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    Clinical Trial Results:
    Phase II study, multicenter, prospective, open label, preemptive treatment of cytomegalovirus (CMV) infection driven by virologic monitoring and quantification of T CD8pp65/IE-1-IFNgamma+ lymphocytes in allogeneic hematopoietic transplantation

    Summary
    EudraCT number
    2011-001449-34
    Trial protocol
    ES  
    Global end of trial date
    14 Nov 2017

    Results information
    Results version number
    v1(current)
    This version publication date
    14 Oct 2022
    First version publication date
    14 Oct 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CMV-INMUNOGUIA
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    -
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Instituto de Investigación Sanitaria INCLIVA
    Sponsor organisation address
    Avd. Menéndez Pelayo 4, acc, Valencia, Spain, 46010
    Public contact
    Marta Peiro, Instituto de Investigación Sanitaria INCLIVA, 34 961973536, gestioncientifica@incliva.es
    Scientific contact
    Marta Peiro, Instituto de Investigación Sanitaria INCLIVA, 34 961973536, gestioncientifica@incliva.es
    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
    04 Jul 2018
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    14 Nov 2017
    Global end of trial reached?
    Yes
    Global end of trial date
    14 Nov 2017
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To determine whether a strategy of early treatment of CMV infection post hematopoietic allogeneic transplant, guided by virological monitoring and quantification of T CD8pp65/IE-1-IFNgamma+ lymphocytes is at least the same or more effective than the standard strategy (historical control group).
    Protection of trial subjects
    The protocol, informed consent form, participant information sheet and any applicable documents were submitted and approved by an appropriate Ethics Committee.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    19 Dec 2011
    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
    Spain: 117
    Worldwide total number of subjects
    117
    EEA total number of subjects
    117
    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)
    105
    From 65 to 84 years
    12
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Patients with Cytomegalovirus infection and treated with hematopoietic allogenic transplant. Matched demographic historical control group with CMV infection

    Pre-assignment
    Screening details
    Patients who met all inclusion/exclusion criteria were included.

    Pre-assignment period milestones
    Number of subjects started
    117
    Number of subjects completed
    117

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

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Study Group
    Arm description
    Valganciclovir, ganciclovir or foscarnet will be used, at the discretion of the site.
    Arm type
    Experimental

    Investigational medicinal product name
    GANCICLOVIR
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    10 mg/kg milligram(s)/kilogram

    Investigational medicinal product name
    FOSCARNET
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    120 mg/kg milligram(s)/kilogram

    Investigational medicinal product name
    VALGANCICLOVIR
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    1800 mg milligram(s)

    Arm title
    Control Group
    Arm description
    A historical review of patients receiving treatment anticipation of CMV infection guided exclusively by monitoring virological.
    Arm type
    No intervention

    Investigational medicinal product name
    No investigational medicinal product assigned in this arm
    Number of subjects in period 1
    Study Group Control Group
    Started
    61
    56
    Completed
    52
    56
    Not completed
    9
    0
         Adverse event, serious fatal
    3
    -
         Adverse event, non-fatal
    6
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Study Group
    Reporting group description
    Valganciclovir, ganciclovir or foscarnet will be used, at the discretion of the site.

    Reporting group title
    Control Group
    Reporting group description
    A historical review of patients receiving treatment anticipation of CMV infection guided exclusively by monitoring virological.

    Reporting group values
    Study Group Control Group Total
    Number of subjects
    61 56 117
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    52 53 105
        From 65-84 years
    9 3 12
        85 years and over
    0 0 0
    Gender categorical
    Units: Subjects
        Female
    28 17 45
        Male
    33 39 72

    End points

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    End points reporting groups
    Reporting group title
    Study Group
    Reporting group description
    Valganciclovir, ganciclovir or foscarnet will be used, at the discretion of the site.

    Reporting group title
    Control Group
    Reporting group description
    A historical review of patients receiving treatment anticipation of CMV infection guided exclusively by monitoring virological.

    Primary: Percentage of patients with negative CMV in blood

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    End point title
    Percentage of patients with negative CMV in blood
    End point description
    End point type
    Primary
    End point timeframe
    Day 7, 14, 21 or 28
    End point values
    Study Group Control Group
    Number of subjects analysed
    61
    56
    Units: % patients
    87
    62
    Statistical analysis title
    McNemar x2
    Comparison groups
    Study Group v Control Group
    Number of subjects included in analysis
    117
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    < 0.05
    Method
    Chi-squared
    Confidence interval

