Role |
|---|---|---|
| Jianyong Li, Phd, MD | The First Affiliated Hospital with Nanjing Medical University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Haematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital | Recruiting | Nanjin | Jiangsu | 210029 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41136989 | Derived | Xia Y, Miao Y, Qian S, Zhang R, Qin S, Xie X, Li B, Sha Y, Tang H, Jin H, Cao L, Xu W, Fan L, Li J, Shi W, Zhu H. Zanubrutinib, lenalidomide and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone as initial treatment in non-germinal center B-cell diffuse large B-cell lymphoma: a multi-center phase 2 study by Jiangsu Cooperative Lymphoma Group (JCLG). BMC Med. 2025 Oct 24;23(1):583. doi: 10.1186/s12916-025-04418-y. |
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| Lenalidomide | Drug | 25 mg capsules administered by mouth once daily on Day 1 to Day 10 of each cycle (21-day cycles) |
|
| Rituximab | Drug | 375 mg/m2 administered intravenously once on Day 1 of each cycle (21-day cycles) |
|
| Cyclophosphamide | Drug | 750 mg/m2 administered intravenously once on Day 1 of each cycle (21-day cycles) |
|
| Doxorubicin | Drug | 50 mg/m2 administered intravenously once on Day 1 of each cycle (21-day cycles) |
|
| Vincristine | Drug | 1.4 mg/m2 administered intravenously once on Day 1 of each cycle (21-day cycles) |
|
| Prednisone (or equivalent) | Drug | 40 mg/m2 capsules administered by mouth once daily on Day 1 to Day 5 of each cycle |
|
Overall survival was defined as the duration from the date of randomization to the date of the participant's death. Median Overall Survival was estimated by using the Kaplan-Meier method. |
| At 2 years |
| Circulating tumor Deoxyribonucleic Acid (ctDNA) clearance rate | ctDNA will be measured at baseline and after 2, 4, 6 cycles of ZR2-CHOP | Baseline (At initial start), at the end of 2,4 ,6 cycles(each cycle is 21 days) |
| Overall response rate after six cycles of ZR2-CHOP | Overall response rate will be assessed by FDG-PET/CT or CT scan according to 2014 Lugano Criteria. | at the end of 6 cycles(each cycle is 21 days) |
| Overall response rate after two, four cycles of ZR2-CHOP | Overall response rate will be assessed by FDG-PET/CT according to 2014 Lugano Criteria. | at the end of 2,4 cycles(each cycle is 21 days) |
| Complete response rate after two, four cycles of ZR2-CHOP | Overall response rate will be assessed by FDG-PET/CT according to 2014 Lugano Criteria. | at the end of 2,4 cycles(each cycle is 21 days) |
| Incidence of adverse events | Toxicities will be summarized by grade and by their relationship to treatment according to CTCAE (version 5.0). | At 2 years |
| First affiliation hospital of nanjing medical university | Recruiting | Nanjing | Jiangsu | 210000 | China |
|
| ID | Term |
|---|---|
| D008228 | Lymphoma, Non-Hodgkin |
| D016403 | Lymphoma, Large B-Cell, Diffuse |
| ID | Term |
|---|---|
| D008223 | Lymphoma |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D008232 | Lymphoproliferative Disorders |
| D008206 | Lymphatic Diseases |
| D006425 | Hemic and Lymphatic Diseases |
| D007160 | Immunoproliferative Disorders |
| D007154 | Immune System Diseases |
| D016393 | Lymphoma, B-Cell |
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| ID | Term |
|---|---|
| C000629551 | zanubrutinib |
| D000077269 | Lenalidomide |
| D000069283 | Rituximab |
| D003520 | Cyclophosphamide |
| D004317 | Doxorubicin |
| D014750 | Vincristine |
| D011241 | Prednisone |
| ID | Term |
|---|---|
| D010797 | Phthalimides |
| D010795 | Phthalic Acids |
| D000146 | Acids, Carbocyclic |
| D002264 | Carboxylic Acids |
| D009930 | Organic Chemicals |
| D010881 | Piperidones |
| D010880 | Piperidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D054833 | Isoindoles |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D058846 | Antibodies, Monoclonal, Murine-Derived |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
| D010752 | Phosphoramide Mustards |
| D009588 | Nitrogen Mustard Compounds |
| D009150 | Mustard Compounds |
| D006846 | Hydrocarbons, Halogenated |
| D006838 | Hydrocarbons |
| D063088 | Phosphoramides |
| D009943 | Organophosphorus Compounds |
| D003630 | Daunorubicin |
| D018943 | Anthracyclines |
| D009279 | Naphthacenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D011083 | Polycyclic Compounds |
| D000617 | Aminoglycosides |
| D006027 | Glycosides |
| D002241 | Carbohydrates |
| D014748 | Vinca Alkaloids |
| D046948 | Secologanin Tryptamine Alkaloids |
| D026121 | Indole Alkaloids |
| D000470 | Alkaloids |
| D007211 | Indoles |
| D054836 | Indolizidines |
| D007212 | Indolizines |
| D011244 | Pregnadienediols |
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
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