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    Clinical Trial Results:
    Evaluation of the impact of remission induction chemotherapy prior to allogeneic stem cell transplantation in relapsed and poor-response patients with AML

    Summary
    EudraCT number
    2014-003124-44
    Trial protocol
    DE  
    Global end of trial date
    05 Apr 2022

    Results information
    Results version number
    v1(current)
    This version publication date
    13 Jul 2024
    First version publication date
    13 Jul 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    DKMS-14-01
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT02461537
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    clinicaltrials.gov: NCT02461537
    Sponsors
    Sponsor organisation name
    DKMS Group gGmbH
    Sponsor organisation address
    Kressbach 1, Tuebingen, Germany, 72072
    Public contact
    CTU Study Manager, DKMS Group gGmbH, 0049 3512107980, etal3asap@dkms.de
    Scientific contact
    CTU Study Manager, DKMS Group gGmbH, 0049 3512107980, etal3asap@dkms.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
    Final
    Date of interim/final analysis
    19 Jul 2022
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    05 Apr 2022
    Global end of trial reached?
    Yes
    Global end of trial date
    05 Apr 2022
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The objective of this trial is to compare outcome of two treatment strategies for patients with high-risk AML who failed to achieve or maintain a complete remission with standard therapy.
    Protection of trial subjects
    All investigations are clinical standard diagnostic procedures, recommended in diagnostic and treatment guidelines.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    17 Sep 2015
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Scientific research
    Long term follow-up duration
    2 Years
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Germany: 281
    Worldwide total number of subjects
    281
    EEA total number of subjects
    281
    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)
    190
    From 65 to 84 years
    91
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    -

    Pre-assignment
    Screening details
    No central screening process was implemented. Only patients who fulfill all eligibility criteria can be enrolled in the trial.

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

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    DISC
    Arm description
    Disease Control Strategy: The DISC arm aims at disease-monitoring and control until start of the conditioning regimen prior to transplantation. The aim is not to induce a remission but to prevent complications from AML with the least toxic approach. Disease-monitoring without anti-leukemic therapy (“Watch and wait”) is the preferred approach except for those patients with rapidly proliferating AML (see definitions). Transplantation should be scheduled as soon as possible. Pharmacologic options aimed at disease control in patients with rapidly proliferating AML comprise low-dose AraC (LDAC) or single-dose mitoxantrone.
    Arm type
    Experimental

    Investigational medicinal product name
    Cytarabin
    Investigational medicinal product code
    SUB06880MIG
    Other name
    ARA-cell
    Pharmaceutical forms
    Concentrate for solution for injection/infusion
    Routes of administration
    Injection
    Dosage and administration details
    LDAC: cytarabine 20 mg/ m2 s.c. once a day for 10 days

    Investigational medicinal product name
    Mitoxantrone
    Investigational medicinal product code
    SUB03309MIG
    Other name
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Infusion
    Dosage and administration details
    Mitoxantrone 10 mg/ m2 i.v. given as single intravenous infusion

    Arm title
    RIST
    Arm description
    The remission-induction strategy encompasses the administration of aggressive induction chemotherapy (HAM) and remission control after hematopoietic recovery.
    Arm type
    Active comparator

    Investigational medicinal product name
    Cytarabin
    Investigational medicinal product code
    SUB06880MIG
    Other name
    ARA-cell
    Pharmaceutical forms
    Concentrate and solvent for solution for injection/infusion
    Routes of administration
    Infusion
    Dosage and administration details
    Patients ≤ 60y: 3 g/m2 over 3h every 12 hours on 3 consecutive days Patients > 60y: 1 g/m2 over 3h every 12 hours on 3 consecutive days

    Investigational medicinal product name
    Mitoxantrone
    Investigational medicinal product code
    SUB03309MIG
    Other name
    Pharmaceutical forms
    Solution for injection/infusion
    Routes of administration
    Infusion
    Dosage and administration details
    Patients ≤60y: 10 mg/m2 on 3 consequtive days starting at the last day of Cytarabin administration Patients >60y: 10 mg/m2 on 3 consequtive days starting at the last day of Cytarabin administration

    Number of subjects in period 1
    DISC RIST
    Started
    140
    141
    Completed
    139
    137
    Not completed
    1
    4
         Consent withdrawn by subject
    1
    1
         Protocol deviation
    -
    3

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    DISC
    Reporting group description
    Disease Control Strategy: The DISC arm aims at disease-monitoring and control until start of the conditioning regimen prior to transplantation. The aim is not to induce a remission but to prevent complications from AML with the least toxic approach. Disease-monitoring without anti-leukemic therapy (“Watch and wait”) is the preferred approach except for those patients with rapidly proliferating AML (see definitions). Transplantation should be scheduled as soon as possible. Pharmacologic options aimed at disease control in patients with rapidly proliferating AML comprise low-dose AraC (LDAC) or single-dose mitoxantrone.

    Reporting group title
    RIST
    Reporting group description
    The remission-induction strategy encompasses the administration of aggressive induction chemotherapy (HAM) and remission control after hematopoietic recovery.

