Description:
The primary purpose of this trial was is to assess the effect of treatment with deferasirox
combined with erythropoietin vs. erythropoietin alone on erythropoiesis in patients with low-
and int-1-risk myelodysplastic syndrome. The addition of deferasirox to erythropoietin can
lead to a potential synergism with the reduction of reactive oxygen species, through both the
NF-kB pathway and the control of free toxic iron. This may create a better environment in the
bone marrow for a better response with erythropoietin.
This study was designed to test in a prospective way the combination of deferasirox with
erythropoietin in terms of their effect on hematopoiesis.
Title
- Brief Title: Combination Study of Deferasirox and Erythropoietin in Patients With Low- and Int-1-risk Myelodysplastic Syndrome.
- Official Title: An Open-label, Phase II, Randomized, Pilot Study to Assess the Effect in Term of Erythroid Improvement of Deferasirox Combined With Erythropoietin Compared to Erythropoietin Alone in Patients With low-and Int-1-risk Myelodysplastic Syndrome.
Clinical Trial IDs
- ORG STUDY ID:
CICL670A2421
- NCT ID:
NCT01868477
Conditions
- Low and Int 1-risk Myelodysplastic Syndrome
Interventions
Drug | Synonyms | Arms |
---|
Deferasirox DFX, DT | | Deferasirox + Erythropoietin alpha |
Erythropoietin alpha | | Erythropoietin alpha |
Deferasirox DFX, FCT | | Deferasirox + Erythropoietin alpha |
Purpose
The primary purpose of this trial was is to assess the effect of treatment with deferasirox
combined with erythropoietin vs. erythropoietin alone on erythropoiesis in patients with low-
and int-1-risk myelodysplastic syndrome. The addition of deferasirox to erythropoietin can
lead to a potential synergism with the reduction of reactive oxygen species, through both the
NF-kB pathway and the control of free toxic iron. This may create a better environment in the
bone marrow for a better response with erythropoietin.
This study was designed to test in a prospective way the combination of deferasirox with
erythropoietin in terms of their effect on hematopoiesis.
Detailed Description
This study did not meet the original enrollment objective of 60 patients and was terminated
without extending enrollment past original planned LPFV of 31-Oct-2016.
Trial Arms
Name | Type | Description | Interventions |
---|
Erythropoietin alpha | Experimental | Patients will receive erythropoietin 40,000 units/week. If after 4 weeks erythroid improvement is inadequate, dose will be escalated to 60,000 units/week. If after 12 weeks of treatment, erythroid improvement in inadequate, patients will be switched to the combination arm. At any time when erythroid response is achieved, erythropoietin treatment will be stopped until end of study. | |
Deferasirox + Erythropoietin alpha | Experimental | Patients will receive deferasirox dispersible tablet (DT) 10 mg/kg/day or deferasirox film-coated tablet (FCT) 7 mg/kg/day in combination with erythropoietin 40,000 units/week. If after 4 weeks erythroid improvement is inadequate, erythropoietin dose will be escalated to 60,000 units/week. If after 12 weeks of treatment, erythroid improvement in inadequate, patients will be discontinued from the study. At any time when erythroid response is achieved, erythropoietin treatment will be stopped until end of study. Patients will continue deferasirox treatment. | - Deferasirox DFX, DT
- Deferasirox DFX, FCT
|
Eligibility Criteria
Key Inclusion Criteria:
- Patients who had low- and Int-1-risk myelodysplastic syndrome
- Documented diagnosis of the following:
Myelodysplastic syndrome that lasted ≥ 3 months and < 3 years Disease must not have been
secondary to treatment with radiotherapy, chemotherapy, and/or immunotherapy for malignant
or autoimmune diseases
- A hemoglobin < 10 g/dL and ≥ 8 g/dL
- History of transfusions < 10 RBC units and must not have been RBC transfusion
dependent
- 300 ng/mL < serum ferritin < 1,500 ng/mL (Values within 10% difference above 1500
ng/ml or 10% difference below 300 ng/ml could have been accepted at the investigator's
discretion.
- Endogenous erythropoietin levels < 500 units/L
- Serum creatinine ≤ 1.5 times upper limit of normal (ULN)
- Creatinine clearance above the concentration limit in locally approved prescribing
information (PI). Patients with creatinine clearance between 40 and less than 60
mL/min, who did not present with additional risk factors that might impair renal
function, were eligible at the discretion of the investigator
Key Exclusion Criteria:
- Patients who had MDS with isolated del(5q)
- Patients who had received prior EPO treatment or other recombinant growth factors
regardless of the outcome (Patient who had received prior EPO treatment or other
recombinant growth factors for less than 4 weeks and not within 3 months before
screening without a documented response are allowed)
- Patients who had received steroids or immunosuppressive therapy for the improvement of
hematological parameters (stable steroid treatment for adrenal failure or chronic
medical conditions, and intermittent dexamethasone as antiemetics were allowed).
