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    Clinical Trial Results:
    A randomized phase II multicenter study with a safety run-in to assess the tolerability and efficacy of the addition of oral lenalidomide to standard induction therapy in AML and RAEB ≥ 66 years and very poor risk AML ≥ 18 years. A study in the frame of the masterprotocol of parallel randomized phase II studies in elderly AML

    Summary
    EudraCT number
    2009-013094-17
    Trial protocol
    NL   BE   NO  
    Global end of trial date
    19 Sep 2024

    Results information
    Results version number
    v1(current)
    This version publication date
    28 Dec 2025
    First version publication date
    28 Dec 2025
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    HOVON103AMLLEN
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    HOVON
    Sponsor organisation address
    Dr. Molewaterplein 40, Rotterdam, Netherlands,
    Public contact
    HOVON Data Center, Erasmus MC, +31 107041560, hdc@erasmusmc.nl
    Scientific contact
    HOVON Data Center, Erasmus MC, +31 107041560, 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
    29 Dec 2023
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    28 Dec 2023
    Global end of trial reached?
    Yes
    Global end of trial date
    19 Sep 2024
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    For part A of the study (if applicable): 1. To assess the safety and tolerability of lenalidomide added to standard induction chemotherapy for AML (frequency and severity of toxicities and the durations of neutropenia and thrombocytopenia) and select the feasible dose level for part B 2. To assess in a randomized comparison the effect of lenalidomide on the CR rate. For part B: 1. To assess the safety and tolerability of lenalidomide added to standard induction chemotherapy for AML (frequency and severity of toxicities and the durations of neutropenia and thrombocytopenia) as regards the selected dose level of lenalidomide 2. To assess in a randomized comparison the effect of lenalidomide on the CR rate.
    Protection of trial subjects
    Insurance and monitoring
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    01 Jun 2010
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Netherlands: 205
    Country: Number of subjects enrolled
    Norway: 1
    Country: Number of subjects enrolled
    Belgium: 66
    Country: Number of subjects enrolled
    Switzerland: 65
    Worldwide total number of subjects
    337
    EEA total number of subjects
    272
    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)
    1
    From 65 to 84 years
    336
    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
    Not applicable
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Control group
    Arm description
    Control with standard medication, no IMP: Daunomycin Days 45mg/m2 3hr infusion on days 1,2,3 Cytarabine 200mg/m2 continuous infusion(24hrs) on days 1 thru 7
    Arm type
    Active comparator

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

    Investigational medicinal product name
    Cytarabine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Cytarabine 200mg/m2 continuous infusion(24hrs) on days 1 thru 7

    Arm title
    Experimental
    Arm description
    Like control, this arm receives standard medication: Daunomycin Days 45mg/m2 3hr infusion on days 1,2,3 Cytarabine 200mg/m2 continuous infusion(24hrs) on days 1 thru 7
    Arm type
    Experimental

    Investigational medicinal product name
    Lenalidomide
    Investigational medicinal product code
    CC-5013
    Other name
    REVLIMID®
    Pharmaceutical forms
    Capsule
    Routes of administration
    Oral use
    Dosage and administration details
    Remission induction treatment Cycle I: lenalidomide is started at a dose level of 10 mg orally day 1-21. Remission induction treatment Cycle II: Decisions regarding dose escalation to 15 and 20 mg day 1-21 of each cycle, continuation with dose level 10, 15 or 20mg or stopping is based on the incidence of DLT. Cycle II will be given as soon as possible after cycle I but at least within 8 weeks after start of cycle I. If after cycle I the bone marrow shows persistence of leukemia it is recommended that patients proceed to cycle II immediately. Otherwise cycle II will be started as soon as there is evidence of haematological regeneration. No dose reduction is allowed.

