ClinicalTrials.gg
RecruitingNCT03258567Updated Nov 10, 2026

Nivolumab in Epstein-Barr Virus (EBV)-Positive Lymphoproliferative Disorders and EBV-Positive Non-HodgkinLymphomas

A Phase 2 interventional study of Nivolumab in Epstein-Barr Virus Infections, Lymphoma and Lymphoproliferative Disorder, sponsored by National Cancer Institute (NCI). Recruiting at 1 site in United States. Open to participants aged 12 Years and older. Per ClinicalTrials.gov, last updated 2026-11-10.

Sponsored by National Cancer Institute (NCI) · Phase 2, Interventional, and Treatment

From the registry’s dates

  • Started Apr 2018; still recruiting 8 years 6 months later.
Phase
Phase 2
Study type
Interventional
Enrollment
40
Allocation
Non-randomized
Ages
12 Years and older
Sex
All
01

Study summary

Background:

The drug Nivolumab has been approved to treat some cancers. Researchers want to see if it can slow the growth of other cancers. They want to study its effects on cancers that may have not responded to chemotherapy or other treatments.

Objectives:

To see if Nivolumab slows the growth of some types of cancer or stops them from getting worse. To test the safety of the drug.

Eligibility:

People 12 and older who have Epstein-Barr Virus (EBV)-positive lymphoproliferative disorders or EBV-positive non-Hodgkin lymphomas with no standard therapy

Design:

Participants will be screened with:

Medical history

Physical exam

Blood and urine tests

CAT scan of the chest, abdomen, and pelvis

Tumor and bone marrow biopsies (sample taken)

Magnetic resonance imaging scan of the brain

Lumbar puncture (also known as spinal tap)

Positron emission tomography/computed tomography scan with a radioactive tracer

Every 2 weeks, participants will get Nivolumab by vein over about 1 hour. They will also have:

Physical exam

Blood and pregnancy tests

Review of side effects and medications

During the study, participants will repeat most of the screening tests. They may also have other biopsies.

After stopping treatment, participants will have a visit every 3 months for 1 year. Then they will have a visit every 6 months for years 2-5, and then once a year. They will have a physical exam and blood tests.

Read the detailed description

BACKGROUND:

  • Epstein-Barr virus (EBV) is a chronic viral infection associated with a heterogeneous group of lymphoproliferative disorders (LPD) and non-Hodgkin lymphomas (NHL).
  • The shared pathobiology of EBV-positive LPDs and NHLs includes a defect in host mechanisms of immune tolerance and immunosurveillance.
  • Programmed death-1 (PD-1) is a surface protein present on T cells, B cells, and macrophages that serves a co-inhibitory role to negatively regulate immune responses
  • PD-1 and its ligands, PD-L1 and PD-L2, are overexpressed in EBV-positive lymphoproliferative disorders and are markers of aggressive behavior.
  • Blockade of the PD-1 pathway induces T-cell responses against tumor antigens in a variety of cancers, including Hodgkin lymphoma, that lead to clinical remissions.
  • Nivolumab is a fully human IgG4 monoclonal anti-PD-1 receptor antibody with clinical activity in both indolent and aggressive lymphomas.

OBJECTIVE:

-To determine the best overall response rate of nivolumab in subjects with EBV-positive LPD and EBV-positive NHL

ELIGIBLITY:

  • Subjects must have a confirmed diagnosis of an EBV-positive LPD, or an EBV-positive NHL confirmed by Laboratory of Pathology, NCI

    --NOTE: LPD subjects may be previously untreated or relapsed from prior therapy; patients with EBV-positive B-cell NHL subjects must have relapsed from previous treatment with an anthracycline and rituximab-based regimen or be considered not eligible for the same

  • Adequate bone marrow function (unless disease-related) defined as:

    • Absolute neutrophil count >= 750/mcL
    • Hemoglobin >= 9g/dL (transfusion permitted)
    • Platelet count >= 50,000/mcL (transfusion not permitted)
  • Age greater than or equal to 12 years

\<TAB>

DESIGN:

