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    Clinical Trial Results:
    Treatment optimization in adult patients with newly diagnosed acute lymphoblastic leukemia or lymphoblastic lymphoma by individualised, targeted and intensified treatment - a phase IV-trial with a phase III-part to evaluate safety and efficacy of nelarabine in T-ALL patients

    Summary
    EudraCT number
    2013-003466-13
    Trial protocol
    DE  
    Global end of trial date
    05 Dec 2024

    Results information
    Results version number
    v1(current)
    This version publication date
    18 Dec 2025
    First version publication date
    18 Dec 2025
    Other versions
    Summary report(s)
    GMALL 08/2013 Ergebnisbericht BfArM

    Trial information

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    Trial identification
    Sponsor protocol code
    GMALL082013
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02881086
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Goethe University
    Sponsor organisation address
    Theodor-Stern-Kai 7, Frankfurt am Main, Germany, 60590
    Public contact
    GMALL Studienzentrale, University Hospital Frankfurt, 0049 6963016365, gmall@em.uni-frankfurt.de
    Scientific contact
    GMALL Studienzentrale, University Hospital Frankfurt, 0049 6963016365, gmall@em.uni-frankfurt.de
    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
    Interim
    Date of interim/final analysis
    25 Oct 2022
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    22 Oct 2022
    Global end of trial reached?
    Yes
    Global end of trial date
    05 Dec 2024
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    To improve event free survival (EFS), remission duration (RD), disease free survival (DFS) and overall survival (OS) compared with the previous trial GMALL 07/2003
    Protection of trial subjects
    The Sponsor ensured that the protocol and all appropriate documentation according to the applicable country-specific laws and regulations were reviewed and approved by the IEC/IRB’s responsible for each site and/or country. The investigator or his/her designee informed the patient/legal representative of all aspects pertaining to the patient’s participation in the study and that participation in the study is voluntary and that they could withdraw at any time. The patient’s/legal representative’s free and expressed informed consent were obtained in writing prior to the screening procedures required for entry into the study according to all applicable regulatory requirements. To maintain confidentiality, all laboratory specimens, evaluation forms, reports and other records were identified by a coded number, sex and year of birth only. Medical information about individual patients obtained in the course of this trial is confidential and was disclosed to third parties, except authorized monitors, auditors or inspectors. Confidentiality was ensured by the use of patient numbers for the identification of each patient; these patient numbers were used for patient data in the patient files and eCRFs.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    15 Jul 2016
    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
    Germany: 1023
    Worldwide total number of subjects
    1023
    EEA total number of subjects
    1023
    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)
    1023
    From 65 to 84 years
    0
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    First patient in 08/24/2016 (MM/DD/YYYY), last patient in 08/16/2022 (MM/DD/YYYY)

    Pre-assignment
    Screening details
    The study was conducted in patients (18 - 55 years) with newly diagnosed acute lymphoblastic leukemia or lymphoblastic lymphoma. Other eligibility criteria were determined within a screening period prior to the first study specific measure.

    Period 1
    Period 1 title
    Overall Trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded
    Blinding implementation details
    Not blinded

    Arms
    Arm title
    GMALL 08/2013 trial
    Arm description
    -
    Arm type
    Experimental

    Investigational medicinal product name
    Nelarabine
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Emulsion for infusion
    Routes of administration
    Infusion
    Dosage and administration details
    1500 mg/m² intravenous during 2 hours on Day 1, 3 and 5

    Number of subjects in period 1
    GMALL 08/2013 trial
    Started
    1023
    Completed
    979
    Not completed
    44
         Not started
    14
         Not evaluable
    30

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    GMALL 08/2013 trial
    Reporting group description
    -

    Reporting group values
    GMALL 08/2013 trial Total
    Number of subjects
    1023 1023
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    1023 1023
        From 65-84 years
    0 0
        85 years and over
    0 0
    Gender categorical
    Units: Subjects
        Female
    388 388
        Male
    635 635
    Subject analysis sets

    Subject analysis set title
    Patients
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The evaluation of the primary endpoint is based on the full analysis set, i. e. all evaluable patients included in the study. The historic control has been accrued between 2003 and 2011 and consists of 2492 patients with available additional information age, sex, risk group, immunophenotype (line), subtype, PH status, t(4;11) status and leukocyte count. We excluded patients with subtype “unknown” from the historical control because subtype information was available for all GMALL 08/2013 patients. This leaves us with 1943 patients. There were no LBL patients in the historical control, therefore LBL patients were also excluded from the GMALL 08/2013 population for this analysis.

