Clinical Trial Results:
A phase II multicentric study in adults with acute myelogenous leukaemia (AML) in first complete remission (CR1) using IV BuCy2 in a once daily Bu regimen targeting a narrow therapeutic window prior to hematopoietic stem cell transplantation.
Summary
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EudraCT number |
2009-016601-42 |
Trial protocol |
FR ES IT |
Global end of trial date |
19 Jun 2014
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Results information
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Results version number |
v1(current) |
This version publication date |
09 Mar 2017
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First version publication date |
09 Mar 2017
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
F60002 IN 202 G0
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
- | ||
WHO universal trial number (UTN) |
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Sponsors
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Sponsor organisation name |
PIERRE FABRE MEDICAMENT
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Sponsor organisation address |
45 Place Abel Gance, Boulogne, France, 92654
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Public contact |
Ta Thanh Minh Christine, PIERRE FABRE MEDICAMENT, 33 0149108000, christine.ta.thanh.minh@pierre-fabre.com
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Scientific contact |
Ta Thanh Minh Christine, PIERRE FABRE MEDICAMENT, 33 0149108000, christine.ta.thanh.minh@pierre-fabre.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
30 Sep 2014
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Is this the analysis of the primary completion data? |
No
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Global end of trial reached? |
Yes
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Global end of trial date |
19 Jun 2014
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
To target the upper range of the busulfan therapeutic window (AUC from 4400 to 6000 μM.min) from a once daily myeloablative regimen in adult patients with AML in CR1 receiving the IV BuCy2 regimen.
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Protection of trial subjects |
Before enrolment in the study trial, the patient was examined by an experienced physician in charge of the study; some routine tests, including usual blood tests for pre-transplant check-up, a chest X-ray, echocardiogram and pulmonary tests function were carried out in order to assess vital functions and monitor the disease. Results of these tests were documented by the physician and the specialized team in charge of performing the hematopoietic stem cell transplantation. The patient was hospitalized 8 days before the transplantation in a bone marrow unit. The entire procedure of transplantation including administration of the conditioning regimen was supervised by a specialized physician. The patient was isolated in a sterile environment. The conditioning regimen consisted of intravenous busulfan over 4 days followed by a day of rest and followed by infusion of cyclophosphamide over 2 days (60 mg/kg/d); there was a day of rest after the last day of cyclophosphamide, then on the following day (Day0) the graft was infused to the patient. During the administration of the conditioning therapy, the dose level of intravenous busulfan were adjusted as it was an objective of the trial . Twelve plasma samples were collected over 4 days. The duration of the initial hospitalization lasted between four and six weeks until complete recovery. The follow-up, the treatments, the transplantation procedure were performed by the physician in charge of the study. He was also responsible of reviewing the patient information sheet and obtaining the patient's agreement. Women of childbearing potential had to have negative serum or urine pregnancy test within 72 hours prior to the start of study treatment. Fertile men and women of childbearing potential were expected to use an effective method of contraception during the 2 months preceding the start of study treatment, during treatment and at least 6 months following the last dose of study treatment.