  • Phase II study of subjects with EBV-positive LPD and EBV-positive NHL, both relapsed and untreated.
  • Subjects will be treated with nivolumab 480 mg IV every 4 weeks for up to 2 years if responding disease with clinical improvement and no unacceptable toxicity.
  • All responding subjects (CR, PR, or SD with clinical benefit) who subsequently relapse or progress within 1 year after discontinuation of study drug are eligible for re-treatment.
  • An optimal two-stage phase II trial design will be used to rule out a best overall response rate of 20%. If fewer than 3 of the first 17 subjects respond, the study would accrue no more subjects.
  • Subjects with both EBV-positive LPD and EBV-positive NHL will be enrolled on this protocol for a total of 37 evaluable subjects. In order to allow for inevaluable subjects and screen failures, the accrual ceiling will be set at 40 subjects.
02

Conditions studied

  • Epstein-Barr Virus Infections
  • Lymphoma
  • Lymphoproliferative Disorder
  • Disorders, Lymphoproliferative

Keywords

  • Monoclonal Antibody
03

In context

Epstein-Barr Virus Infections

175 studies on the registry are indexed under Epstein-Barr Virus Infections; 60 are open to participants now.

This study's planned enrollment of 40 is above the median of 28 across 114 interventional studies indexed under Epstein-Barr Virus Infections.

Browse Epstein-Barr Virus Infections studies →

Lead sponsor

National Cancer Institute (NCI) is the lead sponsor of 3,556 studies on the registry; 336 are open to participants now.

Of its 411 completed or terminated interventional studies of FDA-regulated products, 373 (91%) have results posted.

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

04

Who can participate

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

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Subjects must have or cytologically confirmed EBV-positive LPD or an EBV-positive NHL confirmed by the Laboratory of Pathology, NCI.

    • EBV-positive LPD. Subjects may be previously untreated or from prior therapy.

      1. Lymphomatoid granulomatosis (LYG), grades I-II
      2. Chronic active EBV disease (CAEBV) of B-cells or T-cells
      3. EBV-positive post-transplantation lymphoproliferative disorder (PTLD)

        NOTE: PTLD after solid organ transplantation is excluded. Patients who, at the discretion of the investigator, need urgent therapy with standard agents will not be eligible.

    • EBV-positive B-cell NHL. Subjects must have relapsed from previous treatment with an anthracycline and rituximab-based regimen or be considered not eligible for the same.

      1. Lymphomatoid granulomatosis (LYG), grade III
      2. EBV-positive immunodeficiency-associated diffuse large B-cell lymphoma (DLBCL)
      3. EBV-positive DLBCL
  • Subjects must be at least 2 weeks from prior anti-lymphoma therapy (including radiation therapy)
  • Subjects must be at least 100 days from prior stem cell transplant (autologous or allogeneic) or Donor Lymphocyte Infusion (DLI)

    • Age >=12 years
    • Patients >= 12 and \< 18 years of age should weigh at least 40 kilograms (kg); there is no weight requirement for adult subjects.
    • NOTE: If a pediatric patient is identified for possible enrollment who weighs less than 40 kg, the safety of the nivolumab dosing strategy used in this study must be discussed with the PI and manufacturer to confirm safety, and this discussion/approval for enrollment documented in the medical record prior to declaring the pediatric patient eligible.
  • Adequate performance status as follows:

    • Patients >= 16 years must have Performance Status 0-2 ( >=60%)
    • Pediatric patients \< 16 years must have Lansky play-performance of 60-100%
  • Subjects must have measurable or evaluable disease.
  • Subjects must have adequate organ and bone marrow reserve (unless disease-related) as defined below:

    • - >= 750/mcL; >= 500/mcL if impairment is due to LPD/NHL
    • - >= 50,000/mcL; >= 25,000/mcL if impairment is due to LPD/NHL (transfusions not permitted)
    • - >= 9g/dL (transfusion permitted)
    • total - \< 3.0g/dl OR \< 5.0g/dl if Gilbert s syndrome or disease infiltration of the liver is present
    • (SGOT)/ALT(SGPT) - \<= 3 X institutional
    • serum creatinine OR - Adults: \<= 1.5 mg/dL; Minors: serum Cr \<= age-adjusted normal OR >= 40 ml/min/1.73m\^2

Age(Years) 12-15: Maximum Serum Creatinine (mg/dl): 1.2

Age(Years) > 15: Maximum Serum Creatinine (mg/dl): 1.5

  • A formalin fixed tissue block or at least 15 slides of tumor sample (archival or fresh) must be available for performance of correlative studies. NOTE: Patient must be willing to have a pre-treatment tumor if adequate archival tissue is not available.
  • The toxicity profile of nivolumab in patients with disease involvement of the central nervous system (CNS) is unknown. For this reason, we will introduce early stopping rules.
  • The effects of nivolumab on the developing human fetus are unknown. For this reason, the following measures apply:

