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    Clinical Trial Results:
    A prospective, open-label, multicenter phase-II trial to evaluate the efficacy and safety of a sequential regimen of bendamustine followed by GA101 (obinutuzumab), acalabrutinib (ACP-196) and ABT-199 (venetoclax) in patients with relapsed/refractory CLL (CLL2-BAAG protocol)

    Summary
    EudraCT number
    2017-003133-28
    Trial protocol
    DE  
    Global end of trial date
    26 Sep 2023

    Results information
    Results version number
    v1(current)
    This version publication date
    04 Sep 2024
    First version publication date
    04 Sep 2024
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    CLL2-BAAG
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03787264
    WHO universal trial number (UTN)
    -
    Other trial identifiers
    Sponsor's number: UNI-KÖLN-3403, BfArM: 4042949
    Sponsors
    Sponsor organisation name
    UNIVERSITY OF COLOGNE
    Sponsor organisation address
    ALBERTUS-MAGNUS-PLATZ, Cologne, Germany, 50923
    Public contact
    Anne Domonell, Department I of Internal Medicine, UNIVERSITY HOSPITAL, KERPENER STR. 62, 50937 COLOGNE, GERMANY, +49 22147888220, anne.domonell@uk-koeln.de
    Scientific contact
    PD Dr. med. Paula Cramer, Department I of Internal Medicine, UNIVERSITY HOSPITAL, KERPENER STR. 62, 50937 COLOGNE, GERMAn, +49 22147888220, paula.cramer@uk-koeln.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
    05 Jan 2024
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    26 Sep 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of the study is to evaluate the efficacy of a sequential regimen of two cycles of bendamustine, followed by a combination therapy of GA101 (obinutuzumab), acalabrutinib (ACP-196) and ABT-199 (venetoclax) in patients with relapsed/refractory CLL.
    Protection of trial subjects
    Safety measures to prevent or to manage known risks associated with CLL, such as infections or cytopenia or known adverse reactions related to any of the IMPs have been included in the protocol. Chapter 8 of the protocol included sections how to prevent and manage known side effects, including detailed instruction about modifications and treatment discontinuation. The protocol includes sections with prohibited, permitted and medication used with caution for each study medication, especially for known interactions with CYP3A4 inhibitors or inducers. In particular, since the COVID pandemic had an impact on the saftey of patients treated within the BAAG protocol, detailed guidance about management of COVID19 infections have been included.
    Background therapy
    The treatment landscape for relapsed/refractory CLL faced profound changes and new developments in the past years. Several targeted agents have become available for the treatment of CLL. As most of these agents are well tolerated and have different, potentially synergistic mechanisms of action, several trials evaluating different combinations and aiming at a high efficacy are under way. The CLL2-BAAG trial evaluates a debulking with two cycles bendamustine (only for patients with a higher tumor load and without contraindications for bendamustine), followed by an induction and a maintenance treatment with the obinutuzumab, acalabrutinib and venetoclax in patients with relapsed/refractory CLL. Thus, this trial combines chemotherapy and three synergistic (antibody, BTK-inhibitor and Bcl-2 antagonist) principles of action in order to achieve deep and long-lasting remissions with a short duration of treatment. The primary endpoint is the evaluation of the undetectable measurable residual disease (uMRD) rate in peripheral blood (PB) measured by 4-color flow cytometry at final restaging (RE) at the end of induction treatment (12 weeks after the start of the last induction cycle). Secondary endpoints of the study include further efficacy parameters and safety assessments by type, frequency, seriousness and severity of adverse events (AEs) and their relationship to study treatment. Secondary efficacy endpoints include overall response rate (ORR) at final restaging (RE) at the end of induction treatment (12 weeks after the start of the last induction cycle), ORR after debulking and at the end of maintenance treatment, progression-free survival (PFS), event-free survival (EFS), overall survival (OS), duration of response, treatment-free survival (TFS) and time to next CLL treatment (TTNT).
    Evidence for comparator
    Not applicable.
    Actual start date of recruitment
    14 Jan 2019
    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
    Germany: 46
    Worldwide total number of subjects
    46
    EEA total number of subjects
    46
    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)
    30
    From 65 to 84 years
    16
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    It was planned to enroll 46 eligible patients. Between 14th January 2019 and 25th June 2020, 46 patients were enrolled. Because of a violation of the study's inclusion/exclusion criteria, 1 patient was excluded from the full analysis set (i.e. excluded from both efficacy and safety analyses).

    Pre-assignment
    Screening details
    A total of 49 patients were screened for eligibility and 46 patients were included in the trial. Three (3) patients were not included due to diagnoses other than CLL (n=2) and due to patient's decision (n=1).

    Pre-assignment period milestones
    Number of subjects started
    49 [1]
    Number of subjects completed
    46

    Pre-assignment subject non-completion reasons
    Reason: Number of subjects
    Protocol deviation: 2
    Reason: Number of subjects
    Consent withdrawn by subject: 1
    Notes
    [1] - The number of subjects reported to have started the pre-assignment period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: To verify the eligibility of patients, a central medical review of the screening data was performed and were reviewed by one of the GCLLSG study physicians together with the results of the baseline assessments of immunophenotyping and cytogenetics, for confirmation of the eligibility of the patient. A total of 49 patients were screened for eligibility and 46 patients were included in the trial. Three (3) patients were not eligible and assessed as screening failures.
    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded
    Blinding implementation details
    Not applicable.

