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RecruitingLast updated: 29 May 2026

The AFL Study: Investigating if low-dose, localised radiation therapy can sometimes activate the immune system to cause shrinkage or even disappearance of disease in other parts of the body, outside of the treated region, in people with advanced Follicular LymphomaUnderstanding the Abscopal Effect of Involved-Site Radiotherapy in Patients with Follicular Lymphoma Aged 40 years and over

Trial purpose

Medical clipboardCancer treatment; Diagnostic

Tumor type

Blood Cancers Haematological

Age

People40+

Trial acronym

The AFL Study

Clinical summary

Summary

This study is looking at whether a very low dose of targeted radiotherapy (called involved-site radiation therapy, or ISRT) can help the body's own immune system fight advanced follicular lymphoma.

Usually, radiotherapy treats only the area it is aimed at. In this study, researchers are exploring whether treating just a few spots of lymphoma might also lead to shrinkage, or even disappearance, of cancer in other parts of the body that were not directly treated. This is known as an "abscopal effect".

Participants in this study will receive low-dose radiotherapy to some, but not all, of their lymphoma sites. The goal is to better understand:

  • How often this wider effect happens
  • How the immune system may be involved

Researchers will use regular scans and blood tests (and sometimes tissue samples) to study how the body responds.

Who is it for?
This study is open both to people with follicular lymphoma who have had recurrence of disease after previous treatment, and people who have slow growing or stable lymphoma that would be otherwise managed by close observation without any current active therapy. You must be aged 40 and over.

Study details
All participants will have a PET/CT scan, which is a common scan used to detect lymphoma. This involves a small amount of a radioactive tracer being injected into your blood stream and a scan that shows where lymphoma is in your body.

In addition to standard scans, this study will use two newer types of PET tracers that can give more information about your immune system:

  • 89Zr-IAB22M2C - helps show where certain immune cells (called CD8 T cells) are in your body. These cells can help kill cancer cells.
  • 89Zr-durvalumab - shows a protein called PD-L1, which can be found on some cancer cells and immune cells and is important in how the immune system responds to cancer.

After these tracers are injected, there will be a wait of 1-5 days before the scan, to allow the tracer to be taken up by the body.

By using these new PET tracers, researchers hope to increase their understanding of the effects of radiation on immunity in general and on the abscopal effect in particular.

 

Conditions

This trial is treating people with low grade follicular lymphoma that is either recurrent or slow growing/stable

Eligibility

Inclusion

1) Eligible to receive palliative ISRT for histologically confirmed low grade (WHO grade1,2 or 3a) follicular lymphoma,
2) Requiring ISRT to local disease for palliation or prevention of local disease progression, or eligible for a “watchful waiting” approach to management
3) >2 lymphoma lesions visualized on FDG-PET scan, with FDG uptake > liver (not including spleen or bone marrow disease)
4) >1 FDG-avid lesion(s) located outside planned ISRT volume, with FDG uptake > liver (not including spleen or bone marrow disease)
5) No systemic therapy (chemo or immunotherapy) delivered in the 2 months before radiation therapy
6) No systemic therapy planned for at least 2 months after ISRT
7) Capable of giving informed consent
8) Life expectancy > 12 months
9) ECOG performance status 0-1 (or 2 if impairment is not related to lymphoma)
10) Available FFPE biopsy specimen confirming diagnosis of FL, suitable for translational studies
11) Age >40

Exclusion

1) Initial presentation of stage II disease suitable for curative intent RT
2) Any active high grade lymphoma
3) Any prior history of aggressive or transformed lymphoma
4) >2 prior systemic therapy regimens
5) Taking any immunosuppressive medication (e.g. steroids)
6) Active autoimmune disease
7) Neutropaenia (<1.0 x 109)
8) All FDG-avid disease sites are considered to be high priority for early treatment with ISRT and no lesion can safely be left untreated
9) Irradiation of a lesion selected for ISRT would inadvertently irradiate all nominally “untreated” lesions, intended for observation, to > 0.4 Gy
10) Palliative ISRT is required within 7 days for rapid symptom relief
11) Women who are pregnant or who are breastfeeding

Inclusion

  • You have had treatment, but your cancer has come back (relapsed or recurrent).
  • You have been diagnosed with cancer, but have not received any treatment.

Exclusion

  • You have certain types of non-cancer medical conditions.
  • You have had certain treatments, surgical procedures or drugs.
Message

Clinical trials have complex eligibility criteria, and other criteria may apply for this trial. Ask your doctor about whether this trial could be right for you.

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Trial Identifiers

Information on this page is partially produced from ANZCTR *. View further details about this trial on the registry via the links below:

Trial sponsor

Peter MacCallum Cancer Centre

Scientific Title

Understanding the Abscopal Effect of Involved-Site Radiotherapy in Patients with Follicular Lymphoma Aged 40 years and over

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