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Non-hodgkin Lymphoma, B CellSAKK 38/23NCT06090162

LIBERTY: Liquid Biopsy to Diagnose and Monitor CNS Involvement in High-risk B Cell Non-Hodgkin Lymphoma

A study testing ctDNA detection in people with Non-hodgkin Lymphoma, B Cell, run by Swiss Cancer Institute at 14 sites in Switzerland.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

Prevention and treatment of CNS relapse remains a great unmet clinical need in the management of aggressive B-NHL. Hence, investigating novel diagnostic tests is of paramount importance to improve risk-stratification of lymphoma patients at diagnosis, as is the evaluation of novel therapeutic approaches that may… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Non-hodgkin Lymphoma, B Cell
What is being tested?
ctDNA detection
Could I receive a placebo?
No, everyone receives an active treatment
How many people
64 participants
Where
14 sitesSwitzerland
Study dates
12 Mar 2024to Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Informed consent as documented by signature before registration and prior to any trial specific procedures, according to Swiss law and ICH E6 regulations Swiss law and ICH GCP E6(R2) regulations before registration.
  • Histologically and/or cytologically confirmed newly diagnosed lymphomas including the following:
  • Diffuse large B-cell lymphoma (DLBCL) with at least one of the following characteristics:
  • CNS IPI > 4
  • Non-GC/ABC subtype with IPI > 3
  • Testicular involvement
Show all 22Show fewer
  • Breast involvement
  • Kidney involvement
  • Adrenal involvement
  • Paranasal sinus / orbit involvement
  • Involvement of ≥ 3 extranodal sites
  • HIV-positive
  • Radiological or histological CNS involvement
  • High-grade B-cell lymphoma with MYC translocation with BCL2 and / or BCL6 (HGBL)
  • Burkitt lymphoma
  • Mantle cell lymphoma (blastoid variant or Ki67 >30% or TP53 mutated)
  • Primary CNS lymphoma
  • Note:
  • Aggressive transformation from indolent lymphomas (pretreated or not) are allowed
  • Patients enrolled in other clinical trials may be included
  • Patients must be willing to undergo a lumbar puncture at screening
  • Age ≥ 18 years

Who cannot join

  • Subtypes of Non-Hodgkin lymphoma (NHL) not fulfilling above mentioned criteria (e.g., indolent lymphoma, T-cell lymphoma)
  • Relapsing B-NHL
  • Low/intermediate-risk DLBCL (CNS-IPI < 4) AND no CNS involvement on imaging
  • Any prior lymphoma-directed therapy before registration, with the exception of a maximum of 48 hours steroids prior to lumbar puncture procedure and therapies received for indolent lymphomas prior to transformation
  • Any active advanced or metastatic cancer
  • Any clinical contraindication to lumbar puncture procedure as per local guidelines
  • Any other serious underlying medical, psychiatric, psychological, familial or geographical condition, which in the judgment of the investigator may interfere with the planned diagnostic procedure.

Trial locations and contacts

14 sites in 1 country.

14 sites in 1 country

Switzerland14 sites
  • Kantonspital Aarau

    Aarau, 5001

  • Universitätsspital Basel

    Basel, 4056

  • Istituto Oncologico della Svizzera Italiana (IOSI)

    Bellinzona, 6500

  • Inselspital Bern - Universitätsklinik für Medizinische Onkologie

    Bern, 3010

  • Kantonsspital Graubünden

    Chur, 7000

  • Hôpital Fribourgeois - Hôpital Cantonal

    Fribourg, 1708

  • Hopitaux Universitaire de Genève (HUG)

    Geneva, 1205

  • CHUV - Départment d'oncologie

    Lausanne, 1011

  • Kantonsspital Baselland

    Liestal, 4410

  • Kantonsspital Münsterlingen

    Münsterlingen, 8596

  • Kantonsspital St. Gallen

    Sankt Gallen, 9007

  • Hôpital du Valais, Hôpital de Sion

    Sion, 1951

  • Klinik für Hämatologie und Onkologie Hirslanden Zürich

    Zurich, 8032

  • Stadtspital Triemli Zürich

    Zurich, 8063

Other trials in Switzerland

About this study

Official title: LIBERTY: Liquid Biopsy to Diagnose and Monitor Central Nervous System (CNS) Involvement in High-risk B Cell Non-Hodgkin Lymphoma

Prevention and treatment of CNS relapse remains a great unmet clinical need in the management of aggressive B-NHL. Hence, investigating novel diagnostic tests is of paramount importance to improve risk-stratification of lymphoma patients at diagnosis, as is the evaluation of novel therapeutic approaches that may prevent and / or treat CNS recurrence. Based on the highlighted evidence, the investigators hypothesize that ctDNA detected within the CSF could potentially improve the detection rate of CNS involvement and consequently improve patients' stratification and better discriminate those in need of consolidative CNS prophylaxis on a molecular basis. Similarly, the investigators postulate that CSF ctDNA could be used as a monitoring tool to assess treatment response and guide therapeutic management.