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

    Investigational medicinal product name
    Cytarabine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Cytarabine 200mg/m2 continuous infusion(24hrs) on days 1 thru 7

    Number of subjects in period 1
    Control group Experimental
    Started
    172
    165
    Completed
    104
    77
    Not completed
    68
    88
         Adverse reactions
    16
    28
         Consent withdrawn by subject
    4
    9
         Other
    12
    21
         Lack of efficacy
    36
    30

    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
    337 337
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    1 1
        From 65-84 years
    336 336
    Age continuous
    Units: years
        median (full range (min-max))
    69 (64 to 84) -
    Gender categorical
    Units: Subjects
        Female
    147 147
        Male
    190 190

    End points

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    End points reporting groups
    Reporting group title
    Control group
    Reporting group description
    Control with standard medication, no IMP: Daunomycin Days 45mg/m2 3hr infusion on days 1,2,3 Cytarabine 200mg/m2 continuous infusion(24hrs) on days 1 thru 7

    Reporting group title
    Experimental
    Reporting group description
    Like control, this arm receives standard medication: Daunomycin Days 45mg/m2 3hr infusion on days 1,2,3 Cytarabine 200mg/m2 continuous infusion(24hrs) on days 1 thru 7

    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
    Control group Experimental
    Number of subjects analysed
    172
    165
    Units: Whole
    172
    165
    Attachments
    List of reported SAE's
    Statistical data section from publication
    List of reported non-SAE's
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Adverse events will be reported from the first study-related procedure until 30 days following the last protocol treatment or until the start of subsequent systemic therapy for the disease under study, if earlier.
    Adverse event reporting additional description
    All AEs of CTCAE grade 2 or higher have to be reported on the Adverse Events CRF, with the exception of alopecia, nausea/vomiting and progression of the disease under study, a pre-existing condition that does not increase in severity. Adverse events occurring after 30 days should also be reported if considered related to study drug.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    4
    Reporting groups
    Reporting group title
    Control group
    Reporting group description
    -

    Reporting group title
    Experimental group
    Reporting group description
    -