    Reporting group values
    DISC RIST Total
    Number of subjects
    140 141 281
    Age categorical
    Units: Subjects
        Adults (≥ 18y)
    140 141 281
    Age continuous
    Units: years
        median (full range (min-max))
    61 (18 to 75) 61 (19 to 74) -
    Gender categorical
    Units: Subjects
        Female
    64 61 125
        Male
    76 80 156
    Subject analysis sets

    Subject analysis set title
    Intent-to-Treat Population
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    The intention-to-treat (ITT) population consists of all randomized patients who did not withdraw their informed consent or who violated inclusion-exclusion criteria of trial protocol version 6.0. This opulation was defined also as full analysis set (FAS). The ITT population defined the primary efficacy population. Patients were analyzed in ITT as randomized.

    Subject analysis set title
    Per-Protocol Population
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The population for the per protocol primary efficacy analysis (PP population) consisted of patients in the FAS who received the initial treatment to which they were randomized, and received the first dose of Cytarabine in RIST arm in line with protocol, or received the first day of study intervention (including watch and wait) in DisC arm.

    Subject analysis sets values
    Intent-to-Treat Population Per-Protocol Population
    Number of subjects
    276
    272
    Age categorical
    Units: Subjects
        Adults (≥ 18y)
    276
    272
    Age continuous
    Units: years
        median (full range (min-max))
    61 (18 to 75)
    61 (18 to 75)
    Gender categorical
    Units: Subjects
        Female
    121
    117
        Male
    155
    146

    End points

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    End points reporting groups
    Reporting group title
    DISC
    Reporting group description
    Disease Control Strategy: The DISC arm aims at disease-monitoring and control until start of the conditioning regimen prior to transplantation. The aim is not to induce a remission but to prevent complications from AML with the least toxic approach. Disease-monitoring without anti-leukemic therapy (“Watch and wait”) is the preferred approach except for those patients with rapidly proliferating AML (see definitions). Transplantation should be scheduled as soon as possible. Pharmacologic options aimed at disease control in patients with rapidly proliferating AML comprise low-dose AraC (LDAC) or single-dose mitoxantrone.

    Reporting group title
    RIST
    Reporting group description
    The remission-induction strategy encompasses the administration of aggressive induction chemotherapy (HAM) and remission control after hematopoietic recovery.

    Subject analysis set title
    Intent-to-Treat Population
    Subject analysis set type
    Intention-to-treat
    Subject analysis set description
    The intention-to-treat (ITT) population consists of all randomized patients who did not withdraw their informed consent or who violated inclusion-exclusion criteria of trial protocol version 6.0. This opulation was defined also as full analysis set (FAS). The ITT population defined the primary efficacy population. Patients were analyzed in ITT as randomized.

    Subject analysis set title
    Per-Protocol Population
    Subject analysis set type
    Per protocol
    Subject analysis set description
    The population for the per protocol primary efficacy analysis (PP population) consisted of patients in the FAS who received the initial treatment to which they were randomized, and received the first dose of Cytarabine in RIST arm in line with protocol, or received the first day of study intervention (including watch and wait) in DisC arm.

    Primary: Rate of treatment success

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    End point title
    Rate of treatment success
    End point description
    End point type
    Primary
    End point timeframe
    defined as documented complete remission on day 56 after allogeneic HSCT
    End point values
    DISC RIST Intent-to-Treat Population Per-Protocol Population
    Number of subjects analysed
    139
    137
    276
    272
    Units: N success
        number (not applicable)
    116
    111
    227
    225
    Statistical analysis title
    Primary efficacy analysis
    Statistical analysis description
    Dichotomous success rate
    Comparison groups
    RIST v DISC
    Number of subjects included in analysis
    276
    Analysis specification
    Pre-specified
    Analysis type
    non-inferiority
    P-value
    = 0.054
    Method
    Farrington and Manning
    Confidence interval

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    within 28 days after the end of study treatment, or without treatment until start of subsequent anti-leukemic treatment (start of bridging therapy)/ start of the conditioning regimen
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    24.0
    Reporting groups
    Reporting group title
    DISC
    Reporting group description
    Disease Control Strategy: The DISC arm aims at disease-monitoring and control until start of the conditioning regimen prior to transplantation. The aim is not to induce a remission but to prevent complications from AML with the least toxic approach. Disease-monitoring without anti-leukemic therapy (“Watch and wait”) is the preferred approach except for those patients with rapidly proliferating AML (see definitions). Transplantation should be scheduled as soon as possible. Pharmacologic options aimed at disease control in patients with rapidly proliferating AML comprise low-dose AraC (LDAC) or single-dose mitoxantrone.

    Reporting group title
    RIST
    Reporting group description
    The remission-induction strategy encompasses the administration of aggressive induction chemotherapy (HAM) and remission control after hematopoietic recovery.

