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    Clinical Trial Results:
    Randomised induction and post induction therapy in older patients (>=61 years of age) with acute myeloid leukaemia (AML) and refractory anaemia with excess blasts (RAEB, RAEB-t)

    Summary
    EudraCT number
    2004-001918-13
    Trial protocol
    GB  
    Global end of trial date
    23 Nov 2015

    Results information
    Results version number
    v1(current)
    This version publication date
    11 Jun 2023
    First version publication date
    11 Jun 2023
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    Hovon 43
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    HOVON
    Sponsor organisation address
    De Boelelaan 1117, Amsterdam, Netherlands,
    Public contact
    HOVON Data Center, HOVON, hdc@erasmusmc.nl
    Scientific contact
    HOVON Data Center, HOVON, hdc@erasmusmc.nl
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    30 Apr 2009
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    31 Oct 2008
    Global end of trial reached?
    Yes
    Global end of trial date
    23 Nov 2015
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Main objectives: -Evaluation of the effect of an escalated dose of Daunorubincin in induction treatment -Evaluation of the effect of maintenance treatment with GO for patients in CR
    Protection of trial subjects
    Monitoring and Insurance.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    09 Oct 2000
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 17
    Country: Number of subjects enrolled
    Belgium: 159
    Country: Number of subjects enrolled
    Germany: 193
    Country: Number of subjects enrolled
    Switzerland: 109
    Country: Number of subjects enrolled
    Netherlands: 388
    Worldwide total number of subjects
    866
    EEA total number of subjects
    740
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    249
    From 65 to 84 years
    617
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    All subjects gave written informed consent and were screened according to the inclusion- and exclusion criteria.

    Period 1
    Period 1 title
    Overall period
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Arm A
    Arm description
    -
    Arm type
    Active comparator

    Investigational medicinal product name
    Dauromycin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    45 mg/m2, 3hr infusion on days 1,2,3

    Investigational medicinal product name
    Cytarabin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    200 mg/m2 CI (24 hrs), days 1 thru 7 cycle 1 1000 mg/m2 q 12 hrs, 6 hr infusion, days 1 thru 4 cycle 2

    Arm title
    Arm B
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    Dauromycin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    90 mg/m2, 3hr infusion on days 1,2,3

    Investigational medicinal product name
    Cytarabin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    200 mg/m2 CI (24 hrs), days 1 thru 7 cycle 1 1000 mg/m2 q 12 hrs, 6 hr infusion, days 1 thru 4 cycle 2

    Investigational medicinal product name
    Gemtuzumab ozogamicin
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    6 mg/m2, 2hrs infusion, days 1, 29, 57 post induction

    Number of subjects in period 1
    Arm A Arm B
    Started
    433
    433
    Completed
    93
    101
    Not completed
    340
    332
         Adverse reactions
    46
    57
         Other
    130
    121
         Lack of efficacy
    164
    154

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall period
    Reporting group description
    -

    Reporting group values
    Overall period Total
    Number of subjects
    866 866
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    249 249
        From 65-84 years
    617 617
        85 years and over
    0 0
    Age continuous
    Units: years
        median (full range (min-max))
    67 (60 to 83) -
    Gender categorical
    Units: Subjects
        Female
    383 383
        Male
    483 483

    End points

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    End points reporting groups
    Reporting group title
    Arm A
    Reporting group description
    -

    Reporting group title
    Arm B
    Reporting group description
    -

    Primary: Primary endpoint

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    End point title
    Primary endpoint [1]
    End point description
    End point type
    Primary
    End point timeframe
    See publication.
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: See attached chart/documents for results.
    End point values
    Arm A Arm B
    Number of subjects analysed
    411
    402
    Units: Whole
    411
    402
    Attachments
    List of reported non-SAE's
    List of reported SAE's
    Statistical data section from publication
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    During protocol treatment all deaths, all SAE’s that are life-threatening and any unexpected SAE must be reported within 48 hours of the initial observation of the event. All details should be documented on the Serious Adverse Event and Death Report.
    Adverse event reporting additional description
    Initial reports must be followed-up by a complete report within a further 14 calendar days.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTC
    Dictionary version
    2
    Reporting groups
    Reporting group title
    Arm A
    Reporting group description
    -