    Arms
    Arm title
    Bendamustine (optional), acalabrutinib,obinutuzumab,venetoclax
    Arm description
    Two cycles of optional debulking with bendamustine were administered before induction. Obinutuzumab was started in the first induction cycle (days 1, 8, and 15), in induction cycle 2 acalabrutinib was added, and in induction cycle 3 venetoclax ramp up (over 5 weeks up to 400 mg) was initiated. All drugs were administered according to the established schedules with daily acalabrutinib, venetoclax, and obinutuzumab once every 4 weeks during induction and every 12 weeks during maintenance. Induction treatment was administered for a total of 8 cycles (i.e., 6 cycles of the triple combination) until final restaging before the patients entered the maintenance phase. Induction cycles had 28 days and maintenance cycles had 84 days. Maintenance treatment was stopped once a (clinical) complete response and undectable MRD (peripheral blood) in 2 consecutive measurements were achieved, at progression, intolerable toxicity, or after the maximum number of 8 cycles of maintenance treatment.
    Arm type
    Experimental

    Investigational medicinal product name
    Bendamustine
    Investigational medicinal product code
    Other name
    ribomustin
    Pharmaceutical forms
    Powder for concentrate and solution for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Patients should receive both cycles of debulking treatment even if the patient´s tumor burden is reduced. In each of the two cycles, bendamustine is administered intravenously on two consecutive days, the cycle is repeated after 28 days. Debulking cycles 1-2: Day 1 bendamustine 70mg/m² i.v., day 2 bendamustine 70mg/m² i.v..

    Investigational medicinal product name
    Acalabrutinib
    Investigational medicinal product code
    Other name
    Calquence
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    The continuous daily administration with acalabrutinib (ACP-196) starts on day 1 of induction cycle 2 under supervision of a study physician and before treatment with obinutuzumab. Induction cycles 2-6, days 1-28: Acalabrutinib 100mg p.o. twice daily. Before the start of the maintenance treatment, two staging assessments (initial response assessment [4 weeks after the start of the last induction cycle] and final restaging [12 weeks after the start of the last induction cycle]) will be performed. During this phase of staging, the intake of acalabrutinib is continued and there is no interruption between induction and maintenance treatment. In the maintenance treatment acalabrutinib will be continued at the same dosage.

    Investigational medicinal product name
    Obinutuzumab
    Investigational medicinal product code
    GA 101
    Other name
    Pharmaceutical forms
    Concentrate and solvent for solution for injection/infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Induction cycle 1: Day 1 obinutuzumab 100mg i.v., day 1 (or 2) obinutuzumab 900mg i.v., day 8 obinutuzumab 1000mg i.v., day 15 obinutuzumab 1000mg i.v.. Induction cycles 2-6: Day 1 obinutuzumab 1000mg i.v.. Maintenance cycles 1-8: Day 1 obinutuzumab 1000mg i.v..

    Investigational medicinal product name
    Venetoclax
    Investigational medicinal product code
    ABT 199
    Other name
    Pharmaceutical forms
    Film-coated tablet
    Routes of administration
    Oral use
    Dosage and administration details
    The daily intake of venetoclax starts with a weekly dose ramp-up to final dose on day 1 of induction cycle 3. Patients will receive the first dosage of venetoclax on day 1 of induction cycle 3 in clinic/outpatient clinic/private practice before the start of the administration of obinutuzumab. Induction cycle 3: Days 1-7 venetoclax 20mg (2 tabl. at 10mg), days 8-14 venetoclax 50mg (1 tabl. at 50mg), days 15-21 venetoclax 100mg (1 tabl. at 100mg), days: 22-28 venetoclax 200mg (2 tabl. at 100mg). Induction cycles 4-6: Days 1-28 venetoclax 400mg (4 tabl. at 100mg). Before the start of the maintenance treatment, two staging assessments (initial response assessment [4 weeks after the start of the last induction cycle] and final restaging [12 weeks after the start of the last induction cycle]) will be performed. During this phase of staging, the intake of venetoclax is continued at the same dosage. There is no interruption between induction and maintenance treatment.

    Number of subjects in period 1
    Bendamustine (optional), acalabrutinib,obinutuzumab,venetoclax
    Started
    46
    Completed
    34
    Not completed
    12
         Physician decision
    1
         Adverse event, non-fatal
    8
         Progressive disease
    1
         New CLL treatment (stem cell transplantation))
    1
         Protocol deviation
    1

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial (overall period)
    Reporting group description
    -