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Background therapy |
Allogeneic Hematopoietic Stem Cell transplantation (HSCT) is a curative therapy and is widely used in the treatment of various haematological and non-haematological malignancies. The conditioning therapy is a key point in this procedure. Apart from the conditioning regimen, during the allogeneic procedure, many concomitant treatments are usually administered before or after infusion of the graft as prophylaxis to prevent occurrence of side effects or as part of supportive care. The graft was administered after the end of the conditioning therapy. Oral phenytoin was used as seizure prophylaxis. The prophylaxis to prevent the occurrence of veno-occlusive disease was based on heparin. The prophylaxis for prevention of the graft-versus-host-disease could have combined antithymoglobuline (if indicated) and ciclosporin and methotrexate. The recommended doses and duration of the graft-versus-host-disease prophylaxis was to be adapted based on local institutional guidelines. Hydration with glucose serum or chloride serum, uromitexan and anti-emetic therapies were recommended and adjusted according to the local institutional guidelines. Others medications such as blood transfusions, platelet transfusions, growth factor, antibiotics, antifungal treatment were given according to institutional guidelines. | ||
Evidence for comparator |
not applicable. The study was a phase multicentric study, open-label | ||
Actual start date of recruitment |
17 May 2010
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Long term follow-up planned |
Yes
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Long term follow-up rationale |
Safety, Efficacy | ||
Long term follow-up duration |
2 Years | ||
Independent data monitoring committee (IDMC) involvement? |
No
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Spain: 2
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Country: Number of subjects enrolled |
France: 22
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Country: Number of subjects enrolled |
Italy: 6
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Worldwide total number of subjects |
30
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EEA total number of subjects |
30
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
30
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From 65 to 84 years |
0
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85 years and over |
0
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Recruitment
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Recruitment details |
30 patients were enrolled from 8 active centers in 3 countries. The patient's eligibilty was assessed by an experienced physician within four weeks before the start of conditioning regimen. First patient enrolled on the 17th May 2010; last patient enrolled on the 21th May 2012. | ||||||
Pre-assignment
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Screening details |
Patient eligibility was assessed from Day-36 to Day-9 (the period before the day of transplantation was counted as negative). Patient's informed consent was signed. Parameters: demographics, disease, organ functions, laboratory tests, eligibility for transplantation, compatible donor, no exclusion criteria. Assignement of patient number. | ||||||
Pre-assignment period milestones
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Number of subjects started |
30 | ||||||
Intermediate milestone: Number of subjects |
pre study screeening period: 30
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Number of subjects completed |
30 | ||||||
Period 1
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Period 1 title |
study treatment period-follow-up periods (overall period)
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Is this the baseline period? |
Yes | ||||||
Allocation method |
Not applicable
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Blinding used |
Not blinded | ||||||
Blinding implementation details |
not applicable
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Arms
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Arm title
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overall cohort-study treatment period and follow-up periods | ||||||
Arm description |
The study was split in study treatment period and study follow-up periods. The reference day was Day0 the day of transplantation. After Day0 the number of days was counted as positive. Before Day0, the days was counted as negative. The study treatment period started from Day-8 up to Day+28: 30 patients (overall cohort) were enrolled and treated with IV BuCy2 as conditioning regimen prior to allogeneic hematopoietic stem cell transplantation. During this period, in-patients evaluations for safety and efficacy were done until Day+28. Follow-up period 1 : Day+29 up to Day+100; Follow-up period 2: Day+101 up to Day+365; Follow-up period 3: Day+366 up to Day+730. During the 3 study follow-up periods, the patients could have received additional therapies as part of the transplantation procedure, and the clinical evaluations with safety and efficacy parameters were collected. All 30 patients were evaluable for pharmacokinetic, safety and efficacy analysis. | ||||||
Arm type |
Investigational arm | ||||||
Investigational medicinal product name |
Busilvex
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Investigational medicinal product code |
F60002
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Other name |
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Pharmaceutical forms |
Concentrate for solution for infusion
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Routes of administration |
Intravenous use
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Dosage and administration details |
First administered dose (Day-8) was 3.2 mg/kg according to either actual body weight (ABW) for normal patients or to adjusted ideal body weight (AIBW) for obese patients. Then subsequent doses (Day-7 to Day-5) were adjusted according to the targeted AUC (i.e.: 5200 μM.min), corresponding to the middle of the therapeutic window (i.e.: 4400-6000 μM.min) and based on prior PK information collected from the dose before. One-day rest (Day-4) followed the last administration of IV Bu before cyclophosphamide treatment.
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Investigational medicinal product name |
Cyclophosphamide
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Investigational medicinal product code |
cyclophosphamide
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Other name |
Cytoxan; Endoxan
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Pharmaceutical forms |
Powder for solution for infusion
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Routes of administration |
Intravenous use
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Dosage and administration details |
One-day rest (Day-4) followed the last administration of IV Bu before cyclophosphamide administered at a dose of 60 mg/kg over two to four hours for two consecutive days (total dose 120 mg/kg) (Day-3 toDay-2). One-day rest (Day-1) followed the IV BuCy2 regimen before Stem Cell Infusion on Day0.