    Serious adverse events
    Control group Experimental group
    Total subjects affected by serious adverse events
         subjects affected / exposed
    68 / 169 (40.24%)
    82 / 159 (51.57%)
         number of deaths (all causes)
    136
    136
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Additional description: All combined
         subjects affected / exposed
    4 / 169 (2.37%)
    0 / 159 (0.00%)
         occurrences causally related to treatment / all
    1 / 4
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Vascular disorders
    Additional description: All combined
         subjects affected / exposed
    4 / 169 (2.37%)
    1 / 159 (0.63%)
         occurrences causally related to treatment / all
    2 / 4
    1 / 1
         deaths causally related to treatment / all
    2 / 3
    0 / 0
    General disorders and administration site conditions
    General disorders and administration site conditions
    Additional description: All combined
         subjects affected / exposed
    3 / 169 (1.78%)
    14 / 159 (8.81%)
         occurrences causally related to treatment / all
    3 / 3
    7 / 14
         deaths causally related to treatment / all
    2 / 2
    3 / 9
    Respiratory, thoracic and mediastinal disorders
    Respiratory, thoracic and mediastinal disorders
    Additional description: All combined
         subjects affected / exposed
    8 / 169 (4.73%)
    17 / 159 (10.69%)
         occurrences causally related to treatment / all
    5 / 9
    13 / 18
         deaths causally related to treatment / all
    2 / 5
    4 / 7
    Psychiatric disorders
    Psychiatric disorders
    Additional description: All combined
         subjects affected / exposed
    0 / 169 (0.00%)
    2 / 159 (1.26%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Investigations
    Investigations
    Additional description: All combined
         subjects affected / exposed
    0 / 169 (0.00%)
    1 / 159 (0.63%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Injury, poisoning and procedural complications
    Additional description: All combined
         subjects affected / exposed
    2 / 169 (1.18%)
    0 / 159 (0.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Cardiac disorders
    Additional description: All combined
         subjects affected / exposed
    9 / 169 (5.33%)
    9 / 159 (5.66%)
         occurrences causally related to treatment / all
    3 / 9
    7 / 9
         deaths causally related to treatment / all
    1 / 6
    2 / 2
    Nervous system disorders
    Nervous system disorders
    Additional description: All combined
         subjects affected / exposed
    6 / 169 (3.55%)
    9 / 159 (5.66%)
         occurrences causally related to treatment / all
    2 / 6
    8 / 9
         deaths causally related to treatment / all
    1 / 2
    0 / 0
    Blood and lymphatic system disorders
    Blood and lymphatic system disorders
    Additional description: All combined
         subjects affected / exposed
    7 / 169 (4.14%)
    10 / 159 (6.29%)
         occurrences causally related to treatment / all
    7 / 7
    10 / 11
         deaths causally related to treatment / all
    2 / 2
    0 / 0
    Gastrointestinal disorders
    Gastrointestinal disorders
    Additional description: All combined
         subjects affected / exposed
    11 / 169 (6.51%)
    11 / 159 (6.92%)
         occurrences causally related to treatment / all
    10 / 11
    10 / 11
         deaths causally related to treatment / all
    4 / 4
    1 / 1
    Hepatobiliary disorders
    Hepatobiliary disorders
    Additional description: All combined
         subjects affected / exposed
    1 / 169 (0.59%)
    2 / 159 (1.26%)
         occurrences causally related to treatment / all
    1 / 1
    1 / 2
         deaths causally related to treatment / all
    1 / 1
    0 / 1
    Skin and subcutaneous tissue disorders
    Skin and subcutaneous tissue disorders
    Additional description: All combined
         subjects affected / exposed
    1 / 169 (0.59%)
    3 / 159 (1.89%)
         occurrences causally related to treatment / all
    1 / 1
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Renal and urinary disorders
    Renal and urinary disorders
    Additional description: All combined
         subjects affected / exposed
    1 / 169 (0.59%)
    2 / 159 (1.26%)
         occurrences causally related to treatment / all
    1 / 1
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Infections and infestations
    Additional description: All combined
         subjects affected / exposed
    22 / 169 (13.02%)
    26 / 159 (16.35%)
         occurrences causally related to treatment / all
    23 / 25
    21 / 28
         deaths causally related to treatment / all
    8 / 10
    9 / 12
    Metabolism and nutrition disorders
    Metabolism and nutrition disorders
    Additional description: All combined
         subjects affected / exposed
    4 / 169 (2.37%)
    6 / 159 (3.77%)
         occurrences causally related to treatment / all
    4 / 4
    4 / 7
         deaths causally related to treatment / all
    0 / 0
    0 / 1
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Control group Experimental group
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    166 / 169 (98.22%)
    157 / 159 (98.74%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Additional description: All combined
         subjects affected / exposed
    2 / 169 (1.18%)
    0 / 159 (0.00%)
         occurrences all number
    2
    0
    Vascular disorders
    Vascular disorders
    Additional description: All combined
         subjects affected / exposed
    39 / 169 (23.08%)
    50 / 159 (31.45%)
         occurrences all number
    54
    71
    Surgical and medical procedures
    Surgical and medical procedures
    Additional description: All combined
         subjects affected / exposed
    1 / 169 (0.59%)
    2 / 159 (1.26%)
         occurrences all number
    1
    2
    Pregnancy, puerperium and perinatal conditions
    Pregnancy, puerperium and perinatal conditions
    Additional description: All combined
         subjects affected / exposed
    1 / 169 (0.59%)
    0 / 159 (0.00%)
         occurrences all number