Read the detailed description

Non-Hodgkin B-cell lymphoma (B-NHL) are cancers that arise from a subtype of white blood cells (lymphocyte) and typically involve the lymphatic system; they represent 4% of all cancers [SEER database, access 2022]. Despite booming novel antineoplastic agent development, a significant number of aggressive B-NHL patients continue to succumb to their disease, experiencing rapidly progressive disease or early relapse. Central nervous system or CNS (brain, spinal cord and cerebrospinal fluid (CSF)) involvement in aggressive B-NHL is a rare (2-5%) but it is a devastating event, with a life expectancy ranging between 2 and 5 months [PMID: 30125215]. Circulating tumor DNA (ctDNA) represents fragmented DNA that originates from tumors cells, carrying specific cancer-associated mutations that can be detected in the blood or other fluids subsumed under "liquid biopsies".

The role of ctDNA gained momentum with the advent of high throughput sequencing technologies, becoming increasingly relevant for clinical practice. In lymphoma, detecting and monitoring ctDNA has been shown to be feasible and of high prognostic relevance regarding response and relapse. As such, ctDNA is emerging as a promising biomarker that can provide valuable diagnostic and prognostic information [PMID: 30125215, PMID: 29449275]. Identification of patients suffering from aggressive B-NHL at high risk of CNS relapse remains extremely challenging and currently mainly relies on a clinical score (CNS-IPI) [PMID: 27382100]. The detection of asymptomatic CNS is limited to conventional techniques and is not standardized [PMID: 22927246]. In patients with biopsy-proven CNS lymphoma, ctDNA can be detected in CSF (CSF ctDNA) in approximately 95% of cases. Furthermore, CSF ctDNA is predictive of CNS relapse in a small series of neurologically asymptomatic patients with aggressive B-NHL [PMID: 36542815, PMID: 32079701, PMID: 34551072]. Prevention and treatment of CNS involvement remains a great unmet clinical need. The discovery of novel and robust biomarkers is of paramount importance for early detection and risk-adapted therapeutic strategies for CNS involvement. The investigators hypothesize that CSF ctDNA is superior to current standard diagnostic procedures (e.g., flowcytometry or cytology) to detect CNS involvement in high-risk patients.

Furthermore, in patients with positive CSF ctDNA, the investigators also postulate that the concept of monitoring minimal residual disease (MRD, small amount of ctDNA that persists in patients that have no signs of active disease on standard imaging techniques) will provide additional information on patient prognosis.

This is a multicenter prospective diagnostic study to compare the performance of experimental diagnostic test (ctDNA) versus conventional cytology (CC) and flow cytometry (FC). Each high-risk B-NHL participant will proceed through standard work-up to evaluate potential CNS involvement including a neurological physical examination, a brain MRI and a diagnostic lumbar puncture. Each participant's CSF will be assessed by the two diagnostic tests (CSF ctDNA and conventional test (CC/FC)); the gold standard being proven CNS lymphoma involvement.

Being tested
ctDNA detection
Keywords
High-risk B Cell Non-Hodgkin Lymphoma, ctDNA, experimental diagnostic test
Medical subject headings
Lymphoma, Non-Hodgkin

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ctDNA detectionDiagnostic test

    ctDNA detection on CSF and blood

Study groups in NCT06090162
Study groupRoleWhat they receive
experimental diagnostic testExperimentalLumbar punction at diagnosis. CSF and blood samples will be assessed by the two diagnostic tests (CSF ctDNA and conventional test (CC/FC))
Receives: Diagnostic Test: ctDNA detection

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Sensitivity

    Sensitivity of liquid biopsy (ctDNA) measured within CSF in its performance to detect CNS involvement in newly diagnosed high-risk B-NHL in comparison to standard conventional diagnostic approaches (CC / FC). For the evaluation of the primary endpoint, only patients with confirmed CNS involvement at baseline (real positives) will be analyzed. CNS involvement at baseline is defined as having at least one of the following conditions:

    • Positive brain or spine MRI
    • Neurological symptoms of lymphoma manifestations (including ophthalmic symptoms)
    • Histologically confirmed CNS involvement