    Subject analysis sets values
    Patients
    Number of subjects
    861
    Age categorical
    Units: Subjects
        Adults (18-64 years)
    861
        From 65-84 years
    0
        85 years and over
    0
    Age continuous
    Units:
        
    ( )
    Gender categorical
    Units: Subjects
        Female
    338
        Male
    523

    End points

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    End points reporting groups
    Reporting group title
    GMALL 08/2013 trial
    Reporting group description
    -

    Subject analysis set title
    Patients
    Subject analysis set type
    Full analysis
    Subject analysis set description
    The evaluation of the primary endpoint is based on the full analysis set, i. e. all evaluable patients included in the study. The historic control has been accrued between 2003 and 2011 and consists of 2492 patients with available additional information age, sex, risk group, immunophenotype (line), subtype, PH status, t(4;11) status and leukocyte count. We excluded patients with subtype “unknown” from the historical control because subtype information was available for all GMALL 08/2013 patients. This leaves us with 1943 patients. There were no LBL patients in the historical control, therefore LBL patients were also excluded from the GMALL 08/2013 population for this analysis.

    Primary: Event Free Survival

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    End point title
    Event Free Survival [1]
    End point description
    End point type
    Primary
    End point timeframe
    time from first day of study treatment (date of first administration of study medication) to relapse, treatment failure (partial remission or worse), occurrence of a second malignant tumor or death from any cause, whichever occurs first
    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 primary endpoint (EFS) was based on a historical comparative group which cannot be reported in this system, because the pts of the historical group are not part of the trial. The detailed description is found in the report to BfArM. The two-sided log-rank (chi-squared) test for the evaluation of the primary endpoint was performed. The resulting p-value is < 0.001. Consequently, the null hypothesis of equality of hazard rates can be rejected.
    End point values
    GMALL 08/2013 trial
    Number of subjects analysed
    861
    Units: Patients
    861
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Treatment phase
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    4.03
    Reporting groups
    Reporting group title
    GMALL 08/2013
    Reporting group description
    All patients who started therapy

