Homoharringtonine, BCL-2 Inhibitor, Rituximab, and Prednisone in Relapsed/Refractory Diffuse Large B-Cell Lymphoma

NCT07159906 | Not Yet Recruiting Phase 1

• 1 other identifier: IIT20250087C-R2
• Study Type: interventional
• Target: 62
• Locations: 1 country
• Sites: 1

Brief Summary

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in China and worldwide. Although standard immunochemotherapy with Rituximab, Cyclophosphamide, Doxorubicin Hydrochloride, Vincristine (Oncovin), and Prednisone (R-CHOP) achieves durable remissions in many patients, approximately 30-40% experience relapse or refractory disease with poor outcomes. Novel strategies are needed for patients who are not candidates for transplantation or who relapse after multiple lines of therapy. Homoharringtonine (HHT) is a natural cephalotaxine alkaloid extracted from Cephalotaxus species, clinically approved in China for acute and chronic myeloid leukemias. It inhibits ribosomal protein synthesis, modulates oncogenic and epigenetic signaling pathways, and induces apoptosis through mitochondrial and stress-activated pathways. Importantly, HHT downregulates the anti-apoptotic protein Myeloid Cell Leukemia 1 (MCL-1), a critical resistance factor to B-cell lymphoma 2 (BCL-2) inhibitors. This provides a strong mechanistic rationale for combining HHT with a BCL-2 inhibitor, together with rituximab and prednisone, in relapsed/refractory DLBCL. This prospective, multicenter, single-arm, Phase Ib/II study will evaluate the safety, tolerability, and efficacy of HHT, a BCL-2 inhibitor, rituximab, and prednisone in adult patients with relapsed/refractory DLBCL. Phase Ib will enroll 15-22 patients to determine the maximum tolerated dose (MTD), dose-limiting toxicities (DLT), and the recommended phase II dose (RP2D) of HHT. Phase II will enroll 40 patients treated at RP2D to evaluate the overall response rate (ORR) after 3 and 6 cycles per Lugano 2014 criteria. Secondary endpoints include complete remission (CR), partial remission (PR), progression-free survival (PFS), and overall survival (OS). Exploratory analyses will incorporate molecular biomarkers such as genomic profiling, circulating tumor DNA (ctDNA), and spatial transcriptomics.

Conditions

Diffuse Large B-Cell Lymphoma; Relapsed Non-Hodgkin Lymphoma; Refractory Non-Hodgkin Lymphoma

Outcome Measures

Primary Outcomes (4)

• Dose-Limiting Toxicities (DLT)

  Incidence of dose-limiting toxicities assessed during Cycle 1, according to NCI Common Terminology Criteria for Adverse Events (CTCAE) v5.0.

  Cycle 1 (first 21-day cycle)

• Maximum Tolerated Dose (MTD)

  The highest dose level at which ≤1 out of 6 patients experience a DLT, determined during dose-escalation phase.

  End of Phase Ib dose-escalation

• Recommended Phase II Dose (RP2D)

  RP2D determined based on DLT, MTD, safety, and preliminary efficacy findings in Phase Ib.

  End of Phase Ib dose-escalation

• Overall Response Rate (ORR)

  Proportion of patients achieving CR or PR, assessed per Lugano 2014 criteria using Positron Emission Tomography-Computed Tomography (PET-CT) or Computed Tomography (CT).

  At Cycle 3 and Cycle 6

Secondary Outcomes (4)

• Complete Response (CR) Rate

  At Cycle 3 and Cycle 6

• Partial Response (PR) Rate

  At Cycle 3 and Cycle 6

• Progression-Free Survival (PFS)

  Up to 24 months from enrollment

• Overall Survival (OS)

  Up to 24 months from enrollment

Study Arms (1)

HHT-Based Combination

EXPERIMENTAL

Patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) will receive the investigational combination of homoharringtonine, BCL2 inhibitor, rituximab, and prednisone. Treatment will be administered in 21-day cycles, with dose escalation in Phase Ib to determine dose-limiting toxicities (DLTs), maximum tolerated dose (MTD), and recommended Phase II dose (RP2D), followed by a Phase II expansion to evaluate efficacy and safety.

Drug: Homoharringtonine; Drug: BCL-2 inhibitor; Drug: CD20 Antibody; Drug: Glucocorticoid (GC)

Interventions

Homoharringtonine DRUG

A cephalotaxine alkaloid and protein synthesis inhibitor that downregulates Myeloid Cell Leukemia 1 (MCL-1), administered intravenously in 21-day cycles. Dose escalation in Phase Ib will determine dose-limiting toxicities (DLTs), maximum tolerated dose (MTD), and recommended Phase II dose (RP2D).