    Measured: at baseline

Secondary outcomes (8)
  1. Specificity

    Specificity of liquid biopsy (ctDNA) measured within CSF in its performance to detect CNS involvement in newly diagnosed high-risk B-NHL in comparison to standard conventional diagnostic approaches (CC / FC). For the evaluation of specificity, only patients without CNS involvement at baseline (real negatives) will be analyzed. Absence of CNS involvement at baseline is defined as having none of the following conditions:

    • Positive brain or spine MRI
    • Neurological symptoms of lymphoma manifestations (including ophthalmic symptoms)
    • Histologically confirmed CNS involvement

    Measured: at baseline

  2. Time to lymphoma manifestation in the CNS

    Time to lymphoma manifestation in the CNS, defined as time from diagnosis to one of the following events, whatever occurs first:

    • Clinical neurological symptoms likely related to lymphoma manifestations
    • Brain or spine MRI changes compatible with lymphoma involvement
    • Histologically confirmed CNS involvement
    • Confirmed involvement of the eye (positive CC / FC)
    • Death due to lymphoma Patients without lymphoma manifestation in the CNS will be censored at their last tumor assessment by CNS imaging showing non-progression

    Measured: from the date of registration until the date of assessment of neurological symptoms or death due to lymphoma, assessed up to 1 year after registration

  3. Progression-free survival (PFS)

    PFS is defined as the time from diagnosis to lymphoma progression or relapse as per Lugano and / or IPCG criteria, or death whatever occurs first. Patients not having an event at the time of the analysis will be censored at the date of their last tumor assessment showing non-progression.

    Measured: from the date of registration until the date of progression or relapse as per Lugano and / or IPCG criteria, or death whatever occurs first, assessed up to 1 year after registration

  4. Event-free survival (EFS)

    EFS is defined as the time from diagnosis to lymphoma progression or relapse as per Lugano and / or IPCG criteria, treatment stop without achieving a complete response or death whatever occurs first. Patients not having an event at the time of analysis will be censored at the date of their last tumor assessment showing non-progression. This endpoint will be calculated separately for each treatment line.

    Measured: from the date of registration until the date of progression or relapse as per Lugano and / or IPCG criteria, treatment stop without achieving a complete response or death whatever occurs first, assessed up to 1 year after registration

  5. Overall survival (OS)

    OS will be calculated from diagnosis until death from any cause. Patients not experiencing an event will be censored at the last date they were known to be alive.

    Measured: from the date of registration until the date of death, assessed up to 1 year after registration

  6. Overall response rate (ORR)

    Overall response rate (ORR) is defined as either PR or CR according to the Lugano criteria. Patients with no tumor assessment will be considered:

    • non-ORR, if they have no following tumor assessment within the trial (patient died, refused or was lost to follow-up) or if they have non-ORR at the following tumor assessment after the end of therapy.
    • ORR, if they have ORR at the following tumor assessment after end of therapy. This endpoint will be calculated separately for each treatment line.

    Measured: At the date of tumor assessment according to the Lugano criteria, assessed up to 1 year after registration

  7. Duration of response (DOR)

    DOR is evaluated in all patients who achieved a CR after the end of the intended treatment. DOR is defined as time from first complete response until lymphoma progression, relapse or death, whatever occurs first. Response and progression are evaluated according to Lugano criteria. Patients not having an event at the time of analysis will be censored at the date of their last tumor assessment showing non-progression.

    Measured: from the date of first response CR until the date of lymphoma progression, relapse or death, whatever occurs first, assessed up to 1 years after registration

  8. Time to minimal residual disease (MRD) negativity

    Time from first documented MRD positivity (CSF ctDNA detected positive) to first documented MRD negativity. Patients not reaching MRD negativity will be censored at the last time they were known to be MRD positive. Evaluated only in patients with documented MRD positivity at any time.

    Measured: from the date of first documented MRD positivity (CSF ctDNA detected positive) to the date of first documented MRD negativity, assessed up to 1 years after registration

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Oct 2023
  2. Study start12 Mar 2024
  3. Primary completionDec 2026 (estimated)
  4. Study completionDec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Not applicable
Intervention model
Single group
Model description
This is a multicenter prospective diagnostic study to compare the performance of experimental diagnostic test (ctDNA) versus conventional cytology (CC) and flow cytometry (FC).
Masking
None (open label)
Enrolment
64 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06090162
Sponsor's protocol ID
SAKK 38/23
Acronym
SAKK 38/23
Status last verified
Mar 2026
First submitted
12 Oct 2023
Last updated
30 Mar 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A study testing ctDNA detection in people with Non-hodgkin Lymphoma, B Cell, run by Swiss Cancer Institute at 14 sites in Switzerland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 22 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 30 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 14 sites in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Sensitivity (time frame: at baseline). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Mar 2026.

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