    • Women of (WOCBP) must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) during screening and within 48 hours prior to the first dose of nivolumab.
    • WOCBP and men who are sexually active with WOCBP must use adequate (e.g., hormonal or 2 barrier methods with a failure rate of less than 1% per year or abstinence) prior to study entry and throughout study drug administration. WOCBP receiving nivolumab will be instructed to adhere to contraception for a period of 23 weeks after the last dose of product. Men receiving nivolumab and who are sexually active with WOCBP will be instructed to adhere to contraception for a period of 31 weeks after the last dose of investigational product.
    • Women who are not of childbearing potential (i.e., who are or surgically sterile as well as azoospermic men do not require contraception).
    • WOCBP is defined as any female who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy), and who is not postmenopausal. Post menopause is defined as:

      1. Amenorrhea >= 12 consecutive months without another cause, and a documented serum follicle stimulating hormone (FSH) level > 35 mIU/mL or
      2. Women with irregular menstrual periods and a documented serum follicle stimulating hormone (FSH) level > 35 mIU/mL or NOTE: FSH level testing is not required for women >= 62 years old with amenorrhea of >= 1 year
      3. Women on hormone replacement therapy (HRT)
  • Pregnant women are excluded from this study because nivolumab is an IgG monoclonal antibody with the potential for teratogenic or abortifacient effects.
  • Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with nivolumab, nursing should be discontinued if the mother is treated with nivolumab.
  • Ability of subject or Legally Authorized Representative (LAR) to understand and sign the written document.

Exclusion criteria

EXCLUSION CRITERIA:

  • Subjects who are receiving any other agents.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to nivolumab.
  • Subjects with second requiring active systemic therapy are excluded. Subjects with second malignancies not requiring active systemic therapy or pre-malignant conditions such as monoclonal B-cell lymphocytosis (MBL) or monoclonal gammopathy of undetermined significance (MGUS) may be eligible.
  • Subjects with any condition or disease that requires systemic (> 10 mg daily prednisone equivalents) or medications within 14 days of study drug administration. Inhaled or topical steroids are permitted.
  • Subjects with active graft-vs-host disease () requiring steroids or other immunosuppressive agents; history of >=grade II acute GVHD or extensive chronic GVHD.
  • Subjects who have had solid organ transplant.
  • Prior therapy with an , anti-PD-L1, anti-PD-L2, anti-CD137 or anti CTLA-4 antibody.
  • Non-oncology vaccine therapies for prevention of infectious disease within 4 weeks of study drug administration.
  • A serious uncontrolled medical condition requiring therapy.
  • Seizures disorder not controlled by anti-seizure medications.
  • Subjects with CNS involvement may be included on the study as long as they have not had any seizure activity in past 4 weeks.
  • virus surface antigen positive.
  • Active infection with a positive PCR; subjects who are Hepatitis C antibody positive and PCR negative may be eligible. In these cases, the subjects will be monitored via HCV PCR throughout the study.
  • History of anaphylactic reaction to monoclonal antibody therapy.
  • positive subjects are excluded because the function of their T-cell immune responses is impaired.
Terms in these criteria, in plain language(26)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Histologically or cytologically confirmed

The diagnosis was confirmed by looking at a sample under a microscope: tissue from a biopsy or surgery (histology), or cells from a fluid or needle sample (cytology).

Your pathology report is the document that shows this.

Relapsed and refractory

Relapsed: the illness came back after treatment had worked. Refractory: it did not respond to treatment, or stopped responding while still on it.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Karnofsky performance status (KPS)

A 0–100 scale of how well someone can carry out everyday activities. 100 is no complaints and no signs of illness; 70 is able to look after yourself but not to work or keep up normal activity; 50 is needing considerable help and frequent medical care.

Studies often ask for 60 or 70 and above. Your doctor gives the score.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

Biopsy and archival tissue

A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.

Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

Postmenopausal

Periods have stopped for good: usually no period for 12 months in a row without another medical reason, sometimes confirmed by a blood test (FSH).

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Autoimmune disease

A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.

Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Immunosuppression

A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.

Read whether the line is about a condition or about medicines, and which medicines and doses it means.

GVHD (graft-versus-host disease)

After a transplant from a donor, the donor’s immune cells attack the recipient’s body, often the skin, gut or liver.