    Primary: Percentage of patient who develop nephrotoxicity

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    End point title
    Percentage of patient who develop nephrotoxicity
    End point description
    End point type
    Primary
    End point timeframe
    During 100 days of the study
    End point values
    Study Group Control Group
    Number of subjects analysed
    61
    56
    Units: unit(s)
        number (not applicable)
    53
    0
    Statistical analysis title
    Descriptive
    Comparison groups
    Study Group v Control Group
    Number of subjects included in analysis
    117
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    < 0.05
    Method
    Descriptive
    Confidence interval

    Secondary: Percentage of patients who, after achieving hematological recovery, develop neutropenia of <1.0 x109 / L and <0.5 x109 / L

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    End point title
    Percentage of patients who, after achieving hematological recovery, develop neutropenia of <1.0 x109 / L and <0.5 x109 / L
    End point description
    End point type
    Secondary
    End point timeframe
    During the first 100 days of TPH.
    End point values
    Study Group Control Group
    Number of subjects analysed
    61
    56
    Units: % patients
    43
    36
    No statistical analyses for this end point

    Secondary: Percentage of patients who develop CMV disease

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    End point title
    Percentage of patients who develop CMV disease
    End point description
    End point type
    Secondary
    End point timeframe
    During treatment and 2 months after tratment
    End point values
    Study Group Control Group
    Number of subjects analysed
    61
    56
    Units: % patients
    3
    2
    No statistical analyses for this end point

    Secondary: Frequency and type of infections

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    End point title
    Frequency and type of infections
    End point description
    End point type
    Secondary
    End point timeframe
    During treatment and 2 months of follow-up.
    End point values
    Study Group Control Group
    Number of subjects analysed
    61
    56
    Units: number of infeccions
    61
    56
    No statistical analyses for this end point

    Secondary: Total days of antiviral treatment

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    End point title
    Total days of antiviral treatment
    End point description
    End point type
    Secondary
    End point timeframe
    End of treatment
    End point values
    Study Group Control Group
    Number of subjects analysed
    61
    56
    Units: days
    28
    31
    No statistical analyses for this end point

    Secondary: Consumables: drug used, number of drug administrations / day, use of central / peripheral catheter.

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    End point title
    Consumables: drug used, number of drug administrations / day, use of central / peripheral catheter.
    End point description
    End point type
    Secondary
    End point timeframe
    During treatment
    End point values
    Study Group Control Group
    Number of subjects analysed
    61
    56
    Units: days
    61
    56
    No statistical analyses for this end point

    Adverse events

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    Adverse events information [1]
    Timeframe for reporting adverse events
    Adverse events occured during treatment or within 28 days after the end of treatment.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    4.0
    Reporting groups
    Reporting group title
    Study Group
    Reporting group description
    Valganciclovir, ganciclovir or foscarnet will be used, at the discretion of the site.

    Notes
    [1] - There are no non-serious adverse events recorded for these results. It is expected that there will be at least one non-serious adverse event reported.
    Justification: Non serious adverse events occurr usually in all patients postrasplant
    Serious adverse events
    Study Group
    Total subjects affected by serious adverse events
         subjects affected / exposed
    43 / 61 (70.49%)
         number of deaths (all causes)
    5
         number of deaths resulting from adverse events
    Vascular disorders
    Haemorrhage
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Stomatitis
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Abdominal pain
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Lumbar pain
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Respiratory failure
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Respiratory tract infection
         subjects affected / exposed
    3 / 61 (4.92%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Dyspnoea
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Pleural effusion
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
         subjects affected / exposed
    2 / 61 (3.28%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    hemoperitoneum
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Cardiac arrest
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Epilepsy
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Aplasia
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Pancytopenia
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Neutropenia
         subjects affected / exposed
    7 / 61 (11.48%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Febrile neutropenia
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Graft versus host disease
         subjects affected / exposed
    2 / 61 (3.28%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal haemorrhage
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    6 / 61 (9.84%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Peritonitis
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Acute Gastroenteritis
         subjects affected / exposed
    2 / 61 (3.28%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Biliary colic
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Hepatic failure
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Hepatomegaly
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Renal fa
         subjects affected / exposed
    4 / 61 (6.56%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Dysuria
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Cystitis haemorrhagic
         subjects affected / exposed
    3 / 61 (4.92%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Endocrine disorders
    Hyperbilirubinaemia
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Intermittent claudication
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Septic shock
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Staphylococcal bacteraemia
    Additional description: Staphylococcus epidermis
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Fever
         subjects affected / exposed
    8 / 61 (13.11%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Cytomegalovirus infection reactivation
         subjects affected / exposed
    1 / 61 (1.64%)
         occurrences causally related to treatment / all
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Study Group
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    0 / 61 (0.00%)

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    19 May 2014
    Changes in sections: Name and description of the investigational product; principal objective and randomization process
    30 Dec 2014
    Summary of changes: To add a clinical report form specific for data collection of the control group

    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
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    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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