    Serious adverse events
    GMALL 08/2013
    Total subjects affected by serious adverse events
         subjects affected / exposed
    377 / 1009 (37.36%)
         number of deaths (all causes)
    227
         number of deaths resulting from adverse events
    50
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Papillary thyroid carcinoma
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Brain vein thrombosis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hygroma
         subjects affected / exposed
    2 / 1009 (0.20%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Lung artery embolism
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Subsegmental pulmonary embolism
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Thromboembolic event
         subjects affected / exposed
    9 / 1009 (0.89%)
         occurrences causally related to treatment / all
    7 / 9
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Infusion related reaction
         subjects affected / exposed
    2 / 1009 (0.20%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Pain
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Immune system disorders
    Allergic reaction
         subjects affected / exposed
    2 / 1009 (0.20%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Anaphylactic reaction to Etoposid
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Anaphylaxis
         subjects affected / exposed
    6 / 1009 (0.59%)
         occurrences causally related to treatment / all
    6 / 6
         deaths causally related to treatment / all
    0 / 0
    Hemolytic-uremic syndrome
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hypophysitis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Suspected HLH
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Adult respiratory distress syndrome
         subjects affected / exposed
    3 / 1009 (0.30%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    2 / 2
    Adult respiratory distress syndrome, lung infection
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Bronchopulmonary hemorrhage
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Hypoxia
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pleural effusion
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonitis
         subjects affected / exposed
    3 / 1009 (0.30%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Pneumothorax
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory failure
         subjects affected / exposed
    3 / 1009 (0.30%)
         occurrences causally related to treatment / all
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    Psychiatric disorders
    Delirium
         subjects affected / exposed
    2 / 1009 (0.20%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Delirium and psychotic Symptoms
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Depression
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Epileptical attack
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Psychosis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Suicide attempt
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Investigations
    CPK increased
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Creatinine incrased
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Platelet count decreased
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Abdominal soft tissue necrosis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Cardiac arrest
         subjects affected / exposed
    2 / 1009 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Left ventricular dysfunction
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Cerebral vasospasm
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Depressed level of consciousness
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Double vision
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Edema cerebral
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Incomplete cauda equina syndrome
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Intracranial hemorrhage
         subjects affected / exposed
    10 / 1009 (0.99%)
         occurrences causally related to treatment / all
    10 / 10
         deaths causally related to treatment / all
    2 / 2
    Ischemia cerebrovascular (suspected)
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    JC infection
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Leukoencephalopathy
         subjects affected / exposed
    3 / 1009 (0.30%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Nelarabine associated Guillain Barre Syndrom
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Polyneuropathy
         subjects affected / exposed
    2 / 1009 (0.20%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 1
    Reduction of vigilance, coordination disorder, disorientation
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Reversible posterior leukoencephalopathy syncrome
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Seizure
         subjects affected / exposed
    4 / 1009 (0.40%)
         occurrences causally related to treatment / all
    3 / 4
         deaths causally related to treatment / all
    0 / 0
    Somnolence
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Subdural hematoma
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Tetraparesis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Unclear neurological symptom complex
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Intracerebral hemorrhage
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Neutropenia
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Prolonged Thrombopenia
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Eye disorders
    Sicca-Syndrome
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Bleeding
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Duodenal perforation
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Enterocolitis
         subjects affected / exposed
    2 / 1009 (0.20%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Generalized mucositis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Ileus
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Mallory-Weiß-Syndrome
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Mucositis oral
         subjects affected / exposed
    5 / 1009 (0.50%)
         occurrences causally related to treatment / all
    5 / 5
         deaths causally related to treatment / all
    0 / 0
    Pancreatitis
         subjects affected / exposed
    8 / 1009 (0.79%)
         occurrences causally related to treatment / all
    8 / 8
         deaths causally related to treatment / all
    0 / 0
    Sigmadivertikulosis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Cirrhosis of the liver
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Elevation of blood bilirubin and transaminase
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatopathy
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Liver abscess
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Liver parenchyma damage
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Steatosis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    29 / 1009 (2.87%)
         occurrences causally related to treatment / all
    29 / 30
         deaths causally related to treatment / all
    1 / 1
    Acute renal failure
         subjects affected / exposed
    5 / 1009 (0.50%)
         occurrences causally related to treatment / all
    5 / 5
         deaths causally related to treatment / all
    0 / 0
    Increased creatinine, renal failure
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Prolongation of MTX-level decrease
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal failure
         subjects affected / exposed
    6 / 1009 (0.59%)
         occurrences causally related to treatment / all
    4 / 6
         deaths causally related to treatment / all
    0 / 0
    Renal failure/insufficiency
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal insufficiency
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Arthritis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Aseptic necrosis of bone
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Avascular necrosis
         subjects affected / exposed
    3 / 1009 (0.30%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Femur necrosis both sides
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Osteonecrosis
         subjects affected / exposed
    26 / 1009 (2.58%)
         occurrences causally related to treatment / all
    26 / 27
         deaths causally related to treatment / all
    0 / 0
    Osteonecrosis of femoral head both sides
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Osteonecrosis of femoral head right side
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Osteoporosis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Rhabdomyolyse