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Baseline characteristics reporting groups
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Reporting group title |
study treatment period-follow-up periods
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Reporting group description |
Overall cohort: 30 adult patients diagnosed with acute myelogenous leukemia in first complete remission. The characteristics of patients at baseline (diagnosis, prior medical history, prior treatment, clinical and biological tests for eligibility) were collected during visits before enrolment and start of the conditioning therapy. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
overall cohort-study treatment period and follow-up periods
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Reporting group description |
The study was split in study treatment period and study follow-up periods. The reference day was Day0 the day of transplantation. After Day0 the number of days was counted as positive. Before Day0, the days was counted as negative. The study treatment period started from Day-8 up to Day+28: 30 patients (overall cohort) were enrolled and treated with IV BuCy2 as conditioning regimen prior to allogeneic hematopoietic stem cell transplantation. During this period, in-patients evaluations for safety and efficacy were done until Day+28. Follow-up period 1 : Day+29 up to Day+100; Follow-up period 2: Day+101 up to Day+365; Follow-up period 3: Day+366 up to Day+730. During the 3 study follow-up periods, the patients could have received additional therapies as part of the transplantation procedure, and the clinical evaluations with safety and efficacy parameters were collected. All 30 patients were evaluable for pharmacokinetic, safety and efficacy analysis. |
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End point title |
Number of patients in Bu therapeutic window [1] | ||||||
End point description |
To target the upper range of the busulfan therapeutic window (AUC from 4400 to 6000 μM.min) from a once daily myeloablative regimen in adult patients with AML inCR1 receiving the IV BuCy2 regimen. A daily PK guided dose adjustment from Day-7 (Dose 2) to Day-5 (Dose 4) of Bu treatment was expected to enable the same targeting performance (≥ 70 to 80% ofpatients within the therapeutic window) as that achieved for the larger therapeutic window (i.e.: 3600 – 6000 μM.min) without dose adjustment.
The endpoint value was expressed by the number of subjects within the Bu therapeutic window (AUC from 4400 to 6000 μM.min).
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End point type |
Primary
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End point timeframe |
Blood sampling for pharmacokinetic analysis performed over 4 days from Day-8 (dose 1) to Day-5 (dose 4) in order to calculate daily busulfan plasma exposure (AUC). Doses were ajusted from Day-7 (dose 2) to Day-5 (dose 4).
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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: The endpoint number of patients in Bu therapeutic window was calculated and reported as absolute count. No statistical test was performed for this endpoint |
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No statistical analyses for this end point |
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End point title |
intrapatient variability of clearance | ||||||||
End point description |
To confirm the narrow intra-patient variability of once daily busulfan pharmacokinetics already demonstrated on a q.i.d. dosing regimen.
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End point type |
Secondary
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End point timeframe |
For once-daily busulfan infusion over four days of treatment from Day-8 to Day-5 (dose 1 to dose 4)
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No statistical analyses for this end point |
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End point title |
number of patients alive during study treatment period | ||||||
End point description |
proportion of patients alive at the end of the study treatment period (Day+28).
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End point type |
Secondary
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End point timeframe |
from Day-8 up to Day+28
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No statistical analyses for this end point |
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End point title |
number of patients with engraftment during study treatment period | ||||||
End point description |
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End point type |
Secondary
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End point timeframe |
from Day-8 up to Day+28
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No statistical analyses for this end point |
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End point title |
Number of patients alive at Day+100 | ||||||
End point description |
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End point type |
Secondary
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End point timeframe |
From Day-8 up to Day+28 (study treatment period) and Day+29 up to Day+100 (Follow-up period 1)
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No statistical analyses for this end point |
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End point title |
Number of patients with TRM at Day+100 | ||||||
End point description |
TRM: transplant-related mortality; TRM was expressed as a number of patients who died from causes other than relapse of the underlying hematological malignancy.