Also known as: HHT

HHT-Based Combination

BCL-2 inhibitor DRUG

An oral selective BCL2 inhibitor administered once daily D1-7. Combined with homoharringtonine, rituximab, and prednisone in 21-day cycles.

Also known as: Lisaftoclax, APG-2575

HHT-Based Combination

CD20 Antibody DRUG

An anti-CD20 monoclonal antibody administered intravenously, used in combination with chemotherapy or targeted regimens for B-cell malignancies.

Also known as: Rituximab

HHT-Based Combination

Glucocorticoid (GC) DRUG

glucocorticoid , given as part of the combination regimen to enhance anti-lymphoma effect.

Also known as: Prednisone

HHT-Based Combination

Eligibility Criteria

• Age: 18 Years - 99 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Histopathologically confirmed CD20-positive diffuse large B-cell lymphoma;
• Age ≥18 years at enrollment, regardless of gender, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-3;
• Disease is refractory to or progresses within one year after first-line standard therapy containing anti-CD20 monoclonal antibodies and anthracycline-based chemotherapy, or has failed or relapsed after second-line or later standard treatment regimens, or has relapsed after autologous hematopoietic stem cell transplantation (more than 6 months post-transplant);
• At least one measurable lesion present (as defined by the Lugano 2014 response criteria: measurable lesion is defined as a lymph node lesion with a longest diameter \>1.5 cm on CT axial imaging, or an extranodal lesion with a longest diameter \>1.0 cm, and 18F-FDG PET/CT positive lesion);
• Able to provide written informed consent and capable of understanding and complying with all study requirements.

You may not qualify if:

• Patients with poor compliance or inability to attend regular follow-up visits;
• Presence of severe organ dysfunction, as judged by the investigator, that renders the patient unsuitable for participation in this trial;
• Absolute neutrophil count \< 1.0 × 10⁹/L, platelet count \< 50 × 10⁹/L, or hemoglobin \< 80 g/L (excluding cases due to lymphoma bone marrow infiltration);
• Other factors, as determined by the investigator, that may lead to forced early withdrawal from the study, such as other serious medical conditions (including psychiatric disorders) requiring concomitant treatment, alcoholism, drug abuse, or family/social factors that may affect patient safety or compliance;
• History of immunodeficiency, including HIV-positive status, or other acquired or congenital immunodeficiency diseases;
• Pregnant or breastfeeding women, and fertile patients unwilling to use contraception.
• Acute or chronic active hepatitis B or C infection, with HBV DNA \> 2000 IU/mL or 10⁴ copies/mL, or HCV RNA \> 10³ copies/mL;
• Central nervous system (CNS) metastases; however, patients with asymptomatic CNS metastases or those with symptoms that have been treated and stabilized for ≥4 weeks may be eligible;
• Prior history of allogeneic hematopoietic stem cell transplantation;
• Cardiac dysfunction: baseline Corrected QT interval (QTc) ≥ 500 ms; Left Ventricular Ejection Fraction (LVEF) \< 45%, or New York Heart Association (NYHA) classification Class III/IV heart failure;
• Known severe hypersensitivity to benzyl alcohol or any other components of the study drugs;
• Requirement for concomitant use of strong CYP3A4 inducers due to medical necessity.

Sponsors & Collaborators

• First Affiliated Hospital of Zhejiang University: lead

Study Sites (1)

Department of Hematology, The First Affiliated Hospital, School of Medicine, Zhejiang University

Hangzhou, Zhejiang, 310003, China

Location

MeSH Terms

Conditions

Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin

Interventions

Homoharringtonine; PTH2 protein, human; Lisaftoclax; Rituximab; Glucocorticoids; Prednisone

Condition Hierarchy (Ancestors)

Lymphoma, B-Cell; Lymphoma; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Hemic and Lymphatic Diseases; Immunoproliferative Disorders; Immune System Diseases

Intervention Hierarchy (Ancestors)

Harringtonines; Alkaloids; Heterocyclic Compounds; Benzazepines; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds, 4 or More Rings; Antibodies, Monoclonal, Murine-Derived; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Proteins; Amino Acids, Peptides, and Proteins; Serum Globulins; Globulins; Adrenal Cortex Hormones; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Physiological Effects of Drugs; Pharmacologic Actions; Chemical Actions and Uses; Pregnadienediols; Pregnadienes; Pregnanes; Steroids; Fused-Ring Compounds; Polycyclic Compounds

Central Study Contacts

Jie Jin, MD

CONTACT

+86 13505716779; jiej0503@163.com

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 17, 2025
• First Posted: September 8, 2025
• Study Start: September 8, 2025
• Primary Completion (Estimated): August 1, 2027
• Study Completion (Estimated): August 1, 2028
• Last Updated: September 8, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)