    1
    0
    General disorders and administration site conditions
    General disorders and administration site conditions
    Additional description: All combined
         subjects affected / exposed
    47 / 169 (27.81%)
    56 / 159 (35.22%)
         occurrences all number
    63
    106
    Immune system disorders
    Immune system disorders
    Additional description: All combined
         subjects affected / exposed
    9 / 169 (5.33%)
    12 / 159 (7.55%)
         occurrences all number
    9
    15
    Reproductive system and breast disorders
    Reproductive system and breast disorders
    Additional description: All combined
         subjects affected / exposed
    5 / 169 (2.96%)
    2 / 159 (1.26%)
         occurrences all number
    5
    2
    Respiratory, thoracic and mediastinal disorders
    Respiratory, thoracic and mediastinal disorders
    Additional description: All combined
         subjects affected / exposed
    42 / 169 (24.85%)
    50 / 159 (31.45%)
         occurrences all number
    55
    75
    Psychiatric disorders
    Psychiatric disorders
    Additional description: All combined
         subjects affected / exposed
    24 / 169 (14.20%)
    25 / 159 (15.72%)
         occurrences all number
    35
    35
    Investigations
    Investigations
    Additional description: All combined
         subjects affected / exposed
    61 / 169 (36.09%)
    60 / 159 (37.74%)
         occurrences all number
    171
    174
    Injury, poisoning and procedural complications
    Injury, poisoning and procedural complications
    Additional description: All combined
         subjects affected / exposed
    3 / 169 (1.78%)
    2 / 159 (1.26%)
         occurrences all number
    3
    2
    Cardiac disorders
    Cardiac disorders
    Additional description: All combined
         subjects affected / exposed
    27 / 169 (15.98%)
    35 / 159 (22.01%)
         occurrences all number
    35
    41
    Nervous system disorders
    Nervous system disorders
    Additional description: All combined
         subjects affected / exposed
    23 / 169 (13.61%)
    40 / 159 (25.16%)
         occurrences all number
    29
    62
    Blood and lymphatic system disorders
    Blood and lymphatic system disorders
    Additional description: All combined
         subjects affected / exposed
    98 / 169 (57.99%)
    90 / 159 (56.60%)
         occurrences all number
    185
    167
    Ear and labyrinth disorders
    Ear and labyrinth disorders
    Additional description: All combined
         subjects affected / exposed
    1 / 169 (0.59%)
    5 / 159 (3.14%)
         occurrences all number
    1
    5
    Eye disorders
    Eye disorders
    Additional description: All combined
         subjects affected / exposed
    17 / 169 (10.06%)
    14 / 159 (8.81%)
         occurrences all number
    18
    14
    Gastrointestinal disorders
    Gastrointestinal disorders
    Additional description: All combined
         subjects affected / exposed
    111 / 169 (65.68%)
    111 / 159 (69.81%)
         occurrences all number
    236
    216
    Hepatobiliary disorders
    Hepatobiliary disorders
    Additional description: All combined
         subjects affected / exposed
    4 / 169 (2.37%)
    6 / 159 (3.77%)
         occurrences all number
    4
    8
    Skin and subcutaneous tissue disorders
    Skind and subcutaneous tissue disorders
    Additional description: All combined
         subjects affected / exposed
    86 / 169 (50.89%)
    97 / 159 (61.01%)
         occurrences all number
    120
    165
    Renal and urinary disorders
    Renal and urinary disorders
    Additional description: All combined
         subjects affected / exposed
    19 / 169 (11.24%)
    28 / 159 (17.61%)
         occurrences all number
    30
    28
    Endocrine disorders
    Endocrine disorders
    Additional description: All combined
         subjects affected / exposed
    3 / 169 (1.78%)
    0 / 159 (0.00%)
         occurrences all number
    3
    0
    Musculoskeletal and connective tissue disorders
    Musculoskeletal and connective tissue disorders
    Additional description: All combined
         subjects affected / exposed
    20 / 169 (11.83%)
    14 / 159 (8.81%)
         occurrences all number
    24
    18
    Infections and infestations
    Infections and infestations
    Additional description: All combined
         subjects affected / exposed
    111 / 169 (65.68%)
    109 / 159 (68.55%)
         occurrences all number
    228
    234
    Metabolism and nutrition disorders
    Metabolism and nutrition disorders
    Additional description: All combined
         subjects affected / exposed
    77 / 169 (45.56%)
    83 / 159 (52.20%)
         occurrences all number
    209
    192

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    30 May 2011
    Amendment 1 The reason for this amendment is to add participating centers.
    08 Dec 2011
    Amendment 2 The reason for this amendment/addendum is the change in packaging and distribution of the IMP and the addition of the pregnancy prevention RMP. Brief description of amendment/addendum: Protocol update following the change in the ABR and EudraCT form regarding the packaging of the IMP lenalidomide (from capsules in bottles to capsules in blisters/wallets, capsules themselves remain unchanged) and the addition of the lenalidomide pregnancy prevention RMP. NB: The already supplied (QP-released) medication in bottles will be used up by the sites.
    05 Jun 2012
    Amendment 3 The reason for this amendment is to correct some errors regarding section D of the EudraCT form (splitting the IMP into 2 IMPs due to different strengths, authorities in section D9, country where marketing authorization has been granted), which prevents the distributor from releasing medication.
    10 Apr 2013
    Amendment 4 The reason for this amendment is to add participating centers and to change local investigators.

    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

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/32020044
    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
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