A Phase 2 interventional study of Laboratory Biomarker Analysis and Lenalidomide in Recurrent Diffuse Large B-Cell Lymphoma, Recurrent Grade 1 Follicular Lymphoma and Recurrent Grade 2 Follicular Lymphoma, sponsored by M.D. Anderson Cancer Center. Active, not recruiting at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-03-09.
Sponsored by M.D. Anderson Cancer Center · Phase 2, Interventional, and Treatment
This phase II trial studies how well rituximab and pembrolizumab with or without lenalidomide works in treating patients with follicular lymphoma and diffuse large B-cell lymphoma that has returned after a period of improvement. Immunotherapy with monoclonal antibodies, such as rituximab and pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Drugs used in chemotherapy, such as lenalidomide, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving rutuximab with pembrolizumab and lenalidomide may work better at treating follicular lymphoma and diffuse large B-cell lymphoma.
PRIMARY OBJECTIVES:
I. To determine the overall response rate (ORR) in subjects with relapsed follicular lymphoma (FL) treated with rituximab plus pembrolizumab.
II. To determine the ORR in subjects with relapsed/refractory FL and relapsed/refractory diffuse large B-cell lymphoma (DLBCL) who have failed chimeric antigen receptor (CAR) T cell therapy and are treated with rituximab in combination with pembrolizumab and lenalidomide. (Cohort 2)
SECONDARY OBJECTIVES:
I. To determine the safety and toxicity. II. To determine the complete response rate (CRR). III. To determine the overall progression-free survival (PFS). IV. To compare PFS between patients relapsing =\< one year vs > one year after last prior therapy.
V. To determine the overall survival (OS). VI. To determine the safety and toxicity. (Cohort 2) VII. To determine the CRR. (Cohort 2) VIII. To determine the overall PFS. (Cohort 2) IX. To compare PFS between patients relapsing =\< one year vs > one year after last prior therapy. (Cohort 2) X. To determine the OS. (Cohort 2)
EXPLORATORY OBJECTIVES:
I. To determine effects of rituximab plus pembrolizumab therapy on peripheral blood T cells.
II. To correlate features of peripheral blood T cells with toxicities after rituximab plus pembrolizumab therapy.
III. To correlate features of peripheral blood T cells with response and PFS after rituximab plus pembrolizumab therapy.
IV. To correlate baseline tumor characteristics with response and PFS after rituximab plus pembrolizumab therapy.
V. To determine effects of rituximab, pembrolizumab, and lenalidomide therapy on peripheral blood T cells. (Cohort 2) VI. To correlate features of peripheral blood T cells with toxicities after rituximab, pembrolizumab, and lenalidomide therapy. (Cohort 2) VII. To correlate features of peripheral blood T cells with response and PFS after rituximab, pembrolizumab, and lenalidomide therapy. (Cohort 2) VIII. To correlate baseline tumor characteristics with response and PFS after rituximab, pembrolizumab, and lenalidomide therapy. (Cohort 2)
OUTLINE: Patients are assigned to 1 of 2 cohorts.
COHORT I: Patients receive rituximab intravenously (IV) over 4-8 hours on days 1, 8, 15, and 22. Patients also receive pembrolizumab IV over 1 hour on day 2 every 3 weeks for up to 16 cycles (1 year) in the absence of disease progression or unacceptable toxicity.
COHORT II: Patients receive rituximab IV over 4-8 hours on days 1, 8 and 15 of cycle 1, and day 1 of cycle 2. Patients also receive pembrolizumab IV over 1 hour on day 2 every 3 weeks for up to 2 years, and lenalidomide orally (PO) on days 1-14 every 3 weeks for up to 12 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 30 days, every 3 months for 1 year, and then every 6 months thereafter.
1,390 studies on the registry are indexed under Lymphoma, Large B-Cell, Diffuse; 350 are open to participants now.
