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Active, not recruitingNCT02446457Updated Mar 9, 2026Results posted

Rituximab and Pembrolizumab With or Without Lenalidomide in Treating Patients With Relapsed Follicular Lymphoma and Diffuse Large B-Cell Lymphoma

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

Phase
Phase 2
Study type
Interventional
Enrollment
53
Allocation
Non-randomized
Ages
18 Years and older
Sex
All
01

Study summary

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.

Read the detailed description

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.

02

Conditions studied

  • Recurrent Diffuse Large B-Cell Lymphoma
  • Recurrent Grade 1 Follicular Lymphoma
  • Recurrent Grade 2 Follicular Lymphoma
  • Recurrent Grade 3a Follicular Lymphoma
03

In context

Lymphoma, Large B-Cell, Diffuse

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 →

Lead sponsor

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.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • For cohort 1: Male or female subjects with histologic proof of follicular lymphoma grade 1, 2, or 3a relapsing after at least one prior systemic therapy that included rituximab (or other monoclonal CD20 antibody); patients should have documented rituximab-sensitive disease defined as a documented complete or partial response lasting at least 6 months after the last rituximab-containing therapy
  • For cohort 2: Male or female subjects with histologic proof of follicular lymphoma grade 1, 2, or 3a relapsing after at least two prior systemic therapies, which must include CAR T cell therapy or histologic proof of DLBCL relapsing after at least two prior systemic therapies, which must include CAR T cell therapy
  • Either the subject or his/her legally authorized representative be willing and able to provide written informed consent for the trial
  • Have measurable disease (>= 1.5 cm in the longest diameter for nodal or extranodal disease)
  • Have a performance status of 0 or 1 on the Eastern Cooperative Oncology Group (ECOG) performance scale
  • Absolute neutrophil count (ANC) >= 1.0 x 10\^9/L, performed within 28 days of treatment initiation
  • Platelets >= 50 x 10\^9/L, performed within 28 days of treatment initiation
  • Hemoglobin >= 8.0 g/dL, performed within 28 days of treatment initiation
  • 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

    • Creatinine clearance will be calculated per institutional standard
  • Serum total bilirubin =\< 1.5 x ULN OR direct bilirubin =\< ULN for subjects with total bilirubin levels > 1.5 ULN, performed within 28 days of treatment initiation
  • Aspartate aminotransferase (AST)/serum glutamic oxaloacetic transaminase (SGOT) and alanine aminotransferase (ALT)/serum glutamic pyruvic transaminase (SGPT) =\< 2.5 x ULN OR =\< 5 x ULN for subjects with lymphoma in the liver, performed within 28 days of treatment initiation
  • International normalized ratio (INR) or prothrombin time (PT) =\< 1.5 x ULN unless subject is receiving anticoagulant therapy as long as PT or partial thromboplastin time (PTT) is within therapeutic range of intended use of anticoagulants performed within 28 days of treatment initiation
  • Activated partial thromboplastin time (aPTT) =\< 1.5 x ULN unless subject is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants, performed within 28 days of treatment initiation
  • Female subject of childbearing potential should have a negative urine or serum pregnancy test within 72 hours prior to receiving the first dose of study medication; if the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
  • 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

    • Females of reproductive potential enrolled in the lenalidomide cohort must adhere to the scheduled pregnancy testing as required in the Revlimid Risk Evaluation and Mitigation Strategy (REMS) program
  • Male subjects should agree to use two methods of contraception starting with the first dose of study therapy through 120 days after the last dose of study therapy
  • All study participants enrolled in the lenalidomide containing cohort (cohort 2) must be registered into the mandatory Revlimid REMS program, and be willing and able to comply with the requirements of the REMS program

Exclusion criteria

Exclusion Criteria:

  • Is currently participating and receiving study therapy or has participated in a study of an investigational agent and received study drug or using an investigation device within 4 weeks of the first dose of treatment
  • Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment
  • Has had a prior monoclonal antibody within 4 weeks prior to study day 1 or who has not recovered (i.e., =\< grade 1 or at baseline) from adverse events (AEs) due to agents administered more than 4 weeks earlier
  • 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

    • Note: If subject received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting therapy
  • Has a known additional malignancy that is progressing and requires active treatment; exceptions include basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or in situ cervical cancer that has undergone potentially curative therapy
  • Has known active central nervous system (CNS) lymphoma and/or lymphomatous meningitis; subjects with previously treated CNS lymphoma and/or lymphomatous meningitis may participate provided they are stable (without evidence of progression by imaging for at least four weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are not using steroids for at least 7 days prior to trial treatment
  • No active autoimmune disease that has required systemic treatment in past 2 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs); replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment; subjects with vitiligo or resolved childhood asthma/atopy would be an exception to this rule; subjects that require intermittent use of bronchodilators, local steroid injections or inhaled or topical steroids would not be excluded from the study; subjects with hypothyroidism stable on hormone replacement or Sjogren's syndrome will not be excluded from the study
  • Has evidence of interstitial lung disease or active, non-infectious pneumonitis that required steroids or current pneumonitis
  • Has an active infection requiring systemic therapy
  • Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator
  • Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial
  • Is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the pre-screening or screening visit through 120 days after the last dose of trial treatment
  • 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)

    • Note: Subjects that received prior therapy with pidilizumab are an exception to this criterion and may qualify for the study
  • Has a known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies)
  • Has known active hepatitis B (e.g., hepatitis B virus surface antigen [HBsAg] reactive) or hepatitis C (e.g., hepatitis C virus [HCV] ribonucleic acid [RNA] qualitative is detected)
  • Has received a live vaccine within 30 days prior to the first dose of trial treatment
05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Non-randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
53 participants (actual)

