Myelodysplastic SyndromePhase 2NCT00840827
Efficacy and Safety of Lenalidomide in Combination With Cyclosporine A in Patients With Myelodysplastic Syndromes
A Phase 2 study testing lenalidomide and cyclosporine A in people with Myelodysplastic Syndrome, run by Weill Medical College of Cornell University at 1 site in United States.
Trial summary
Lenalidomide has shown significant efficacy in the treatment of anemia associated with both 5q- and non 5q- MDS patients. The mechanism(s) of action of lenalidomide in MDS is still to be determined, but given the differences in response rates seen, it is probable that the mechanism is different for patients with 5q… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Myelodysplastic Syndrome
- What is being tested?
- lenalidomide and cyclosporine A
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 6 participants
- Where
- 1 siteUnited States
- Study dates
- Dec 2008to Dec 2010
- Phase
- Phase 2
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Understand and voluntarily sign an informed consent form.
- Age ≥ 18 years at the time of signing the informed consent form.
- Able to adhere to the study visit schedule and other protocol requirements.
- Diagnosis of low or intermediate-1 risk IPSS (MDS without an abnormality of chromosome 5 involving a deletion between bands q31 and q33. Red blood cell (RBC) transfusion-dependent anemia as having received ≥ 2 units of RBCs within 8 weeks on the first day of study treatment.
- ECOG performance status of ≤ 2 at study entry
- Laboratory test results within the following ranges:
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- Absolute neutrophil count (ANC) >500 x 109/L
- Platelet count ≥ 50 x 109/L
- Serum creatinine ≤ 2.0 mg/dL
- Total bilirubin ≤ 1.5 mg/dL
- AST (SGOT) and ALT (SGPT) ≤ 2 x ULN
- Disease free of prior malignancies for ≥ 5 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "insitu" of the cervix or breast.
- All study participants must be registered into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist®.
- Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again within 24 hours of prescribing lenalidomide (prescriptions must be filled within 7 days) and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking lenalidomide. FCBP must also agree to ongoing pregnancy testing. Men must also agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy.
- Able to take asprin (81 or 325 mg) daily as a prophylactic anticoagulation (patients intolerant to ASA may use warfarin or low molecular weight heparin).
Who cannot join
- Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
- Pregnant or breast feeding females. (Lactating females must agree not to breast feed while taking lenalidomide).
- Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.
- Use of any other experimental drug or therapy within 28 days of baseline.
- Known hypersensitivity to thalidomide. Prior ≥ grade 3 NCI CTCAE (Version 3.0) allergic reaction/hypersensitivity.
- The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs.
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- Any prior use of lenalidomide.
- Concurrent use of other anti-cancer agents or treatments.
- Known positive for HIV or infectious hepatitis, type A, B, or C.
- Inability to aspirate bone marrow (dry tap).
- Proliferative (WBC ≥ 12,000/ul) CMML
- An abnormality of chromosome 5 involving a deletion between bands q31 and q 33.
- Any of the following lab abnormalities:
- Absolute neutrophil count (ANC) <500 cells/mm3 (0.5 x 109/L)
- Platelet count ≤ 50,000/mm3 (50 x 109/L)
- Serum creatinine ≥ 2.5 mg/dL (221µmol/L)
- Serum SGOT/AST or SGPT/ALT ≥ 2.0 x upper limit of normal (ULN)
- Serum direct bilirubin ≥ 2.0 mg/dL (34µmol/L)
- Clinically significant anemia due to factors such as iron, B12 or folate deficiencies, autoimmune or hereditary hemolysis or gastrointestinal bleeding (if a marrow aspirate is not evaluable for storage iron, transferring saturation must be ≥ 20% and serum ferritin not less than 50ng/mL).
- Use of hematopoietic growth factors within 7 days of the first day of study drug treatment.
- Chronic use (≥2 weeks) of greater than physiologic doses of a corticosteroid agent (dose equivalent to ≥ 10mg/day of prednisone) within 28 days of the first study drug treatment.