This study's enrollment of 53 is above the median of 47 across 1,185 interventional studies indexed under Lymphoma, Large B-Cell, Diffuse.
Browse Lymphoma, Large B-Cell, Diffuse studies →M.D. Anderson Cancer Center is the lead sponsor of 2,999 studies on the registry; 581 are open to participants now.
Of its 599 completed or terminated interventional studies of FDA-regulated products, 402 (67%) have results posted.
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Serum creatinine =\< 1.5 x upper limit of normal (ULN) OR measured or calculated creatinine clearance (glomerular filtration rate [GFR] can also be used in place of creatinine or creatinine clearance [CrCl]) >= 60 mL/min GFR or CrCl for subjects with creatinine levels > 1.5 x institutional ULN, performed within 28 days of treatment initiation
Female subjects of childbearing potential should be willing to use 2 methods of birth control or be surgically sterile, or abstain from heterosexual activity for the course of the study through 120 days after the last dose of study medication; female subjects of childbearing potential are those who have not been surgically sterilized or have not been free from menses for > 1 year
Exclusion Criteria:
Has had prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to study day 1 or who has not recovered (i.e., =\< grade 1 or at baseline) from AEs due to a previously administered agent; * Note: Subjects with =\< grade 2 neuropathy are an exception to this criterion and may qualify for the study
Has received prior therapy with an anti-programmed cell death 1 (PD-1), anti-programmed cell death ligand 1 (PD-L1), anti-programmed cell death ligand 2 (PD-L2), anti- cluster of differentiation (CD)137, or anti-cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) antibody (including ipilimumab or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways)
Patients receive rituximab IV over 4-8 hours on days 1, 8, 15, and 22. Patients also receive pembrolizumab IV over 1 hour on day 2 every 3 weeks for up to 16 cycles (1 year) in the absence of disease progression or unacceptable toxicity.
Other: Laboratory Biomarker Analysis · Biological: Pembrolizumab · Biological: Rituximab
Patients receive rituximab IV over 4-8 hours on days 1, 8 and 15 of cycle 1, and day 1 of cycle 2. Patients also receive pembrolizumab IV over 1 hour on day 2 every 3 weeks for up to 2 years, and lenalidomide PO on days 1-14 every 3 weeks for up to 12 cycles in the absence of disease progression or unacceptable toxicity.
Other: Laboratory Biomarker Analysis · Drug: Lenalidomide · Biological: Pembrolizumab · Biological: Rituximab
Correlative studies
Given PO
Also known as: CC-5013, CC5013, CDC 501, Revlimid
Given IV
Also known as: Keytruda, Lambrolizumab, MK-3475, SCH 900475
Given IV
Also known as: ABP 798, BI 695500, C2B8 Monoclonal Antibody, Chimeric Anti-CD20 Antibody, CT-P10, IDEC-102, IDEC-C2B8, IDEC-C2B8 Monoclonal Antibody, MabThera, Monoclonal Antibody IDEC-C2B8, PF-05280586, Rituxan, Rituximab ABBS, Rituximab Biosimilar ABP 798, Rituximab Biosimilar BI 695500, Rituximab Biosimilar CT-P10, Rituximab Biosimilar GB241, Rituximab Biosimilar IBI301, Rituximab Biosimilar JHL1101, Rituximab Biosimilar PF-05280586, Rituximab Biosimilar RTXM83, Rituximab Biosimilar SAIT101, rituximab biosimilar TQB2303, rituximab-abbs, RTXM83, Truxima
Overall Response Rate (Complete + Partial Responses)
To determine the overall response rate (ORR) in subjects with relapsed follicular lymphoma (FL) treated with Rituximab plus pembrolizumab therapy. II. To determine the ORR in subjects with relapsed/refractory FL and relapsed/refractory diffuse large B-Cell lymphoma (DLBCL) who failed chimeric antigen receptor (CAR) T cell therapy and rea treated with rituximab in combination with pembrolizumab and lenalidomide (Cohort 2)
Time frame: Approximately 1 year and 6 months
Incidence of Toxicity
Will be graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Toxicity will be monitored simultaneously using the Bayesian stopping boundaries calculated based on beta-binomial distributions. Toxicity defined as any grade 3 or 4 non-hematologic toxicity that in the opinion of the principal investigator is at least possibly related to study treatment. Toxicity evaluation will be based on the incidence of severity and type of adverse events (including physical and laboratory). Frequency tables will be used to summarize categorical variables. Logistic regression will be utilized to assess the effect of patient prognostic factors on the toxicity rate.
