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JOURNAL ONKOLOGIE – STUDIE

Study Comparing Blinatumomab Alternating With Low-intensity Chemotherapy Versus Standard of Care Chemotherapy for Older Adults With Newly Diagnosed Philadelphia-negative B-cell Precursor Acute Lymphoblastic Leukemia

Rekrutierend

NCT-Nummer:
NCT04994717

Studienbeginn:
November 2021

Letztes Update:
09.08.2024

Wirkstoff:
Blinatumomab, Low-intensity chemotherapy regimen, SOC chemotherapy regimen

Indikation (Clinical Trials):
Leukemia, Precursor Cell Lymphoblastic Leukemia-Lymphoma, Leukemia, Lymphoid

Geschlecht:
Alle

Altersgruppe:
Erwachsene (18+)

Phase:
Phase 3

Sponsor:
Amgen

Collaborator:
-

Studienleiter

MD
Study Director
Amgen

Kontakt

Studienlocations
(3 von 149)

Universitaetsklinikum Augsburg
86156 Augsburg
(Bayern)
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Charite - Universitaetsmedizin Berlin, Campus Benjamin Franklin
12200 Berlin
(Berlin)
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Universitaetsklinikum Dresden
01307 Dresden
(Sachsen)
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Universitaetsklinikum Duesseldorf
40225 Duesseldorf
(Nordrhein-Westfalen)
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Universitaetsklinikum Heidelberg
69120 Heidelberg
(Baden-Württemberg)
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Universitaetsklinikum Jena
07747 Jena
(Thüringen)
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Universitaetsklinikum Schleswig-Holstein
24105 Kiel
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Klinikum der LMU Muenchen
81377 Muenchen
(Bayern)
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91010 Duarte
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92868-3201 Orange
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94143 San Francisco
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32804 Orlando
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Cleveland Clinic Foundation
44195 Cleveland
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Saint Francis Hospital, Inc
29607 Greenville
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77030 Houston
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2065 St Leonards
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4029 Herston
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4102 Woolloongabba
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3084 Heidelberg
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3000 Melbourne
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6020 Innsbruck
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4020 Linz
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8000 Brugge
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1200 Bruxelles
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2650 Edegem
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3500 Hasselt
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4000 Liege
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5530 Yvoir
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1797 Sofia
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M5G 2M9 Toronto
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7501066 Santiago
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00029 Helsinki
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78157 Le Chesnay Cedex
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59000 Lille
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44093 Nantes Cedex 1
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06202 Nice cedex 3
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33604 Pessac Cedex
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35000 Rennes Cedex 9
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11527 Athens
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57010 Thessaloniki
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1097 Budapest
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4032 Debrecen
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3300 Eger
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4400 Nyiregyhaza
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70124 Bari
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24127 Bergamo
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40138 Bologna
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16132 Genova
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73100 Lecce
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30174 Mestre (VE)
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20122 Milano
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80131 Napoli
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00161 Roma
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37134 Verona
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466-8560 Nagoya-shi
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010-8543 Akita-shi
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910-1193 Yoshida-gun
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812-8582 Fukuoka-shi
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830-0011 Kurume-shi
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960-1295 Fukushima-shi
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003-0006 Sapporo-shi
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650-0047 Kobe-shi
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920-8641 Kanazawa-shi
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259-1193 Isehara-shi
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232-0024 Yokohama-shi
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852-8501 Nagasaki-shi
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701-1192 Okayama-shi
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545-8586 Osaka-shi
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589-8511 Osakasayama-shi
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329-0498 Shimotsuke-shi
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990-9585 Yamagata-shi
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49241 Busan
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58128 Hwasun
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Seoul National University Hospital
03080 Seoul
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Severance Hospital Yonsei University Health System
03722 Seoul
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06591 Seoul
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01120 Ciudad de Mexico
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01330 Mexico City
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64460 Monterrey
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Hematologica Alta Especialidad
52787 Huixquilucan
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Universitair Medisch Centrum Groningen
9713 GZ Groningen
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3004-561 Coimbra
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1099-023 Lisboa
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1169-050 Lisboa
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1649-035 Lisboa
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022328 Bucharest
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400015 Cluj-Napoca
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700483 Iasi
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550245 Sibiu
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14004 Cordoba
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41013 Sevilla
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39008 Santander
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37007 Salamanca
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08916 Badalona
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08035 Barcelona
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46026 Valencia
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413 45 Goteborg
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40458 Taichung
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40705 Taichung
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70403 Tainan
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10002 Taipei
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33305 Taoyuan
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06100 Ankara
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34214 Istanbul
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35340 Izmir
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55139 Samsun
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NW1 2PG London
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Studien-Informationen

