Application of PD-1 Inhibitors, Tenofovir, Chidamide, and Lenalidomide in Relapsed/Refractory EBV-associated Lymphoproliferative Disorders.

Not Applicable

Not yet recruiting

• Conditions: Lenalidomide; EBV-Associated Lymphoproliferative Disorders; PD-1 Inhibitor; Tenofovir; Chidamide
• Interventions: Drug: PD-1 Inhibitor Combined with Tenofovir, Chidamide, and Lenalidomide for the Treatment of EBV-Associated Lymphoproliferative Disorders.

• Registration Number: NCT07133763
• Lead Sponsor: The Affiliated Hospital of Xuzhou Medical University

Brief Summary

This study is a prospective, multicenter, single-arm clinical trial designed to evaluate the efficacy and safety of PD-1 inhibitor combined with tenofovir, chidamide, and lenalidomide in the treatment of relapsed or refractory Epstein-Barr virus (EBV)-associated lymphoproliferative disorders (LPDs). The primary endpoint is the overall response rate (ORR) at 3 months, including complete response (CR) and partial response (PR). Secondary endpoints include overall survival (OS), progression-free survival (PFS), as well as safety and tolerability assessments. Eligible patients must have histologically confirmed EBV-positive B-cell or T/NK-cell LPDs with measurable lesions. This combination regimen targets multiple mechanisms, including inhibition of EBV replication, activation of the immune system, and enhancement of antitumor effects, aiming to provide an innovative therapeutic strategy for this challenging disease.

Detailed Description

Not available

Study Timeline

• Status Verified: 2025-08
• Study First Submitted: 2025-08-04
• Study First Submitted QC: 2025-08-14
• Last Update Submitted: 2025-08-14
• Study First Posted: 2025-08-21
• Last Update Posted: 2025-08-21
• Study Start: 2025-09-01
• Primary Completion: 2027-09-01
• Study Completion: 2027-09-01

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 50

Inclusion Criteria

1. Histologically confirmed EBV-associated lymphoproliferative disorders, including EBV-positive B-cell LPD and EBV-positive T/NK-cell LPD, with EBV-encoded RNA (EBER)+ by in situ hybridization, or EBV nuclear antigen (EBNA)+, or latent membrane protein (LMP1/2)+ in the lesion tissue.
2. Age ≤75 years with an ECOG performance status ≤2.
3. At least one bidimensionally measurable lesion for evaluation: for nodal lesions, longest diameter ≥1.5 cm and shortest diameter ≥1.0 cm; for extranodal lesions, longest diameter ≥1.0 cm; or ≥20% monoclonal EBV-infected lymphocytes detected by flow cytometry.
4. Expected survival of more than 3 months.
5. Ability to comply with follow-up. Patients must be aware of the nature of their disease and voluntarily agree to participate in the study and follow-up.

Exclusion Criteria

1. Patients with impaired liver or kidney function, defined as serum direct bilirubin, indirect bilirubin, and/or ALT, AST, or serum creatinine levels >2 times the upper limit of normal, unless deemed lymphoma-related.

2. Patients with bone marrow failure, defined as absolute neutrophil count (ANC) <1.5×10⁹/L or platelets <75×10⁹/L, unless the hematologic abnormalities are considered due to bone marrow infiltration by lymphoma.

3. Patients who have experienced grade ≥3 neurotoxicity within the past 2 weeks.

4. Patients with chronic heart failure classified as NYHA Class III or IV, or with left ventricular ejection fraction <50%, or with a history within the past 6 months of any of the following: acute coronary syndrome, acute heart failure (Class III or IV), or significant ventricular arrhythmias (e.g., sustained ventricular tachycardia, ventricular fibrillation, or post-resuscitation sudden cardiac arrest).

5. Patients with AIDS, syphilis, or active hepatitis B (HBV DNA >1×10⁴ copies/ml) or active hepatitis C infection.

6. Patients diagnosed with malignancies other than lymphoma or currently undergoing treatment for other cancers, except:

   ① Those who have received curative treatment and have been disease-free for ≥5 years prior to enrollment;

   ② Patients with adequately treated, non-melanoma skin cancers such as basal cell carcinoma without evidence of disease;

   ③ Patients with adequately treated carcinoma in situ of the cervix without evidence of disease.

7. Patients with other hematologic diseases (e.g., hemophilia, myelofibrosis) considered unsuitable for the study by the investigator.

8. Patients with severe active infections.

9. Patients who underwent Grade 2 or higher surgery within 3 weeks before treatment initiation.

10. Patients with a history of substance abuse, or medical, psychological, or social conditions that may interfere with study participation or evaluation, as judged by the investigator.

11. Any other condition the investigator considers unsuitable for study enrollment.

12. Known hypersensitivity to any component of the investigational drugs.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Evaluate efficacy and safety of multi-drug therapy in EBV-Associated Lymphoproliferative Disorders.	PD-1 Inhibitor Combined with Tenofovir, Chidamide, and Lenalidomide for the Treatment of EBV-Associated Lymphoproliferative Disorders.	To investigate the therapeutic effect of PD-1 inhibitor combined with tenofovir, chidamide, and lenalidomide in EBV-Associated Lymphoproliferative Disorders, and to evaluate its safety and clinical benefit in this patient population.

Primary Outcome Measures

Name	Time	Method
To evaluate the 3-month overall response rate (ORR), including complete and partial responses, in relapsed/refractory EBV-associated LPD patients treated with PD-1 inhibitor, tenofovir, chidamide, and lenalidomide.	After 3 months of treatment according to the study protocol, a comprehensive efficacy assessment will be conducted. Patients achieving CR or PR will continue treatment, while those with SD or PD will be withdrawn from the study.

Secondary Outcome Measures

Name	Time	Method
24-month Progression-free Survival Rate in Relapsed/Refractory EBV-Associated Lymphoproliferative Disorders.	From first dose until first documented progression or death (assessed at 24 months)	Proportion of patients without disease progression at 24 months per Lugano 2014 criteria.
24-month Overall Survival Rate in Relapsed/Refractory EBV-Associated Lymphoproliferative Disorders.	From first dose until death from any cause (assessed at 24 months）	Proportion of patients alive at 24 months after initiation of tirelizumab combination therapy.