    Reporting group values
    Overall trial (overall period) Total
    Number of subjects
    46 46
    Age categorical
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    30 30
        From 65-84 years
    16 16
        85 years and over
    0 0
    Age continuous
    Units: years
        median (inter-quartile range (Q1-Q3))
    60.5 (53 to 67) -
    Gender categorical
    Units: Subjects
        Female
    13 13
        Male
    33 33
    Presence of deletion in 17p
    Cytogenetic risk factor
    Units: Subjects
        No
    36 36
        Yes
    9 9
        Missing information
    1 1
    IGHV mutational status
    Cytogenetic risk factor
    Units: Subjects
        Unmutated
    35 35
        Mutated
    11 11
    CLL-IPI risk group
    International prognostic index used for CLL
    Units: Subjects
        Low
    3 3
        Intermediate
    16 16
        High
    13 13
        Very high
    12 12
        Missing information
    2 2
    TP53 mutational status
    Cytogenetic risk factor
    Units: Subjects
        Unmutated
    32 32
        Mutated
    13 13
        Missing information
    1 1
    Binet stage
    Status of the disease
    Units: Subjects
        Binet A
    16 16
        Binet B
    16 16
        Binet C
    14 14
    Cumulative illness rating scale (CIRS)
    Validated score to evaluate the comorbidity
    Units: Scores
        median (inter-quartile range (Q1-Q3))
    3 (1 to 5) -
    Observation time
    Time between trial registration and last observation or death
    Units: Months
        median (inter-quartile range (Q1-Q3))
    36.3 (35.2 to 38.0) -
    Subject analysis sets

    Subject analysis set title
    Full analysis set
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    The full analysis set (FAS) includes all patients enrolled into the trial who received at least 3 cycles of induction therapy. This means that at least one dose of any compound of the trial medication has to be documented for the third cycle of induction treatment. In total, 46 patients have been enrolled at the end of recruitment. One patient was excluded from the study due to subsequently detected violation of inclusion/exclusion-criteria. This patient was also excluded from the full analysis set, i.e. this patient was excluded from efficacy and safety analyses.

    Subject analysis sets values
    Full analysis set
    Number of subjects
    45
    Age categorical
    Units: Subjects
        In utero
    0
        Preterm newborn infants (gestational age < 37 wks)
    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)
    30
        From 65-84 years
    15
        85 years and over
    0
    Age continuous
    Units: years
        median (inter-quartile range (Q1-Q3))
    60 (53 to 66)
    Gender categorical
    Units: Subjects
        Female
    13
        Male
    32
    Presence of deletion in 17p
    Cytogenetic risk factor
    Units: Subjects
        No
    36
        Yes
    8
        Missing information
    1
    IGHV mutational status
    Cytogenetic risk factor
    Units: Subjects
        Unmutated
    34
        Mutated
    11
    CLL-IPI risk group
    International prognostic index used for CLL
    Units: Subjects
        Low
    3
        Intermediate
    16
        High
    13
        Very high
    11
        Missing information
    2
    TP53 mutational status
    Cytogenetic risk factor
    Units: Subjects
        Unmutated
    32
        Mutated
    13
        Missing information
    0
    Binet stage
    Status of the disease
    Units: Subjects
        Binet A
    16
        Binet B
    16
        Binet C
    13
    Cumulative illness rating scale (CIRS)
    Validated score to evaluate the comorbidity
    Units: Scores
        median (inter-quartile range (Q1-Q3))
    2 (1 to 4.5)
    Observation time
    Time between trial registration and last observation or death
    Units: Months
        median (inter-quartile range (Q1-Q3))
    36.3 (35.3 to 38.0)

    End points

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    End points reporting groups
    Reporting group title
    Bendamustine (optional), acalabrutinib,obinutuzumab,venetoclax
    Reporting group description
    Two cycles of optional debulking with bendamustine were administered before induction. Obinutuzumab was started in the first induction cycle (days 1, 8, and 15), in induction cycle 2 acalabrutinib was added, and in induction cycle 3 venetoclax ramp up (over 5 weeks up to 400 mg) was initiated. All drugs were administered according to the established schedules with daily acalabrutinib, venetoclax, and obinutuzumab once every 4 weeks during induction and every 12 weeks during maintenance. Induction treatment was administered for a total of 8 cycles (i.e., 6 cycles of the triple combination) until final restaging before the patients entered the maintenance phase. Induction cycles had 28 days and maintenance cycles had 84 days. Maintenance treatment was stopped once a (clinical) complete response and undectable MRD (peripheral blood) in 2 consecutive measurements were achieved, at progression, intolerable toxicity, or after the maximum number of 8 cycles of maintenance treatment.

    Subject analysis set title
    Full analysis set
    Subject analysis set type
    Sub-group analysis
    Subject analysis set description
    The full analysis set (FAS) includes all patients enrolled into the trial who received at least 3 cycles of induction therapy. This means that at least one dose of any compound of the trial medication has to be documented for the third cycle of induction treatment. In total, 46 patients have been enrolled at the end of recruitment. One patient was excluded from the study due to subsequently detected violation of inclusion/exclusion-criteria. This patient was also excluded from the full analysis set, i.e. this patient was excluded from efficacy and safety analyses.

    Primary: Undetectable measurable residual disease (uMRD) rate in peripheral blood at final restaging after end of induction treatment

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    End point title
    Undetectable measurable residual disease (uMRD) rate in peripheral blood at final restaging after end of induction treatment [1]
    End point description
    Undetectable measurable residual disease (uMRD) is defined as less than 1 CLL cell among 10.000 leukocytes, i.e. <10-4. The uMRD rate is defined as the proportion of patients having achieved uMRD by 4-color flow cytometry at final restaging based on the full analysis set. The corresponding 95% confidence interval will be calculated according to Clopper-Pearson. The primary objective of the study is to test the null hypothesis H0: "uMRD rate <=70%" (with corresponding alternative hypothesis H1: "uMRD rate >70%") by comparing the uMRD rate with the benchmark of P0=70% using a one-sided one-sample binomial test and a pre-specified significance level of 2.5%. The efficacy of the study treatment will be concluded if the null hypothesis is rejected.
    End point type
    Primary
    End point timeframe
    At final restaging, which is 12 weeks after the last cycle of induction treatment.
    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 uMRD rate in peripheral blood at final restaging after end of induction treatment was compared with the benchmark of P0=70% using a one-sided one-sample binomial test: P = 0.258.
    End point values
    Full analysis set
    Number of subjects analysed
    45
    Units: Percentage
    number (not applicable)
        uMRD rate
    75.6
        95% confidence interval: lower bound
    60.5
        95% confidence interval: upper bound
    87.1
    No statistical analyses for this end point