         subjects affected / exposed
    6 / 1009 (0.59%)
         occurrences causally related to treatment / all
    6 / 9
         deaths causally related to treatment / all
    0 / 0
    Spondylodiscitis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Abdominal infection
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Appendicitis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Appendicitis perforated
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Bone infection
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Catheter related infection
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Device related infection
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Disseminated Aspergillosis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Empyem cerebral
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Encephalitis infection
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Endocarditis infective
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Febrile infection
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Fungal infection
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Fungal pneumonia or atypical pneumonia
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Generalized Mucormycosis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatic infection (Morganella morganii)
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatitis viral
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatolienal Candidiasis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Influenza A virus infection
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Invasive mycosis of the lungs
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Lung infection
         subjects affected / exposed
    7 / 1009 (0.69%)
         occurrences causally related to treatment / all
    6 / 7
         deaths causally related to treatment / all
    1 / 1
    Lung infection (fungal)
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Lung infection with ARDS
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Lymph gland infection
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Meningitis bacterial (E. Coli)
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Meningoenzephalitis (HHV6)
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 1
    Mucormycosis
         subjects affected / exposed
    2 / 1009 (0.20%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 2
    Necrotizing fasciitis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    PCJ-Pneumonia
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumocystis jirovecii Pneumonia
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumogenic sepsis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
         subjects affected / exposed
    2 / 1009 (0.20%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    1 / 1
    Pneumonia with Covid-19
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 1
    Reactivation of CMV, CMV- pneumonia
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory infection
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    70 / 1009 (6.94%)
         occurrences causally related to treatment / all
    66 / 73
         deaths causally related to treatment / all
    24 / 27
    Sepsis 3MRGN (E-Coli)
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Septic cardiomyopathy
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Septic shock
         subjects affected / exposed
    5 / 1009 (0.50%)
         occurrences causally related to treatment / all
    5 / 6
         deaths causally related to treatment / all
    2 / 2
    Soft tissue infection
         subjects affected / exposed
    2 / 1009 (0.20%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Viral infection (varizella)
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Viral infection SARS CoV-2
         subjects affected / exposed
    78 / 1009 (7.73%)
         occurrences causally related to treatment / all
    6 / 81
         deaths causally related to treatment / all
    0 / 0
    Wound infection
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Infection (Fusarium petroliphilum)
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    1 / 1
    Metabolism and nutrition disorders
    Diabetic ketoacidosis
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyperglycemia
         subjects affected / exposed
    3 / 1009 (0.30%)
         occurrences causally related to treatment / all
    3 / 3
         deaths causally related to treatment / all
    0 / 0
    Hypoglycemia
         subjects affected / exposed
    1 / 1009 (0.10%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Hyponatremia
         subjects affected / exposed
    2 / 1009 (0.20%)
         occurrences causally related to treatment / all
    1 / 2
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    GMALL 08/2013
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    968 / 1009 (95.94%)
    Investigations
    Blood Bilirubin increased
         subjects affected / exposed
    589 / 1009 (58.37%)
         occurrences all number
    1111
    Fibrinogen decreased
         subjects affected / exposed
    357 / 1009 (35.38%)
         occurrences all number
    674
    Lipase increased
         subjects affected / exposed
    136 / 1009 (13.48%)
         occurrences all number
    181
    Neutrophil Count decreased
         subjects affected / exposed
    270 / 1009 (26.76%)
         occurrences all number
    409
    Platelet Count decreased
         subjects affected / exposed
    404 / 1009 (40.04%)
         occurrences all number
    1013
    White Blood Cell decreased
         subjects affected / exposed
    301 / 1009 (29.83%)
         occurrences all number
    525
    Antithrombin deficiency
         subjects affected / exposed
    523 / 1009 (51.83%)
         occurrences all number
    1513
    Immunoglobulin deficiency
         subjects affected / exposed
    58 / 1009 (5.75%)
         occurrences all number
    115
    Transaminase increased
         subjects affected / exposed
    733 / 1009 (72.65%)
         occurrences all number
    2101
    Vascular disorders
    Thrombosis
         subjects affected / exposed
    106 / 1009 (10.51%)
         occurrences all number
    125
    Nervous system disorders
    Headache
         subjects affected / exposed
    53 / 1009 (5.25%)
         occurrences all number
    70
    Paresthesia
         subjects affected / exposed
    65 / 1009 (6.44%)
         occurrences all number
    113
    Blood and lymphatic system disorders
    Anemia
         subjects affected / exposed
    93 / 1009 (9.22%)
         occurrences all number
    240
    Febrile Neutropenia
         subjects affected / exposed
    108 / 1009 (10.70%)
         occurrences all number
    147
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    194 / 1009 (19.23%)
         occurrences all number
    334
    Fever
         subjects affected / exposed
    52 / 1009 (5.15%)
         occurrences all number
    66
    Immune system disorders
    Allergic Reaction
         subjects affected / exposed
    106 / 1009 (10.51%)
         occurrences all number
    143
    Gastrointestinal disorders
    Diarrhea
         subjects affected / exposed
    64 / 1009 (6.34%)
         occurrences all number
    75
    Nausea
         subjects affected / exposed
    107 / 1009 (10.60%)
         occurrences all number
    151
    Mucositis
         subjects affected / exposed
    503 / 1009 (49.85%)
         occurrences all number
    638
    Renal and urinary disorders
    Acute or Chronic Kidney Injury
         subjects affected / exposed
    57 / 1009 (5.65%)
         occurrences all number
    64
    Infections and infestations
    Infection
         subjects affected / exposed
    583 / 1009 (57.78%)
         occurrences all number
    1059
    Metabolism and nutrition disorders
    Hyperglycemia
         subjects affected / exposed
    86 / 1009 (8.52%)
         occurrences all number
    159
    Hypertriglyceridemia
         subjects affected / exposed
    204 / 1009 (20.22%)
         occurrences all number
    476
    Hypoalbuminemia
         subjects affected / exposed
    132 / 1009 (13.08%)
         occurrences all number
    183

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    20 Jun 2017
    Change in the delivery and labeling of the investigational medicinal product Nelarabine
    18 Nov 2020
    Protocol V2 Amendment 1 dated 09/04/2020 (MM/DD/YYYY), Pat.-Info dated 09/04/2020 (MM/DD/YYYY), SmPC
    05 Apr 2022
    GMP
    14 Mar 2024
    Protocol V3 Amendment 2 dated 02/27/2024 (MM/DD/YYYY), Shortening of the post-treatment observation period and an additional questionnaire for patient self-documentation of cognitive function

    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.
    non reported
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