PD-1, PD-L1 and checkpoint inhibitors

PD-1, PD-L1 and CTLA-4 are proteins that act as brakes on the immune system. Checkpoint inhibitors, such as pembrolizumab or nivolumab, block them so the immune system can attack a cancer.

PD-L1 can also be measured in a tumour sample. Some scores count stained tumour cells only (TPS); others also count certain immune cells (CPS). The study names the score and the minimum it uses.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Non-randomized
Intervention model
Single group
Masking
None (open label)
Enrollment
40 participants (estimated)

Study arms

  • Experimental
    Nivolumab (A)

    Nivolumab, 3mg/kg IV every 2 weeks for up to 2 years in subjects with responding disease with clinical benefit if they are tolerating treatment (closed effective with activation of Amendment C)

    Biological: Nivolumab

  • Experimental
    Nivolumab (B)

    Nivolumab, 480 mg IV every 4 weeks for up to 2 years in subjects with responding disease with clinical benefit if they are tolerating treatment

    Biological: Nivolumab

Interventions

  • BiologicalNivolumab

    Nivolumab, 480 mg IV every 4 weeks for up to 2 years in subjects with responding disease with clinical benefit if they are tolerating treatment

06

What researchers measure

Primary outcomes

  1. overall response rate of nivolumab in patients with EBV-positive LPD and EBV-positive NHL

    number of patients who respond to the protocol therapy (CR, PR, SD)

    Time frame: one year

Secondary outcomes

  1. toxicity profile of nivolumab in patients with EBV-LPD

    number and type of AEs experienced

    Time frame: 4 weeks

  2. PFS of patients with EBV-LPD treated with nivolumab

    number of patients who do not experience progressive disease

    Time frame: annually

  3. overall survival of patients with EBV-LPD treated with nivolumab

    number of patients that survive 5 years or more

    Time frame: annually

  4. duration of remission for patients who respond to nivolumab

    number of months patients stay in remission

    Time frame: 4 weeks

07

Study locations

1 of 1 sites recruiting
  • National Institutes of Health Clinical Center
    Bethesda, Maryland 20892, United States
    Recruiting
    • For more information at the NIH Clinical Center contact National Cancer Institute Referral Office · Contact888-624-1937
08

References and documents

Individual participant data

Plan to share: Yes — There is a plan to make IPD and related data dictionaries available. In addition, all large scale genomic sequencing data will be shared with subscribers to dbGaP.

Supporting information: Study protocol, Statistical analysis plan, Informed consent form

Time frame: Clinical data will be available during the study and indefinitely. Genomic data will be available once genomic data are uploaded per protocol GDS plan for as long as database is active.

Access criteria: Clinical data will be made available via subscription to BTRIS and with the permission of the study PI. Genomic data will be made available via dbGaP through requests to the data custodians.

09

Timeline

4 registry updates since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Started Apr 2018 (actual). Primary completion is estimated for Jun 2029, 133 months after the start.

How these figures are worked out, and which studies are left out of them.

Registered
Aug 22, 2017
First posted
Aug 23, 2017
StartActual
Apr 26, 2018
Primary completionEst.
Jun 1, 2029
CompletionEst.
Jun 1, 2031
Last update
Nov 10, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
Minor edits
Nothing that changes what the study is or who can join. Edited: description and verification date
4 updates, last Nov 10, 2026
Show all 4 updates
  1. Nov 10, 2026
    Minor edits only
    + 1 other change: verification date
  2. Oct 16, 2026
    Minor edits only
    + 2 other changes: verification date and description
  3. Oct 13, 2026
    Minor edits only
    + 1 other change: description
  4. Oct 2, 2026
    Minor edits only
    + 1 other change: description

From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗

10

Registry details

Key details

Study ID
NCT03258567
Responsible party
Sponsor
First posted
Aug 23, 2017
Start date
Apr 26, 2018
Primary completion
Jun 1, 2029 (estimated)
Completion
Jun 1, 2031 (estimated)
Last update
Nov 10, 2026

Study contacts

NCI Medical Oncology Referral Office
Contact
ncimo_referrals@nih.gov
(240) 760-6050
Christopher J Melani, M.D.
Contact
christopher.melani@nih.gov
(240) 760-6057
Christopher J Melani, M.D.
principal investigator · National Cancer Institute (NCI)

Oversight

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

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Studies of the drug tested here: Nivolumab

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