Brief Summary:

The safety run-in part of the study aims to evaluate the safety and tolerability of

blinatumomab alternating with low-intensity chemotherapy. The phase 3 part of the study

aims to compare event-free survival (EFS) and overall survival (OS) of participants

receiving blinatumomab alternating with low-intensity chemotherapy to EFS and (OS) of

participants receiving standard of care (SOC) chemotherapy.

Ein-/Ausschlusskriterien

Inclusion Criteria:

- Age ≥ 55 years at the time of informed consent. OR

Age 40 to < 55 years of age if at least 1 of the following comorbidities at the time of

informed consent:

- history of grades 3 and 4 pancreatitis

- diabetes mellitus with end-organ damage

- severe liver disease such as cirrhosis stage 2 with portal hypertension or history

of esophageal variceal bleeding and aspartate transaminase (AST)/alanine

aminotransferase (ALT) > 10 x upper limit of normal (ULN) (liver cirrhosis must be

confirmed by biopsy)

- body mass index (BMI) ≥ 40 combined with relevant comorbidities such as metabolic

syndrome

- Any further combination of documented severe comorbidities that the investigator

judges to be incompatible with administering an intensive pediatric based, adult

adapted standard chemotherapy regimen but still compatible with the suggested

protocol for older participants in both the experimental and the SOC arm. The

participant history will be reviewed by the medical monitor during screening to

determine enrollment acceptability based on a standard list with types of

comorbidities allowed. A medical advisory board is available to the investigators

for questions/advice and includes experts in the field of adult leukemia with

experience with the use of blinatumomab, the global development lead for

blinatumomab and the medical monitor of the study.

- Participants with newly diagnosed Philadelphia (Ph)-negative B-cell precursor

acute lymphoblastic leukemia (ALL)

- Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2, higher ECOG

score allowed if due to underlying leukemia

- All participants must have adequate organ function as defined below:

- renal: estimated glomerular filtration rate based on MDRD calculation ≥ 50

mL/min/1.73 m^2

- liver function: total bilirubin ≤ 2x upper limit of normal (ULN; unless Gilbert's

Disease or if liver involvement with leukemia); exception for participants 40 to <

55 years of age if they have a comorbidity listed above: severe liver disease such

as cirrhosis stage 2 with portal hypertension or history of esophageal variceal

bleeding and AST/ALT > 10 x ULN (liver cirrhosis must be confirmed by biopsy)

- cardiac: left ventricular ejection fraction (LVEF) ≥ 50%

Exclusion Criteria:

- Active central nervous system (CNS) leukemia not resolved with IT chemotherapy

during screening.

- Clinically relevant CNS pathology requiring treatment (eg, unstable epilepsy).

- Current autoimmune disease or history of autoimmune disease with potential CNS

involvement

- Known infection with human immunodeficiency virus (HIV)

- Known infection with chronic or active infection with hepatitis B (eg, hepatitis b

surface [HBs] antigen reactive or quantifiable hepatitis b virus [HBV] viral load)

or hepatitis C virus (HCV) (eg, HCV RNA [qualitative] is detected).