Time frame: Up to 30 days after the completion of study treatment
Complete Response Rate
Logistic regression will be utilized to assess the effect of patient prognostic factors on the response rate.
Time frame: Up to 2 years after completion of study treatment
Progression-free Survival (PFS)
The PFS will be compared between patients relapsing =\< 1 year vs \> 1 year after last prior therapy. The distribution of time-to-event endpoints will be estimated using the method of Kaplan and Meier. Comparison of time-to-event endpoints by important subgroups will be made using the log-rank test. Cox proportional hazard regression will be employed for multivariate analysis on time-to-event outcomes.
Time frame: Up to 2 years after completion of study treatment
Overall Survival
The distribution of time-to-event endpoints will be estimated using the method of Kaplan and Meier. Comparison of time-to-event endpoints by important subgroups will be made using the log-rank test. Cox proportional hazard regression will be employed for multivariate analysis on time-to-event outcomes.
Time frame: Up to 2 years after completion of study treatment
| Milestone | Cohort 1 | Cohort 2 |
|---|---|---|
| Started | 30 | 14 |
| Completed | 10 | 3 |
| Not completed | 20 | 11 |
| Withdrew: Adverse event | 6 | 1 |
| Withdrew: Death | 0 | 2 |
| Withdrew: Withdrawal by subject | 0 | 1 |
| Withdrew: Relocation | 1 | 0 |
| Withdrew: Progression of disease | 13 | 7 |
To determine the overall response rate (ORR) in subjects with relapsed follicular lymphoma (FL) treated with Rituximab plus pembrolizumab therapy. II. To determine the ORR in subjects with relapsed/refractory FL and relapsed/refractory diffuse large B-Cell lymphoma (DLBCL) who failed chimeric antigen receptor (CAR) T cell therapy and rea treated with rituximab in combination with pembrolizumab and lenalidomide (Cohort 2)
| Participants | Cohort I (Rituximab, Pembrolizumab) | Cohort II (Rituximab, Pembrolizumab, Lenalidomide) |
|---|---|---|
| Complete Response (CR) | 15 | 5 |
| Partial Response (PR) | 5 | 0 |
| Not Evaluable | 0 | 2 |
| Progressive Disease (PD) | 0 | 7 |
Will be graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Toxicity will be monitored simultaneously using the Bayesian stopping boundaries calculated based on beta-binomial distributions. Toxicity defined as any grade 3 or 4 non-hematologic toxicity that in the opinion of the principal investigator is at least possibly related to study treatment. Toxicity evaluation will be based on the incidence of severity and type of adverse events (including physical and laboratory). Frequency tables will be used to summarize categorical variables. Logistic regression will be utilized to assess the effect of patient prognostic factors on the toxicity rate.
Results for this outcome have not been posted.
Logistic regression will be utilized to assess the effect of patient prognostic factors on the response rate.
Results for this outcome have not been posted.
The PFS will be compared between patients relapsing =\< 1 year vs \> 1 year after last prior therapy. The distribution of time-to-event endpoints will be estimated using the method of Kaplan and Meier. Comparison of time-to-event endpoints by important subgroups will be made using the log-rank test. Cox proportional hazard regression will be employed for multivariate analysis on time-to-event outcomes.
Results for this outcome have not been posted.