- B12 and folate deficient patients with and without clinical symptoms (patients were
rescreened after successful therapy of B12 and folate deficiency)
- Uncontrolled seizures or uncontrolled hypertension
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Difference in Percentage of Patients Achieving Erythroid Response Within 12 Weeks, by Treatment Group (Full Analysis Set) |
Time Frame: | Baseline up to 12 weeks |
Safety Issue: | |
Description: | Difference in percentage of patients achieving an erythroid response within 12 weeks of treatment between the two arms according to modified IWG 2006 criteria increase in hemoglobin (Hb) ≥ 1.5 g/dL. Erythroid response is defined as the increase in Hb from baseline ≥ 1.5 g/dL. Patients achieving erythroid response at least once within 12 weeks were considered responders |
Secondary Outcome Measures
Measure: | Absolute Change From Baseline to Post-baseline Value for Hemoglobin(g/dL)(Full Analysis Set) |
Time Frame: | Baseline up to 24 weeks |
Safety Issue: | |
Description: | Hematological response criteria defined as: Erythroid response: hemoglobin (Hb) increase from baseline >= 1.5 g/dL (baseline < 11 g/dL), neutrophil response: increase from baseline >= 100% and increase > 0.5 × 10^9/L (baseline <1 × 10^9/L), platelet response: increase from baseline >= 30 × 10^9/L (baseline <100 × 10^9/L) according to modified IWG 2006 criteria |
Measure: | Summary of Hematologic Improvement in Patients Randomized to EPO+DFX and EPO Alone, Within 24 Weeks of Treatment (Full Analysis Set) |
Time Frame: | Baseline up to 24 weeks |
Safety Issue: | |
Description: | Percentage of participants achieving an hematologic improvement defined as: neutrophil improvement: increase from baseline >0.5 × 10^9/L (baseline = 1.0 × 10^9/L ), platelet improvement: increase from baseline ≥ 30 × 10^9/L (baseline = 100 × 10^9/L), hemoglobin improvement: Hb increase from baseline ≥ 1 g/dL (baseline<11 g/dL) |
Measure: | Absolute Change in Hemoglobin Values up to 24 Weeks |
Time Frame: | Baseline up to 24 weeks |
Safety Issue: | |
Description: | Absolute change in hemoglobin values for patients showing improvement: Hemoglobin improvement Hb increase from baseline ≥ 1 g/dL (baseline<11 g/dL) |
Measure: | Absolute Change in Platelets and Neutrophil Levels up to 24 Weeks |
Time Frame: | Baseline up to 24 weeks |
Safety Issue: | |
Description: | Absolute change in platelets and neutrophil levels for participants showing improvement: neutrophil improvement: increase from baseline >0.5 × 10^9/L (baseline = 1.0 × 10^9/L ), platelet improvement: increase from baseline ≥ 30 × 10^9/L (baseline = 100 × 10^9/L) |
Measure: | Summary of Erythroid Response in Participants Randomized to EPO Alone at Baseline and Switched to EPO+DFX After 12 Weeks of Treatment (Full Analysis Set) |
Time Frame: | Week 13 up to 24 weeks |
Safety Issue: | |
Description: | Erythroid response: hemoglobin increase from baseline > = 1.5 g/dL (baseline <11 g/dL) |
Measure: | Summary of Erythroid Response Within 24 Weeks in Participants Randomized to EPO at Baseline and Not Switched to EPO+DFX After 12 Weeks of Treatment (Full Analysis Set) |
Time Frame: | baseline up to 24 weeks |
Safety Issue: | |
Description: | Erythroid response: hemoglobin increase from baseline > = 1.5 g/dL (baseline <11 g/dL). Percentages are based on N. Confidence intervals are calculated using Clopper-Pearson method. Hemoglobin value is at time of first response |
Measure: | Absolute Change in Serum Ferritin up to 24 Weeks for Erythropoietin Alpha Arm (Full Analysis Set) |
Time Frame: | Baseline up to 24 weeks |
Safety Issue: | |
Description: | Absolute change in serum ferritin from baseline |
Measure: | Absolute Change in Serum Ferritin up to 24 Weeks for Deferasirox + Erythropoietin Alpha Arm (Full Analysis Set) |
Time Frame: | Baseline up to 24 weeks |
Safety Issue: | |
Description: | Absolute change in serum ferritin from baseline |
Measure: | Absolute Change in Serum Ferritin up to 24 Weeks for EPO+DFX at 12 Weeks Arm (Full Analysis Set) |
Time Frame: | Baseline up 24 weeks |
Safety Issue: | |
Description: | Absolute change in serum ferritin from baseline |
Measure: | Absolute Change in Hemoglobin (Hb) From Baseline for Erythropoietin Alpha Arm (Full Analysis Set) |
Time Frame: | Baseline up to 24 weeks |
Safety Issue: | |
Description: | This analysis included patients randomized either to EPO or DFX+EPO at baseline as well as patients who did not have erythroid response at week 12 in the EPO group and switched to combination therapy. |
Measure: | Absolute Change in Hemoglobin (Hb) From Baseline for Deferasirox + Erythropoietin Alpha Arm (Full Analysis Set) |
Time Frame: | Baseline up to 24 weeks |
Safety Issue: | |
Description: | This analysis included patients randomized either to EPO or DFX+EPO at baseline as well as patients who did not have erythroid response at week 12 in the EPO group and switched to combination therapy. |
Measure: | Absolute Change in Hemoglobin (Hb) From Baseline for EPO+DFX at 12 Weeks Arm (Full Analysis Set) |
Time Frame: | Baseline up to 24 weeks |
Safety Issue: | |
Description: | This analysis included patients randomized either to EPO or DFX+EPO at baseline as well as patients who did not have erythroid response at week 12 in the EPO group and switched to combination therapy. The time-course of Hb and its absolute changes from baseline was summarized by descriptive statistics by visit and erythroid response. Patients randomized to EPO and not switching after 12 weeks to EPO+DFX would consist of only responders. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | Novartis Pharmaceuticals |
Trial Keywords
- myelodysplastic syndrome
- MDS
- myelodysplasia
- blood disorder
- cytopenias
- low blood counts
- progressive bone marrow failure
- adult
- ICL570
- deferasirox
- erythropoietin
- erythropoiesis
- NF-kB pathway
- hematopoiesis.
Last Updated
October 31, 2018