    Secondary: Progression-free survival (PFS)

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    End point title
    Progression-free survival (PFS)
    End point description
    Progression-free survival (PFS) will be calculated from the date of registration until first documented disease progression (as defined by the IWCLL response criteria [2008] and unless documented before start of the induction treatment) or death by any cause, whichever occurs first. These will be counted as events for PFS. The initiation of a subsequent CLL treatment after the study treatment will not be counted as an event or as a reason for censoring. Patients who have not experienced disease progression or death will be censored at the date of the last response/tumor assessment they were assessed as being event-free. If no response/tumor assessments were documented after registration, patients will be censored at the time of registration + 1 day. Analysis of PFS will be performed descriptively (i.e. without confirmatory testings) using Kaplan-Meier methodology. Kaplan-Meier estimates of rates for 12, 24, and 36 months after registration will be reported.
    End point type
    Secondary
    End point timeframe
    Data for this endpoint will be collected from first study visit until last visit of each study subject.
    End point values
    Full analysis set
    Number of subjects analysed
    45
    Units: Percentage
    number (not applicable)
        12-month survival
    95.6
        24-month survival
    95.6
        36-month survival
    85.0
    Attachments
    Progression-free survival (PFS)
    No statistical analyses for this end point

    Secondary: Time to next treatment (TTNT)

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    End point title
    Time to next treatment (TTNT)
    End point description
    Time to next treatment (TTNT) will be calculated from the date of registration until initiation of subsequent anti-leukemic treatment. These will be counted as events for TTNT. Alive patients for whom no subsequent anti-leukemic tratment is documented will be censored at the date of last observation they were assessed as being event-free. Deceased patients for whom no subsequent anti-leukemic treatment is documented will be censored at the date of death. If no visits were documented after registration, patients will be censored at the time of registration + 1 day. Analysis of TTNT will be performed descriptively (i.e. without confirmatory testings) using Kaplan-Meier methodology. Kaplan-Meier estimates of rates for 12, 24. and 36 months after registration will be reported.
    End point type
    Secondary
    End point timeframe
    Data for this endpoint will be collected from first study visit until last visit of each study subject.
    End point values
    Full analysis set
    Number of subjects analysed
    45
    Units: Percentage
    number (not applicable)
        12-month survival
    97.8
        24-month survival
    95.5
        36-month survival
    85.9
    Attachments
    Time to next treatment (TTNT)
    No statistical analyses for this end point

    Secondary: Overall survival (OS)

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    End point title
    Overall survival (OS)
    End point description
    Overall survival (OS) will be calculated from the date of registration until death by any cause. These will be counted as events for OS. Alive patients will be censored at the date of last observation. If no visits were documented after registration, patients will be censored at the time of registration + 1 day. Analysis of OS will be performed descriptively (i.e. without confirmatory testings) using Kaplan-Meier methodology. Kaplan-Meier estimates for 12, 24, and 36 months after registration will be reported.
    End point type
    Secondary
    End point timeframe
    Data for this endpoint will be collected from first study visit until last visit of each study subject.
    End point values
    Full analysis set
    Number of subjects analysed
    45
    Units: Percentage
    number (not applicable)
        12-month survival
    100.0
        24-month survival
    100.0
        36-month survival
    93.8
    Attachments
    Overall survival (OS)
    No statistical analyses for this end point

    Secondary: Response at final restaging after end of induction treatment

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    End point title
    Response at final restaging after end of induction treatment
    End point description
    Response at final restaging after end of induction treatment will be analyzed descriptively (i.e. without confirmatory testings).
    End point type
    Secondary
    End point timeframe
    At final restaging, which 12 weeks after the last cycle of induction treatment.
    End point values
    Full analysis set
    Number of subjects analysed
    45
    Units: Patients
        Complete response (CR)
    6
        Partial response (PR)
    39
        Stable disease (SD)
    0
        Progressive disease (PD)
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    Timeframe for AE
    Adverse event reporting additional description
    AE additional description
    Assessment type
    Non-systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    19.0
    Reporting groups
    Reporting group title
    RR patient
    Reporting group description
    -