Active hepatitis B and C based on the following results:

- positive for hepatitis B surface antigen (HepBsAg) (indicative of chronic hepatitis

B or recent acute hepatitis B)

- negative HepBsAg and positive for hepatitis B core antibody: negative HBV DNA by PCR

result is necessary to enroll.

- positive Hepatitis C virus antibody (HepCAb): negative hepatitis C virus RNA by PCR

result is necessary to enroll.

- Participant with symptoms and/or clinical signs and/or radiographic and/or

sonographic signs that indicate an acute or uncontrolled chronic infection.

- Cancer chemotherapy for this newly diagnosed B cell ALL before the start of

protocol-required therapy with the exception of IT chemotherapy or pre-phase

chemotherapy. Radiation to a spot lesion such as chloroma or lytic lesion of

bone or vertebrae for pain or vertebral stabilization is allowed.

Studien-Rationale

Primary outcome:

1. Safety run-in: Number of Participants who Experience Treatment-emergent Adverse Events (TEAEs) (Time Frame - Up to approximately 5 years):
Number and percentage of participants who experience one or more TEAE, serious TEAE, treatment-related adverse events, and adverse events of interest.

2. Phase 3: Event-free Survival (EFS) (Time Frame - Up to approximately 5 years):
Time from randomization (enrollment) until treatment failure, relapse or death from any cause, whichever is earlier. Treatment failure is defined as not achieving a hematological complete CR with MRD response <10-4 by the end of the initial disease assessment period. Relapse is defined as hematologic relapse, extramedullary relapse, and/or molecular relapse (MRD positivity >= 10^-3), whichever occurs earlier, in participants with prior achievement of hematologic CR with MRD response <10^-4. Participants without an event will be censored at their last evaluable disease assessment date.

3. Phase 3: Overall Survival (OS) (Time Frame - Up to approximately 5 years):
OS is defined as time from randomization (enrollment) until death due to any cause.

Secondary outcome:

1. Safety run-in: Complete Remission (CR) Rate by the End of Initial Disease Assessment Period (Time Frame - Baseline to Week 14)

2. Safety run-in: Minimal Residual Disease (MRD) Response by the End of Initial Disease Assessment Period (Time Frame - Baseline to Week 14):
MRD response is defined as the percentage of participants who achieve a response of < 10^-4 measured by polymerase chain reaction (PCR).

3. Safety run-in: Relapse-free Survival (RFS) (Time Frame - Up to approximately 5 years):
RFS: In participants who achieve CR, the time from first achievement of this response until date of the first relapse including hematologic relapse, extramedullary relapse, or death due to any cause, whichever occurs first.

4. Safety run-in: Minimal Residual Disease (MRD) Relapse Free Survival (RFS) (Time Frame - Up to approximately 5 years):
MRD RFS: In participants who achieve CR with MRD response, the time from first achievement of this response until date of of the first relapse including molecular relapse, hematological relapse, and/or extramedullary relapse, or death due to any cause, whichever occurs first. (Molecular relapse will be defined 2 ways: MRD>= 10^-3 and MRD>=10^-4. Participants without an event will be censored at their last evaluable disease assessment date.

5. Safety run-in: Steady State Concentration (Css) of Blinatumomab (Time Frame - Up to approximately 34 weeks)

6. Safety run-in: Clearance (CL) of Blinatumomab (Time Frame - Up to approximately 34 weeks)

7. Phase 3: Change from Baseline to End of Initial Disease Assessment Period in Fatigue Score (Time Frame - Baseline to Week 14):
Fatigue score will be measured by Patient-Reported Outcomes Measurement Information System (PROMIS) Fatigue - Short Form 7a.

8. Phase 3: Change from Baseline to End of Initial Disease Assessment Period in Pain Score (Time Frame - Baseline to Week 14):
Pain score will be measured by Brief Pain Inventory - Short Form (BPI-SF); Item 3: pain at its worst in the last 24 hours.