The distribution of time-to-event endpoints will be estimated using the method of Kaplan and Meier. Comparison of time-to-event endpoints by important subgroups will be made using the log-rank test. Cox proportional hazard regression will be employed for multivariate analysis on time-to-event outcomes.
Results for this outcome have not been posted.
Collected over Approximately 1 year and 6 months. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Cohort I (Rituximab, Pembrolizumab) | 0/30 (0%) | 7/30 (23.3%) | 30/30 (100%) |
| Cohort II (Rituximab, Pembrolizumab, Lenalidomide) | 2/14 (14.3%) | 6/14 (42.9%) | 14/14 (100%) |
| Event | Cohort I (Rituximab, Pembrolizumab) | Cohort II (Rituximab, Pembrolizumab, Lenalidomide) |
|---|---|---|
| Febrile Neutropenia (Neutropenia Fever)Blood and lymphatic system disorders | 0/30 | 3/14 |
| FeverGeneral disorders | 1/30 | 2/14 |
| HyperglycemiaNervous system disorders | 1/30 | 1/14 |
| Respiratory FailireRespiratory, thoracic and mediastinal disorders | 0/30 | 1/14 |
| PneumonitisRespiratory, thoracic and mediastinal disorders | 0/30 | 1/14 |
| Pulmonary EmbolismVascular disorders | 0/30 | 1/14 |
| Hypoxia/ Lung InfectionRespiratory, thoracic and mediastinal disorders | 0/30 | 1/14 |
| Lung InfectionInfections and infestations | 0/30 | 1/14 |
| PneumoniaRespiratory, thoracic and mediastinal disorders | 0/30 | 1/14 |
| MeningitsInfections and infestations | 1/30 | 0/14 |
| Event | Cohort I (Rituximab, Pembrolizumab) | Cohort II (Rituximab, Pembrolizumab, Lenalidomide) |
|---|---|---|
| Liver Enzymes AbnormalatiesGastrointestinal disorders | 12/30 | 0/14 |
| FatigueNervous system disorders | 11/30 | 2/14 |
| AST IncreasedBlood and lymphatic system disorders | 0/30 | 5/14 |
| Lymphocyte Count DecreasedBlood and lymphatic system disorders | 10/30 | 0/14 |
| Dyspnea/ WheezingRespiratory, thoracic and mediastinal disorders | 4/30 | 4/14 |
| Nausea/ VomittingGastrointestinal disorders | 1/30 | 4/14 |
| White Blood Cound DecreaseBlood and lymphatic system disorders | 3/30 | 4/14 |
| DiarrheaGastrointestinal disorders | 8/30 | 3/14 |
| Watering EyesGeneral disorders | 8/30 | 0/14 |
| Eye PainGeneral disorders | 8/30 | 0/14 |
| Age, Categorical(Participants) | Cohort 1 | Cohort 2 | Total |
|---|---|---|---|
| <=18 years | 0 | 0 | 0 |
| Between 18 and 65 years | 30 | 12 | 42 |
| >=65 years | 0 | 2 | 2 |
| Sex: Female, Male(Participants) | Cohort 1 | Cohort 2 | Total |
|---|---|---|---|
| Female | 13 | 5 | 18 |
| Male | 17 | 9 | 26 |
| Ethnicity (NIH/OMB)(Participants) | Cohort 1 | Cohort 2 | Total |
|---|---|---|---|
| Hispanic or Latino | 1 | 2 | 3 |
| Not Hispanic or Latino | 29 | 12 | 41 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Race (NIH/OMB)(Participants) | Cohort 1 | Cohort 2 | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 0 | 1 | 1 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 1 | 0 | 1 |
| White | 29 | 11 | 40 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 2 | 2 |
| Region of Enrollment(participants) | Cohort 1 | Cohort 2 | Total |
|---|---|---|---|
| United States | 30 | 14 | 44 |
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Lymphoma, Large B-Cell, Diffuse→
M.D. Anderson Cancer Center