    Reporting group title
    Arm B
    Reporting group description
    -

    Serious adverse events
    Arm A Arm B
    Total subjects affected by serious adverse events
         subjects affected / exposed
    239 / 420 (56.90%)
    228 / 419 (54.42%)
         number of deaths (all causes)
    373
    365
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Neoplasm benign, malignant and unspecif. (inc. cysts/polyp)
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    34 / 420 (8.10%)
    33 / 419 (7.88%)
         occurrences causally related to treatment / all
    2 / 34
    2 / 34
         deaths causally related to treatment / all
    2 / 34
    0 / 31
    Vascular disorders
    Vascular disorders
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    6 / 420 (1.43%)
    3 / 419 (0.72%)
         occurrences causally related to treatment / all
    4 / 7
    1 / 3
         deaths causally related to treatment / all
    1 / 4
    0 / 1
    Surgical and medical procedures
    Surgical and medical procedures
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    1 / 420 (0.24%)
    1 / 419 (0.24%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    0 / 1
    General disorders and administration site conditions
    General disorders and administration site conditions
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    28 / 420 (6.67%)
    25 / 419 (5.97%)
         occurrences causally related to treatment / all
    9 / 28
    11 / 25
         deaths causally related to treatment / all
    6 / 25
    8 / 22
    Unknown
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    54 / 420 (12.86%)
    49 / 419 (11.69%)
         occurrences causally related to treatment / all
    25 / 55
    22 / 51
         deaths causally related to treatment / all
    19 / 48
    15 / 42
    Immune system disorders
    Immune system disorders
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    0 / 420 (0.00%)
    1 / 419 (0.24%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Social circumstances
    Social circumstances
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    1 / 420 (0.24%)
    0 / 419 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Respiratory, thoracic and mediastinal disorders
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    12 / 420 (2.86%)
    13 / 419 (3.10%)
         occurrences causally related to treatment / all
    9 / 12
    10 / 13
         deaths causally related to treatment / all
    8 / 10
    6 / 8
    Psychiatric disorders
    Psychiatric disorders
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    1 / 420 (0.24%)
    0 / 419 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Investigations
    Investigations
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    1 / 420 (0.24%)
    0 / 419 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Injury, poisoning and procedural complications
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    4 / 420 (0.95%)
    4 / 419 (0.95%)
         occurrences causally related to treatment / all
    3 / 4
    3 / 4
         deaths causally related to treatment / all
    1 / 2
    0 / 1
    Congenital, familial and genetic disorders
    Congenital, familial and genetic disorders
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    2 / 420 (0.48%)
    1 / 419 (0.24%)
         occurrences causally related to treatment / all
    2 / 2
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    1 / 1
    Cardiac disorders
    Cardiac disorders
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    11 / 420 (2.62%)
    7 / 419 (1.67%)
         occurrences causally related to treatment / all
    5 / 11
    2 / 7
         deaths causally related to treatment / all
    3 / 7
    0 / 5
    Nervous system disorders
    Nervous system disorder
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    23 / 420 (5.48%)
    18 / 419 (4.30%)
         occurrences causally related to treatment / all
    15 / 23
    8 / 18
         deaths causally related to treatment / all
    11 / 19
    6 / 16
    Blood and lymphatic system disorders
    Blood and lymphatic system disorders
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    15 / 420 (3.57%)
    6 / 419 (1.43%)
         occurrences causally related to treatment / all
    12 / 16
    6 / 7
         deaths causally related to treatment / all
    5 / 8
    0 / 0
    Gastrointestinal disorders
    Gastrointestinal disorders
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    7 / 420 (1.67%)
    9 / 419 (2.15%)
         occurrences causally related to treatment / all
    4 / 7
    5 / 9
         deaths causally related to treatment / all
    2 / 3
    3 / 6
    Hepatobiliary disorders
    Hepatobiliary disorders
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    6 / 420 (1.43%)
    5 / 419 (1.19%)
         occurrences causally related to treatment / all
    6 / 6
    4 / 5
         deaths causally related to treatment / all
    2 / 2
    1 / 1
    Skin and subcutaneous tissue disorders
    Skin and subcutaneous tissue disorders
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    0 / 420 (0.00%)
    1 / 419 (0.24%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal and urinary disorders
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    5 / 420 (1.19%)
    0 / 419 (0.00%)
         occurrences causally related to treatment / all
    4 / 5
    0 / 0
         deaths causally related to treatment / all
    1 / 2
    0 / 0
    Musculoskeletal and connective tissue disorders
    Musculoskeletal and connective tissue disorders
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    0 / 420 (0.00%)
    1 / 419 (0.24%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Infections and infestations
    Additional description: All combined, see SAE chart for details.
         subjects affected / exposed
    57 / 420 (13.57%)
    71 / 419 (16.95%)
         occurrences causally related to treatment / all
    40 / 61
    52 / 72
         deaths causally related to treatment / all
    22 / 41
    35 / 50
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Arm A Arm B
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    401 / 420 (95.48%)
    407 / 419 (97.14%)
    General disorders and administration site conditions
    (prolonged) hospitalisation
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    44 / 420 (10.48%)
    43 / 419 (10.26%)
         occurrences all number
    51
    48
    Death
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    50 / 420 (11.90%)
    52 / 419 (12.41%)
         occurrences all number
    55
    63
    Life threatening
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    5 / 420 (1.19%)
    4 / 419 (0.95%)
         occurrences all number
    5
    4
    Other
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    86 / 420 (20.48%)
    95 / 419 (22.67%)
         occurrences all number
    125
    122
    Pain
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    51 / 420 (12.14%)
    42 / 419 (10.02%)
         occurrences all number
    63
    53
    Severe/permanent disability
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    91 / 420 (21.67%)
    109 / 419 (26.01%)
         occurrences all number
    114
    145
    Syndromes
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    3 / 420 (0.71%)
    6 / 419 (1.43%)
         occurrences all number
    3
    7
    Respiratory, thoracic and mediastinal disorders
    Pulmonary
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    83 / 420 (19.76%)
    88 / 419 (21.00%)
         occurrences all number
    103
    110
    Congenital, familial and genetic disorders
    Congenital anomaly
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    12 / 420 (2.86%)
    21 / 419 (5.01%)
         occurrences all number
    12
    23
    Nervous system disorders
    Neurology
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    77 / 420 (18.33%)
    65 / 419 (15.51%)
         occurrences all number
    96
    87
    Blood and lymphatic system disorders
    Hemorrhage
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    55 / 420 (13.10%)
    54 / 419 (12.89%)
         occurrences all number
    66
    65
    Lymphatic
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    3 / 420 (0.71%)
    1 / 419 (0.24%)
         occurrences all number
    3
    1
    Eye disorders
    Ocular
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    12 / 420 (2.86%)
    23 / 419 (5.49%)
         occurrences all number
    13
    24
    Gastrointestinal disorders
    GI
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    222 / 420 (52.86%)
    244 / 419 (58.23%)
         occurrences all number
    383
    441
    Hepatobiliary disorders
    Hepatic
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    100 / 420 (23.81%)
    111 / 419 (26.49%)
         occurrences all number
    170
    184
    Skin and subcutaneous tissue disorders
    Dermatology/skin
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    185 / 420 (44.05%)
    202 / 419 (48.21%)
         occurrences all number
    252
    299
    Renal and urinary disorders
    GU and renal
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    61 / 420 (14.52%)
    64 / 419 (15.27%)
         occurrences all number
    65
    73
    Endocrine disorders
    Endocrine
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    6 / 420 (1.43%)
    8 / 419 (1.91%)
         occurrences all number
    6
    8
    Musculoskeletal and connective tissue disorders
    Musculoskeletal
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    7 / 420 (1.67%)
    14 / 419 (3.34%)
         occurrences all number
    8
    15
    Infections and infestations
    Infections
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    384 / 420 (91.43%)
    389 / 419 (92.84%)
         occurrences all number
    1336
    1397
    Metabolism and nutrition disorders
    Metabolic
    Additional description: All combined, see non-SAE chart for details.
         subjects affected / exposed
    78 / 420 (18.57%)
    86 / 419 (20.53%)
         occurrences all number
    123
    149