9. Phase 3: Change from Baseline to End of Initial Disease Assessment Period in Global Health Status (Time Frame - Baseline to Week 14):
Global health status will be measured by the Quality of Life Questionnaire (QLQ)-C30 global health status quality of life scale.

10. Phase 3: Change from Baseline to End of Initial Disease Assessment Period in Physical Function (Time Frame - Baseline to Week 14):
Physical function will be measured by the QLQ-C30 functional scale.

11. Phase 3: Change from Baseline to End of Initial Disease Assessment Period in Nausea and Vomiting (Time Frame - Baseline to Week 14):
Nausea and vomiting will be measured by the QLQ-C30 symptom scale.

12. Phase 3: Complete Remission (CR) Rate by the End of Initial Disease Assessment Period (Time Frame - Baseline to Week 14)

13. Phase 3: Minimal Residual Disease (MRD) Response by the End of Initial Disease Assessment Period (Time Frame - Baseline to Week 14):
MRD response is defined as the percentage of participants who achieve a response of < 10^4 measured by polymerase chain reaction (PCR).

14. Phase 3: Relapse-free Survival (RFS) (Time Frame - Up to approximately 5 years):
RFS: In participants who achieve CR, the time from first achievement of this response until the date of the first relapse including hematologic relapse, extra medullary relapse, or death due to any cause, whichever occurs first. Participants without an event will be censored at their last evaluable disease assessment date.

15. Phase 3: Minimal Residual Disease (MRD) Relapse Free Survival (RFS) (Time Frame - Up to approximately 5 years):
In participants who achieve CR with MRD response, the time from first achievement of this response until date of the first relapse including molecular relapse, hematologic relapse, and/or extramedullary relapse, or death due to any cause, whichever occurs first. Molecular relapse will be defined 2 ways: MRD>= 10^-3 and MRD>= 10^-4. Participants without an event will be censored at their last evaluable disease assessment date

16. Phase 3: Minimal Residual Disease (MRD) Over Time (Time Frame - Up to approximately 5 years)

17. Phase 3: Number of Participants who Experience Treatment-emergent Adverse Events (TEAEs) (Time Frame - Up to approximately 5 years):
Number and percentage of participants who experience one or more TEAE, serious TEAE, treatment-related adverse events, and adverse events of interest.

18. Phase 3: Number of Participants who Experience Cluster of Differentiation (CD) 19 Positive and Negative Relapse by Flow Cytometry for Bone Marrow (Time Frame - Up to approximately 5 years)

19. Phase 3: Number of Participants who Experience Cluster of Differentiation (CD) 19 Positive and Negative Relapse Identified by Immunohistochemistry or Flow Cytometry for Cerebrospinal Fluid (Time Frame - Up to end of safety follow up (approximately 44 months))

20. Phase 3: Number of Participants who Experience Cluster of Differentiation (CD) 19 Positive and Negative Relapse for Extramedullary Sites other than Cerebrospinal Fluid (Time Frame - Up to end of safety follow up (approximately 44 months))

21. Phase 3: Rate of Lineage Switch to Acute Myeloid Leukemia (AML) (Time Frame - Up to end of safety follow up (approximately 44 months))

22. Phase 3: Localization of Relapse by Clinical Assessment (Time Frame - Up to end of safety follow up (approximately 44 months))

23. Phase 3: Mortality Rate in Participants who Experience Complete Remission (CR) (Time Frame - Up to approximately 5 years)

24. Phase 3: Number of Participants who have Allogeneic Hematopoietic Stem Cell Transplant (alloHSCT) in Participants who Experience Continuous First Complete Remission (CR) (Time Frame - Up to approximately 5 years)

25. Phase 3: Mortality Rate in Participants who Experience Complete Remission (CR) after Allogeneic Hematopoietic Stem Cell Transplantation (alloHSCT) (Time Frame - Up to approximately 5 years)

26. Phase 3: Relapse Rate Following Allogeneic Hematopoietic Stem Cell Transplantation (alloHSCT) (Time Frame - Up to approximately 5 years)

27. Phase 3: Time to Deterioration using the Fatigue Score (Time Frame - Up to approximately 5 years):
Fatigue score will be measured by PROMIS Fatigue-Short Form 7a.