Study arms

  • Experimental
    Cohort I (rituximab, pembrolizumab)

    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

  • Experimental
    Cohort II (rituximab, pembrolizumab, lenalidomide)

    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

Interventions

  • OtherLaboratory Biomarker Analysis

    Correlative studies

  • DrugLenalidomide

    Given PO

    Also known as: CC-5013, CC5013, CDC 501, Revlimid

  • BiologicalPembrolizumab

    Given IV

    Also known as: Keytruda, Lambrolizumab, MK-3475, SCH 900475

  • BiologicalRituximab

    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

06

What researchers measure

Primary outcomes

  1. 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

Secondary outcomes

  1. 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

  2. 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

  3. 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

  4. 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

07

Results

Posted Feb 27, 2026

Participant flow

Participant flow — Overall Study
MilestoneCohort 1Cohort 2
Started3014
Completed103
Not completed2011
Withdrew: Adverse event61
Withdrew: Death02
Withdrew: Withdrawal by subject01
Withdrew: Relocation10
Withdrew: Progression of disease137

Outcome measures

PrimaryOverall 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
Reported as:
Count of participants · Participants
Overall Response Rate (Complete + Partial Responses)
ParticipantsCohort I (Rituximab, Pembrolizumab)Cohort II (Rituximab, Pembrolizumab, Lenalidomide)
Complete Response (CR)155
Partial Response (PR)50
Not Evaluable02
Progressive Disease (PD)07
SecondaryIncidence 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

Results for this outcome have not been posted.

SecondaryComplete 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

Results for this outcome have not been posted.

SecondaryProgression-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

Results for this outcome have not been posted.

SecondaryOverall 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

Results for this outcome have not been posted.

Adverse events

Collected over Approximately 1 year and 6 months. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
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%)
Most frequent serious events
Showing 10 of 18
Most frequent serious events
EventCohort I (Rituximab, Pembrolizumab)Cohort II (Rituximab, Pembrolizumab, Lenalidomide)
Febrile Neutropenia (Neutropenia Fever)Blood and lymphatic system disorders0/303/14
FeverGeneral disorders1/302/14
HyperglycemiaNervous system disorders1/301/14
Respiratory FailireRespiratory, thoracic and mediastinal disorders0/301/14
PneumonitisRespiratory, thoracic and mediastinal disorders0/301/14
Pulmonary EmbolismVascular disorders0/301/14
Hypoxia/ Lung InfectionRespiratory, thoracic and mediastinal disorders0/301/14
Lung InfectionInfections and infestations0/301/14
PneumoniaRespiratory, thoracic and mediastinal disorders0/301/14
MeningitsInfections and infestations1/300/14
Most frequent other events
Showing 10 of 66
Most frequent other events
EventCohort I (Rituximab, Pembrolizumab)Cohort II (Rituximab, Pembrolizumab, Lenalidomide)
Liver Enzymes AbnormalatiesGastrointestinal disorders12/300/14
FatigueNervous system disorders11/302/14
AST IncreasedBlood and lymphatic system disorders0/305/14
Lymphocyte Count DecreasedBlood and lymphatic system disorders10/300/14
Dyspnea/ WheezingRespiratory, thoracic and mediastinal disorders4/304/14
Nausea/ VomittingGastrointestinal disorders1/304/14
White Blood Cound DecreaseBlood and lymphatic system disorders3/304/14
DiarrheaGastrointestinal disorders8/303/14
Watering EyesGeneral disorders8/300/14
Eye PainGeneral disorders8/300/14

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)Cohort 1Cohort 2Total
<=18 years000
Between 18 and 65 years301242
>=65 years022
Sex: Female, Male
Sex: Female, Male(Participants)Cohort 1Cohort 2Total
Female13518
Male17926
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Cohort 1Cohort 2Total
Hispanic or Latino123
Not Hispanic or Latino291241
Unknown or Not Reported000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Cohort 1Cohort 2Total
American Indian or Alaska Native000
Asian011
Native Hawaiian or Other Pacific Islander000
Black or African American101
White291140
More than one race000
Unknown or Not Reported022
Region of Enrollment
Region of Enrollment(participants)Cohort 1Cohort 2Total
United States301444
08

Study locations

1 site
  • M D Anderson Cancer Center
    Houston, Texas 77030, United States
09

References and documents

Publications

  • Nastoupil LJ, Chin CK, Westin JR, Fowler NH, Samaniego F, Cheng X, Ma MCJ, Wang Z, Chu F, Dsouza L, Obi C, Mims J, Feng L, Zhou S, Green M, Davis RE, Neelapu SS. Safety and activity of pembrolizumab in combination with rituximab in relapsed or refractory follicular lymphoma. Blood Adv. 2022 Feb 22;6(4):1143-1151. doi: 10.1182/bloodadvances.2021006240. PubMed 35015819 ↗

Study documents

  • Protocol and statistical analysis plan · Jun 10, 2024

Documents are hosted by the registry — open the source record to download them.

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Mar 9, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT02446457
Lead sponsor
M.D. Anderson Cancer Center
Collaborators
National Cancer Institute (NCI)
Responsible party
Sponsor
First posted
May 18, 2015
Start date
Jul 31, 2015
Primary completion
Mar 31, 2025
Completion
Apr 30, 2026 (estimated)
Results posted
Feb 27, 2026
Last update
Mar 9, 2026

Study contacts

Ranjit Nair
principal investigator · M.D. Anderson Cancer Center

Oversight

Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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