    Serious adverse events
    RR patient
    Total subjects affected by serious adverse events
         subjects affected / exposed
    28 / 45 (62.22%)
         number of deaths (all causes)
    3
         number of deaths resulting from adverse events
    3
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Hodgkin's disease
    Additional description: Hodgkin's disease
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Large granular lymphocytosis
    Additional description: Large granular lymphocytosis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Pancreatic carcinoma metastatic
    Additional description: Pancreatic carcinoma metastatic
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Prostate cancer
    Additional description: Prostate cancer
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Richter's syndrome
    Additional description: Richter's syndrome
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vascular disorders
    Granulomatosis with polyangiitis
    Additional description: Granulomatosis with polyangiitis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Immune system disorders
    Hypersensitivity
    Additional description: Hypersensitivity
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Infusion related reaction
    Additional description: Infusion related reaction
         subjects affected / exposed
    5 / 45 (11.11%)
         occurrences causally related to treatment / all
    5 / 5
         deaths causally related to treatment / all
    0 / 0
    Incisional hernia
    Additional description: Incisional hernia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Congenital, familial and genetic disorders
    Hydrocele
    Additional description: Hydrocele
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Atrial fibrillation
    Additional description: Atrial fibrillation
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Cerebral cyst
    Additional description: Cerebral cyst
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Facial nerve disorder
    Additional description: Facial nerve disorder
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Transient ischaemic attack
    Additional description: Transient ischaemic attack
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Autoimmune haemolytic anaemia
    Additional description: Autoimmune haemolytic anaemia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Febrile neutropenia
    Additional description: Febrile neutropenia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Neutropenia
    Additional description: Neutropenia
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Leukopenia
    Additional description: Leukopenia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Thrombocytopenia
    Additional description: Thrombocytopenia
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Ear and labyrinth disorders
    Sudden hearing loss
    Additional description: Sudden hearing loss
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Abdominal pain
    Additional description: Abdominal pain
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastritis
    Additional description: Gastritis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Inguinal hernia
    Additional description: Inguinal hernia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Mechanical ileus
    Additional description: Mechanical ileus
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Cholelithiasis
    Additional description: Cholelithiasis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    Acute kidney injury
    Additional description: Acute kidney injury
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Urethral stenosis
    Additional description: Urethral stenosis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Osteoarthritis
    Additional description: Osteoarthritis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Atypical pneumonia
    Additional description: Atypical pneumonia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    COVID-19
    Additional description: COVID-19
         subjects affected / exposed
    6 / 45 (13.33%)
         occurrences causally related to treatment / all
    0 / 7
         deaths causally related to treatment / all
    0 / 1
    COVID-19 pneumonia
    Additional description: COVID-19 pneumonia
         subjects affected / exposed
    5 / 45 (11.11%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 2
    Groin abscess
    Additional description: Groin abscess
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Influenza
    Additional description: Influenza
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Peritonsillar abscess
    Additional description: Peritonsillar abscess
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pneumonia
    Additional description: Pneumonia
         subjects affected / exposed
    3 / 45 (6.67%)
         occurrences causally related to treatment / all
    2 / 5
         deaths causally related to treatment / all
    0 / 0
    Septic shock
    Additional description: Septic shock
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Sinusitis
    Additional description: Sinusitis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin infection
    Additional description: Skin infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Upper respiratory tract infection
    Additional description: Upper respiratory tract infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Metabolism and nutrition disorders
    Tumour lysis syndrome
    Additional description: Tumour lysis syndrome
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    RR patient
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    45 / 45 (100.00%)
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Haemangioma
    Additional description: Haemangioma
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Haemangioma of liver
    Additional description: Haemangioma of liver
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Vascular disorders
    Arteriosclerosis
    Additional description: Arteriosclerosis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Haematoma
    Additional description: Haematoma
         subjects affected / exposed
    6 / 45 (13.33%)
         occurrences all number
    6
    Hypertension
    Additional description: Hypertension
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Phlebitis
    Additional description: Phlebitis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Spider vein
    Additional description: Spider vein
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Thrombophlebitis
    Additional description: Thrombophlebitis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Surgical and medical procedures
    Tooth extraction
    Additional description: Tooth extraction
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    General disorders and administration site conditions
    Chills
    Additional description: Chills
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Drug intolerance
    Additional description: Drug intolerance
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Fatigue
    Additional description: Fatigue
         subjects affected / exposed
    17 / 45 (37.78%)
         occurrences all number
    18
    Extravasation
    Additional description: Extravasation
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Mucosal inflammation
    Additional description: Mucosal inflammation
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Oedema
    Additional description: Oedema
         subjects affected / exposed
    4 / 45 (8.89%)
         occurrences all number
    4
    Oedema peripheral
    Additional description: Oedema peripheral
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Pain
    Additional description: Pain
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Pyrexia
    Additional description: Pyrexia
         subjects affected / exposed
    3 / 45 (6.67%)
         occurrences all number
    3
    Immune system disorders
    Anaphylactic reaction
    Additional description: Anaphylactic reaction
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Allergy to arthropod bite
    Additional description: Allergy to arthropod bite
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Hypogammaglobulinaemia
    Additional description: Hypogammaglobulinaemia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Immunodeficiency
    Additional description: Immunodeficiency
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Reproductive system and breast disorders
    Benign prostatic hyperplasia
    Additional description: Benign prostatic hyperplasia
         subjects affected / exposed
    3 / 45 (6.67%)
         occurrences all number
    3
    Pelvic pain
    Additional description: Pelvic pain
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    2
    Postmenopausal haemorrhage
    Additional description: Postmenopausal haemorrhage
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    2
    Respiratory, thoracic and mediastinal disorders
    Asthma
    Additional description: Asthma
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Bronchitis chronic
    Additional description: Bronchitis chronic
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Cough
    Additional description: Cough
         subjects affected / exposed
    4 / 45 (8.89%)
         occurrences all number
    5
    Epistaxis
    Additional description: Epistaxis
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    5
    Dyspnoea
    Additional description: Dyspnoea
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Oropharyngeal pain
    Additional description: Oropharyngeal pain