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End point type |
Secondary
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End point timeframe |
Study treatment period and follow-up period 1 ( Day-8 up to Day+28 and Day+29 up to Day+100)
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No statistical analyses for this end point |
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End point title |
Number of patients alive at Day+365 | ||||||
End point description |
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End point type |
Secondary
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End point timeframe |
From Day-8 up to Day+365: study treatment period, follow-up period 1 and follow-up period 2
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No statistical analyses for this end point |
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End point title |
Number of patients with TRM at Day+365 | ||||||
End point description |
TRM: transplant-related mortality; TRM was expressed as a number of patients who died from causes other than relapse of the underlying hematological malignancy.
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End point type |
Secondary
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End point timeframe |
From Day-8 up to Day+365: study treatment period, follow-up period 1 and follow-up period 2
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No statistical analyses for this end point |
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End point title |
Number of patients alive at Day+730 | ||||||
End point description |
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End point type |
Secondary
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End point timeframe |
From Day-8 up to Day+730: study treatment period and the 3 follow-up periods.
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No statistical analyses for this end point |
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End point title |
Number of patients with TRM at Day+730 | ||||||
End point description |
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End point type |
Secondary
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End point timeframe |
From Day-8 up to Day+730: study treatment period and the 3 follow-up periods
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No statistical analyses for this end point |
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End point title |
Number of patients with relapse at Day+365 | ||||||
End point description |
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End point type |
Secondary
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End point timeframe |
From Day-8 up to Day+365: study treatment period, follow-up period 1 and follow-up period 2
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No statistical analyses for this end point |
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End point title |
Number of patients with relapse at Day+730 | ||||||
End point description |
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End point type |
Secondary
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End point timeframe |
From Day-8 up to Day+730: study treatment period, and the 3 follow-up periods.
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No statistical analyses for this end point |
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End point title |
Number of patients with VOD | ||||||
End point description |
VOD: veno-occlusive disease. Diagnosis defined by Jones criteria and severity according to McDonald criteria.
Overall 3 episodes of VOD in 2 patients.
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End point type |
Secondary
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End point timeframe |
From Day-8 up to Day+365
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No statistical analyses for this end point |
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End point title |
number of patients with acute GVHD grade III-IV at Day+100 | ||||||
End point description |
GVHD: graft-versus-host-disease. Grading according to Glucksberg criteria.
No patient developed acute GVHD of grade IV.
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End point type |
Secondary
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End point timeframe |
From Day0 up to Day+100: study treatment period and follow-up period 1
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No statistical analyses for this end point |
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End point title |
Myeloablation | ||||||
End point description |
Expected effect of conditioning regimen. number of patients with profound cytopenia after administration of the conditioning regimen (Bucy2)
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End point type |
Secondary
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End point timeframe |
study treatment period (Day-8 to D+28) post-HSCT
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
From Day-8 to Day+365
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Adverse event reporting additional description |
Grading of severity according NCI-CTC v.3 for AEs except for VOD, GVHD, infections and febrile neutropenia. Assessment by physician, collected through the case report form.
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Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
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Reporting groups
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Reporting group title |
overall cohort-study treatment period-follow-up periods
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Reporting group description |
Reporting period for SAEs and non serious AEs: from Day-8 up to Day+365. Reported: related SAEs by patient and related non serious AEs (grade 4) by patient during the period defined above. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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14 Feb 2011 |
The end of the period of inclusion was extended to Q2 2012. |
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21 Jun 2011 |
The amendment modified the planned list of centers and investigators with addition of new center as the accrual was slow. The procedure of IV Bu administration was modified to allow more flexibility to each participating center.
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18 Nov 2011 |
Update of the manufacturer site for Busilvex.There was no consequence for the certification of the finished product. The corresponding section in the protocol was updated. |
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
not applicable |