    Serious adverse events
    DISC RIST
    Total subjects affected by serious adverse events
         subjects affected / exposed
    22 / 139 (15.83%)
    19 / 137 (13.87%)
         number of deaths (all causes)
    66
    58
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Acute myeloid leukaemia
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    Breast cancer
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Tongue neoplasm malignant stage unspecified
    alternative assessment type: Systematic
         subjects affected / exposed
    0 / 139 (0.00%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Injury, poisoning and procedural complications
    Subdural haemorrhage
    alternative assessment type: Systematic
         subjects affected / exposed
    0 / 139 (0.00%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Shock haemorrhagic
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Traumatic intracranial haemorrhage
    alternative assessment type: Systematic
         subjects affected / exposed
    0 / 139 (0.00%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    Cardiac disorders
    Myocardial infarction
    alternative assessment type: Systematic
         subjects affected / exposed
    0 / 139 (0.00%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Nervous system disorders
    Cerebral ischaemia
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
    alternative assessment type: Systematic
         subjects affected / exposed
    2 / 139 (1.44%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    1 / 2
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Administration site extravasation
    alternative assessment type: Systematic
         subjects affected / exposed
    0 / 139 (0.00%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Anal fissure haemorrhage
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Neutropenic colitis
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 1
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Proctitis
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Stomatitis haemorrhagic
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vomiting
    alternative assessment type: Systematic
         subjects affected / exposed
    0 / 139 (0.00%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatobiliary disorders
    Cholecystitis
    alternative assessment type: Systematic
         subjects affected / exposed
    0 / 139 (0.00%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Venoocclusive liver disease
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Epistaxis
    alternative assessment type: Systematic
         subjects affected / exposed
    0 / 139 (0.00%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonitis
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Back pain
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Bronchopulmonary aspergillosis
    alternative assessment type: Systematic
         subjects affected / exposed
    0 / 139 (0.00%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cellulitis
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Clostridial sepsis
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cytomegalovirus infection reactivation
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Diverticulitis
    alternative assessment type: Systematic
         subjects affected / exposed
    0 / 139 (0.00%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Febrile infection
    alternative assessment type: Systematic
         subjects affected / exposed
    2 / 139 (1.44%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Hepatic infection
    alternative assessment type: Systematic
         subjects affected / exposed
    0 / 139 (0.00%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Herpes zoster
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infection
    alternative assessment type: Systematic
         subjects affected / exposed
    0 / 139 (0.00%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infection in an immunocompromised host
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumocystis jirovecii pneumonia
    alternative assessment type: Systematic
         subjects affected / exposed
    0 / 139 (0.00%)
    1 / 137 (0.73%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Pneumonia
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    3 / 137 (2.19%)
         occurrences causally related to treatment / all
    1 / 1
    2 / 3
         deaths causally related to treatment / all
    0 / 0
    1 / 1
    Postoperative wound infection
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Rectal abscess
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Respiratory tract infection
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Sepsis
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    3 / 137 (2.19%)
         occurrences causally related to treatment / all
    1 / 1
    3 / 3
         deaths causally related to treatment / all
    1 / 1
    0 / 0
    Septic shock
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Urosepsis
    alternative assessment type: Systematic
         subjects affected / exposed
    1 / 139 (0.72%)
    0 / 137 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    DISC RIST
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    28 / 139 (20.14%)
    99 / 137 (72.26%)
    Cardiac disorders
    Cardiac disorder
    Additional description: CTCAE Grade 3-5
         subjects affected / exposed
    0 / 139 (0.00%)
    11 / 137 (8.03%)
         occurrences all number
    0
    12
    Infections and infestations
    Infection
    Additional description: CTCAE Grade 3-5
         subjects affected / exposed
    22 / 139 (15.83%)
    78 / 137 (56.93%)
         occurrences all number
    27
    107
    Metabolism and nutrition disorders
    Metabolic disorder
    Additional description: CTCAE Grade 3-5
         subjects affected / exposed
    6 / 139 (4.32%)
    10 / 137 (7.30%)
         occurrences all number
    6
    13

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    17 Apr 2015
    Non-substantial: Mitoxantrone dosing modification, instructions detailed early induction response, serum chemistry assessment in bridging therapy visit, transplant report and other assessments added.
    02 Jul 2015
    Substantial: Changes in the CTA Form submitted to the authorities to indicate a change in the cytarabine concentration to be used in order to make reconstitution of the cytarabine solution feasible for the pharmacy service.
    26 Feb 2016
    Substantial: Addition of inclusion criteria for the poor responder stratum and modification of the potential donor matching grade for eligibility, ancillary research implemented, safety consideration that cytopenia reflects underlying disease, information added on how to document and report pregnancy
    14 Mar 2017
    Substantial: Rewording of an exclusion to an inclusion criterion, information on how to deal with subjects that participate at more than one trial site.
    24 May 2019
    Substantial: Addition of inclusion criteria for poor responders.
    10 Feb 2021
    Non-substantial: Recruitment prolongation.
    11 Mar 2022
    Substantial: Adoption of timelines for final analysis – new study termination criterion.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/38583455
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