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Pleural effusion
    Additional description: Pleural effusion
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Productive cough
    Additional description: Productive cough
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Psychiatric disorders
    Depression
    Additional description: Depression
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Insomnia
    Additional description: Insomnia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Sleep disorder
    Additional description: Sleep disorder
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Product issues
    Device deposit issue
    Additional description: Device deposit issue
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Investigations
    Alanine aminotransferase increased
    Additional description: Alanine aminotransferase increased
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Aspartate aminotransferase increased
    Additional description: Aspartate aminotransferase increased
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Blood lactate dehydrogenase increased
    Additional description: Blood lactate dehydrogenase increased
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Enterobacter test positive
    Additional description: Enterobacter test positive
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Escherichia test positive
    Additional description: Escherichia test positive
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Gamma-glutamyltransferase increased
    Additional description: Gamma-glutamyltransferase increased
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Hepatic enzyme increased
    Additional description: Hepatic enzyme increased
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Weight decreased
    Additional description: Weight decreased
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Injury, poisoning and procedural complications
    Animal bite
    Additional description: Animal bite
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Arthropod bite
    Additional description: Arthropod bite
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Infusion related reaction
    Additional description: Infusion related reaction
         subjects affected / exposed
    19 / 45 (42.22%)
         occurrences all number
    19
    Ligament sprain
    Additional description: Ligament sprain
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Skin abrasion
    Additional description: Skin abrasion
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Thoracic vertebral fracture
    Additional description: Thoracic vertebral fracture
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Transfusion reaction
    Additional description: Transfusion reaction
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Wound
    Additional description: Wound
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Congenital, familial and genetic disorders
    Von Willebrand's disease
    Additional description: Von Willebrand's disease
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Cardiac disorders
    Palpitations
    Additional description: Palpitations
         subjects affected / exposed
    3 / 45 (6.67%)
         occurrences all number
    3
    Ventricular extrasystoles
    Additional description: Ventricular extrasystoles
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Nervous system disorders
    Dizziness
    Additional description: Dizziness
         subjects affected / exposed
    3 / 45 (6.67%)
         occurrences all number
    3
    Headache
    Additional description: Headache
         subjects affected / exposed
    12 / 45 (26.67%)
         occurrences all number
    17
    Hypoaesthesia
    Additional description: Hypoaesthesia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Neuropathy peripheral
    Additional description: Neuropathy peripheral
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Olfactory nerve disorder
    Additional description: Olfactory nerve disorder
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Paraesthesia
    Additional description: Paraesthesia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Polyneuropathy
    Additional description: Polyneuropathy
         subjects affected / exposed
    3 / 45 (6.67%)
         occurrences all number
    3
    Sciatica
    Additional description: Sciatica
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Restless legs syndrome
    Additional description: Restless legs syndrome
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Taste disorder
    Additional description: Taste disorder
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Anaemia
    Additional description: Anaemia
         subjects affected / exposed
    6 / 45 (13.33%)
         occurrences all number
    6
    Aplasia pure red cell
    Additional description: Aplasia pure red cell
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Febrile neutropenia
    Additional description: Febrile neutropenia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Leukopenia
    Additional description: Leukopenia
         subjects affected / exposed
    4 / 45 (8.89%)
         occurrences all number
    5
    Neutropenia
    Additional description: Neutropenia
         subjects affected / exposed
    14 / 45 (31.11%)
         occurrences all number
    18
    Pancytopenia
    Additional description: Pancytopenia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Thrombocytopenia
    Additional description: Thrombocytopenia
         subjects affected / exposed
    19 / 45 (42.22%)
         occurrences all number
    28
    Ear and labyrinth disorders
    Hypoacusis
    Additional description: Hypoacusis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Vertigo positional
    Additional description: Vertigo positional
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Eye disorders
    Blepharospasm
    Additional description: Blepharospasm
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Ocular hyperaemia
    Additional description: Ocular hyperaemia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Visual impairment
    Additional description: Visual impairment
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Gastrointestinal disorders
    Abdominal pain
    Additional description: Abdominal pain
         subjects affected / exposed
    3 / 45 (6.67%)
         occurrences all number
    3
    Abdominal pain upper
    Additional description: Abdominal pain upper
         subjects affected / exposed
    5 / 45 (11.11%)
         occurrences all number
    6
    Abdominal pain lower
    Additional description: Abdominal pain lower
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Aphthous ulcer
    Additional description: Aphthous ulcer
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Barrett's oesophagus
    Additional description: Barrett's oesophagus
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Constipation
    Additional description: Constipation
         subjects affected / exposed
    6 / 45 (13.33%)
         occurrences all number
    7
    Diarrhoea
    Additional description: Diarrhoea
         subjects affected / exposed
    17 / 45 (37.78%)
         occurrences all number
    27
    Dysphagia
    Additional description: Dysphagia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Dyspepsia
    Additional description: Dyspepsia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Flatulence
    Additional description: Flatulence
         subjects affected / exposed
    3 / 45 (6.67%)
         occurrences all number
    3
    Gingival bleeding
    Additional description: Gingival bleeding
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    2
    Glossitis
    Additional description: Glossitis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Gastritis
    Additional description: Gastritis
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Gastrooesophageal reflux disease
    Additional description: Gastrooesophageal reflux disease
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Haemorrhoids
    Additional description: Haemorrhoids
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Mouth haemorrhage
    Additional description: Mouth haemorrhage
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Nausea
    Additional description: Nausea
         subjects affected / exposed
    12 / 45 (26.67%)
         occurrences all number
    18
    Periodontal disease
    Additional description: Periodontal disease
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Stomatitis
    Additional description: Stomatitis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Toothache
    Additional description: Toothache
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Vomiting
    Additional description: Vomiting
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Hepatobiliary disorders
    hepatoloxicity
    Additional description: hepatoloxicity
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Dermatitis atopic
    Additional description: Dermatitis atopic
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Drug eruption
    Additional description: Drug eruption
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    2
    Dry skin
    Additional description: Dry skin
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Hyperhidrosis
    Additional description: Hyperhidrosis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Lichen planus
    Additional description: Lichen planus
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Night sweats
    Additional description: Night sweats
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Palmar-plantar erythrodysaesthesia syndrome