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    01 Dec 2000
    The requirement of a confirmation of a complete remission after an interval of at least 28 days has been removed from the definition of CR (Appendix C). This has led to some minor changes in the protocol. These and a few other minor changes and corrections.
    30 Jan 2001
    The antibody testing against gemtuzumab has been removed, since it is no longer required.
    15 Jun 2001
    The participation of the German AML study group has been added to the title page and the list of study coordinators, the forwarding of SAE reports to Wyeth has been added and the definition of complex cytogenetic abnormalities has been modified. These and a few other minor changes and corrections.
    10 Jun 2004
    The percentage of patients, randomized for post induction treatment (second randomization), turned out to be lower than expected (30% instead of 40%). With the recruitment of 600 patients for the first randomization, it is now expected that only 180 patients will have a second randomization instead of the 240, which is stated in the protocol. Therefore the power, necessary for answering the research question whether GO has an additional value in patients with CR on induction, will be too low. We propose to raise the target number of patients to 800 in order to gain the necessary power for this research question. The power for answering the induction question will also benefit from this.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
    For support, Contact us.
    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
    As of 31 January 2023, all EU/EEA initial clinical trial applications must be submitted through CTIS . Updated EudraCT trials information and information on PIP/Art 46 trials conducted exclusively in third countries continues to be submitted through EudraCT and published on this website.

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