28. Phase 3: Time to Improvements using the Fatigue Score (Time Frame - Up to approximately 5 years):
Fatigue score will be measured by PROMIS Fatigue-Short Form 7a.

29. Phase 3: Time to Deterioration using the Pain Score (Time Frame - Up to approximately 5 years):
Pain score will be measured by BPI-SF; Item 3: pain at its worst in the last 24 hours.

30. Phase 3: Time to Improvements using the Pain Score (Time Frame - Up to approximately 5 years):
Pain score will be measured by BPI-SF; Item 3: pain at its worst in the last 24 hours.

31. Phase 3: Change from Baseline in Global Health Status, Physical Function, Nausea/Vomiting, and All Other Subscales of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) (Time Frame - Baseline to end of study (up to approximately 5 years)):
EORTC QLQ-C30 will include global health status, physical functioning, emotional functioning, cognitive functioning, nausea/vomiting, pain, dyspnea, insomnia, appetite loss, diarrhea, and financial difficulties will be measured by EORTC QLQ-C30.

32. Phase 3: Time to Deterioration for Global Health Status, Physical Function, Nausea/Vomiting, and All Other Subscales of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) (Time Frame - Up to approximately 5 years):
Global health status, physical functioning, role functioning, emotional functioning, cognitive functioning, social functioning, fatigue, nausea/vomiting, pain, dyspnea, insomnia, appetite loss, diarrhea, and financial difficulties will be measured by EORTC QCQ-C30.

33. Phase 3: Time to Improvements for Global Health Status, Physical Function, Nausea/Vomiting, and All Other Subscales of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) (Time Frame - Up to approximately 5 years):
Global health status, physical functioning, role functioning, emotional functioning, cognitive functioning, social functioning, fatigue, nausea/vomiting, pain, dyspnea, insomnia, appetite loss, diarrhea, and financial difficulties will be measured by EORTC QCQ-C30.

Studien-Arme

  • Experimental: Safety Run-in: Blinatumomab alternating with low-intensity chemotherapy
    The safety run-in will be performed prior to initiating the phase 3 randomized part of the study. This safety run-in is to evaluate the safety and tolerability of blinatumomab alternating with low-intensity chemotherapy. The safety run-in also evaluates a shorter dose step interval from (4 days instead of 7 days) and a 1-week (instead of 2-week) drug free interval between blinatumomab cycles. Blinatumomab will be infused at a lower dose for 4 days and increase to a higher dose on Day 5 of the infusion for the remainder of the infusion.
  • Experimental: Phase 3: Blinatumomab alternating with low-intensity chemotherapy
    Participants will receive blinatumomab alternating with low-intensity chemotherapy.
  • Active Comparator: Phase 3: Standard of care (SOC) chemotherapy
    Participants will receive 1 of 2 SOC chemotherapy regimens (GMALL or HyperCVAD) per investigator's choice.

Geprüfte Regime

  • Blinatumomab (Blincyto®):
    Continuous intravenous (cIV) infusion
  • Low-intensity chemotherapy regimen:
    Intravenous (IV), oral (PO), subcutaneous (SC), or intrathecal (IT) administration.
  • SOC chemotherapy regimen:
    Intravenous (IV), oral (PO), subcutaneous (SC), or intrathecal (IT) administration.

Quelle: ClinicalTrials.gov


Sie können folgenden Inhalt einem Kollegen empfehlen:

"Study Comparing Blinatumomab Alternating With Low-intensity Chemotherapy Versus Standard of Care Chemotherapy for Older Adults With Newly Diagnosed Philadelphia-negative B-cell Precursor Acute Lymphoblastic Leukemia"

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