    Additional description: Palmar-plantar erythrodysaesthesia syndrome
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Petechiae
    Additional description: Petechiae
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Pruritus
    Additional description: Pruritus
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Rash maculo-papular
    Additional description: Rash maculo-papular
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Rash
    Additional description: Rash
         subjects affected / exposed
    11 / 45 (24.44%)
         occurrences all number
    12
    Skin lesion
    Additional description: Skin lesion
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Skin mass
    Additional description: Skin mass
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Vitiligo
    Additional description: Vitiligo
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Renal and urinary disorders
    Acute kidney injury
    Additional description: Acute kidney injury
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Nephrolithiasis
    Additional description: Nephrolithiasis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Pollakiuria
    Additional description: Pollakiuria
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Renal failure
    Additional description: Renal failure
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Renal impairment
    Additional description: Renal impairment
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Urinary retention
    Additional description: Urinary retention
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Urinary tract obstruction
    Additional description: Urinary tract obstruction
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Musculoskeletal and connective tissue disorders
    Arthralgia
    Additional description: Arthralgia
         subjects affected / exposed
    4 / 45 (8.89%)
         occurrences all number
    4
    Arthritis
    Additional description: Arthritis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Back pain
    Additional description: Back pain
         subjects affected / exposed
    3 / 45 (6.67%)
         occurrences all number
    5
    Bone pain
    Additional description: Bone pain
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Flank pain
    Additional description: Flank pain
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Kyphosis
    Additional description: Kyphosis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Muscle spasms
    Additional description: Muscle spasms
         subjects affected / exposed
    6 / 45 (13.33%)
         occurrences all number
    6
    Musculoskeletal pain
    Additional description: Musculoskeletal pain
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Myalgia
    Additional description: Myalgia
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Neck pain
    Additional description: Neck pain
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Osteoporosis
    Additional description: Osteoporosis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Pain in extremity
    Additional description: Pain in extremity
         subjects affected / exposed
    3 / 45 (6.67%)
         occurrences all number
    3
    Infections and infestations
    Abscess
    Additional description: Abscess
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Acarodermatitis
    Additional description: Acarodermatitis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Bacterial vaginosis
    Additional description: Bacterial vaginosis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Bronchitis
    Additional description: Bronchitis
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Chronic sinusitis
    Additional description: Chronic sinusitis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Catheter site infection
    Additional description: Catheter site infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Conjunctivitis
    Additional description: Conjunctivitis
         subjects affected / exposed
    5 / 45 (11.11%)
         occurrences all number
    8
    COVID-19
    Additional description: COVID-19
         subjects affected / exposed
    7 / 45 (15.56%)
         occurrences all number
    10
    COVID-19 pneumonia
    Additional description: COVID-19 pneumonia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Diverticulitis
    Additional description: Diverticulitis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    2
    Erysipelas
    Additional description: Erysipelas
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Furuncle
    Additional description: Furuncle
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Gastroenteritis
    Additional description: Gastroenteritis
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Gastrointestinal infection
    Additional description: Gastrointestinal infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Genital herpes
    Additional description: Genital herpes
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Herpes virus infection
    Additional description: Herpes virus infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Herpes zoster
    Additional description: Herpes zoster
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Implant site infection
    Additional description: Implant site infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Infection
    Additional description: Infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Lower respiratory tract infection
    Additional description: Lower respiratory tract infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Nail bed infection
    Additional description: Nail bed infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Nasopharyngitis
    Additional description: Nasopharyngitis
         subjects affected / exposed
    8 / 45 (17.78%)
         occurrences all number
    10
    Otitis media
    Additional description: Otitis media
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Oral herpes
    Additional description: Oral herpes
         subjects affected / exposed
    3 / 45 (6.67%)
         occurrences all number
    3
    Pneumonia parainfluenzae viral
    Additional description: Pneumonia parainfluenzae viral
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Pneumonia
    Additional description: Pneumonia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Pneumonia pneumococcal
    Additional description: Pneumonia pneumococcal
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Pyelonephritis
    Additional description: Pyelonephritis
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Rhinovirus infection
    Additional description: Rhinovirus infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Respiratory tract infection
    Additional description: Respiratory tract infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Sinusitis
    Additional description: Sinusitis
         subjects affected / exposed
    3 / 45 (6.67%)
         occurrences all number
    3
    Skin infection
    Additional description: Skin infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Tooth infection
    Additional description: Tooth infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Upper respiratory tract infection
    Additional description: Upper respiratory tract infection
         subjects affected / exposed
    5 / 45 (11.11%)
         occurrences all number
    6
    Urinary tract infection
    Additional description: Urinary tract infection
         subjects affected / exposed
    8 / 45 (17.78%)
         occurrences all number
    12
    Vaginal infection
    Additional description: Vaginal infection
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Metabolism and nutrition disorders
    Abnormal loss of weight
    Additional description: Abnormal loss of weight
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Decreased appetite
    Additional description: Decreased appetite
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Dehydration
    Additional description: Dehydration
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Diabetes mellitus
    Additional description: Diabetes mellitus
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Hyperlipasaemia
    Additional description: Hyperlipasaemia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Hyperkalaemia
    Additional description: Hyperkalaemia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Hypercreatininaemia
    Additional description: Hypercreatininaemia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Hyperamylasaemia
    Additional description: Hyperamylasaemia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Hyperuricaemia
    Additional description: Hyperuricaemia
         subjects affected / exposed
    5 / 45 (11.11%)
         occurrences all number
    6
    Hypocalcaemia
    Additional description: Hypocalcaemia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Hypokalaemia
    Additional description: Hypokalaemia
         subjects affected / exposed
    5 / 45 (11.11%)
         occurrences all number
    7
    Hypomagnesaemia
    Additional description: Hypomagnesaemia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Hypophosphataemia
    Additional description: Hypophosphataemia
         subjects affected / exposed
    1 / 45 (2.22%)
         occurrences all number
    1
    Iron deficiency
    Additional description: Iron deficiency
         subjects affected / exposed
    2 / 45 (4.44%)
         occurrences all number
    2
    Tumour lysis syndrome
    Additional description: Tumour lysis syndrome
         subjects affected / exposed
    3 / 45 (6.67%)
         occurrences all number
    3

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    18 Dec 2018
    The protocol was amended and Protocol Version: v1.2 was approved: Duration of SAE Reporting was amended.
    06 Jan 2020
    Due to the new safety documents for acalabrutinib, bendamustine, obinutuzumab and venetoclax, some changes to the study protocol and patient information were necessary; in addition, an addendum was created for patients already included in the study. Furthermore, some necessary adjustments were made to the study protocol with regard to the planned safety analysis and the change of a financial sponsor. In October 2019, the safety analysis of the first 6 patients who were treated for at least 8 weeks with the triple combination of obinutuzumab, acalabrutinib and venetoclax was carried out as planned in the protocol. It showed no unexpected or cumulative toxicities, but a very favourable safety profile. The members of the CLL2-BAAG protocol committee assessed the AEs/ SAEs that occurred and indicated that there were no safety concerns with the triple combination and that enrolment could continue without restrictions or new safety precautions. Thus, further recruitment was carried out without limitation. There was also a change of financial sponsor from Acerta to AstraZeneca, as AstraZeneca acquired a majority stake in Acerta and the Acalabruntinb programme for externally sponsored studies was transferred to AstraZeneca. This does not result in any changes to the investigational product acalabrutinib or its manufacture.
    16 Mar 2021
    Due to the new safety documents for acalabrutinib, obinutuzumab and venetoclax changes to the patient information were necessary; these relate to acalabrutinib and obinutuzumab. As recruitment for the trial has already been completed and no new patients will be included in the trial, only an addendum was created for all patients included in the trial. In future, the Summary of Product Characteristics will be used as the reference document for acalabrutinib instead of the IB.
    02 Jun 2022
    Due to new safety documents for bendamustine, acalabrutinib, obinutuzumab and venetoclax, changes to the patient information were necessary; these relate to acalabrutinib and obinutuzumab. As enrolment of the study has already been completed and no new patients are being included in the study, only an addendum to the patient information was created for all patients included in the study. Furthermore, a new section on the benefit-risk assessment of the Covid-19 pandemic, including vaccinations and passive immunisation, and a new section on additional scientific investigations on blood samples already taken were added to the protocol. The corresponding consent of the patients is also requested in the addendum to the patient information.
    14 Sep 2022
    In addition to the amended protocol, the new SmPCs for venetoclax (March 2022), obinutuzumab (April 2022 & July 2022) and bendamustine (February 2022).were submitted. According to the Sponsor's assessment, the changes in the new Summary of Product Characteristics for venetoclax (March 2022), obinutuzumab (July 2022) and bendamustine (February 2022) are only of a formal nature and therefore not substantive. The substantial amendments regarding the side effects of the Obinutuzumab SmPC were already incorporated into the protocol in the previous amendment. A table showing the changes to the individual SmPCs and the sponsor assessment is attached.
    04 Apr 2023
    (Non-Substantial Amendment) Submission of new RSI for Obinutuzumab SmPC 12/2022 ; Acalabrutinib SmPC 01/2023; Venetoclax SmPC 02/2023; Bendamustin SmPC 07/2022

    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

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/38620072
    http://www.ncbi.nlm.nih.gov/pubmed/35988545
    For support, Contact us.
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