- Use of experimental or standard drug (i.e chemotherapeutic, immunosuppressive, cytoprotective agents) for the treatment of MDS within 28 days of the first day of study drug
- Prior history of malignancy other than MDS except basal cell or squamous cell carcinoma in situ of the cervix or breast, unless the patient has been free of disease for ≥ 5 year.
- Myocardial infarction within 6 months prior to enrollment, or NYHA (New York Hospital Association) Class III or IV heart failure disease. History of active angina, congestive heart disease, uncontrolled angina, severe uncontrolled ventricular arrhythmias, electrocardiographic evidence of uncontrolled ischemia and/or active conduction system abnormalities, or myocardial infarction within 6 months prior to enrollment, acute ischemia, or active conduction system abnormalities.
- Active viral or bacterial infections or any coexisting medical problem that would significantly increase the risks of this treatment program.
- History of thromboembolic event within the past 6 months prior to enrollment.
- Patients who have a hypersensitivity to Sandimmune® (cyclosporine).
Trial locations and contacts
1 site in 1 country.
United States1 site
Weill Cornell Medical College
New York, New York, 10021
About this study
Official title: A Single-Arm, Open-Label Study of the Efficacy and Safety of Lenalidomide in Combination With Cyclosporine A in Patients With Red Blood Cell Transfusion-Dependent Myelodysplastic Syndromes
Lenalidomide has shown significant efficacy in the treatment of anemia associated with both 5q- and non 5q- MDS patients. The mechanism(s) of action of lenalidomide in MDS is still to be determined, but given the differences in response rates seen, it is probable that the mechanism is different for patients with 5q- disease compared to non 5q- patients. T-cell mediated activation of intramedullary apoptosis in patients with early MDS leading to impaired hematopoiesis has been well described. Immunomodulation with agents such as ATG, cyclosporine and thalidomide have demonstrated clear activity in some patients with MDS. Lenalidomide, among its many effects, is a potent immunomodulator, which may contribute to its ability to improve red blood cell counts in patients with MDS. It is possible that this effect could be augmented with the addition of cyclosporine A (CSA), in a similar manner to CSA effects in patients with other bone marrow failure syndromes such as aplastic anemia.
Subjects will be treated with lenalidomide 10 mg PO daily days 1-28 of a 28-day cycle. Cyclosporine A will be started on day 1 of cycle 2 (day 29) at a dose of 5 mg/kg per day given orally in 2 divided doses. Cyclosporine A levels will be assessed weekly and doses will be adjusted to maintain a serum trough level between 100-450 mg/ml. Patients will continue on therapy for minimum of 16 weeks unless toxicity occurs which precludes continuation on therapy, disease progression and/or patient withdrawal of consent. Patients not achieving response after completing 16 weeks of therapy will discontinue treatment. Patients achieving response will continue therapy until disease progression, unacceptable toxicity or loss of response.
- Conditions
- Myelodysplastic Syndrome
- Being tested
- lenalidomide, cyclosporine A
- Keywords
- stage (IPSS low and INT-1), RBC transfusion-dependent, non-del 5q MDS
- Medical subject headings
- Myelodysplastic Syndromes
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
lenalidomideDrug
Also called revlimid
Lenalidomide 10mg po daily
cyclosporine ADrug
Also called Sandimmune
CSA 250mg orally twice daily
| Study group | Role | What they receive |
|---|---|---|
| all patients | Experimental | Lenalidomide 10mg po daily/ CSA 250mg orally twice daily Receives: Drug: lenalidomide; Drug: cyclosporine A |
What is being measured
The primary outcome is the main question the study is designed to answer.
Efficacy of Lenalidomide in Combination With Cyclosporine A (CSA) to Achieve Red Cell Transfusion Independence in Subjects With Low- or Intermediate-1 Risk IPSS MDS Without a Del (5q31-33) Cytogenetic Abnormality.
Efficacy of lenalidomide + CSA will be evaluated as a function of red blood cell transfusion needs improvement (≥ 50% decrease in RBC transfusion requirements after 16 weeks of study treatment).
Measured: 16 weeks
Efficacy of Lenalidomide in Combination With Cyclosporine A (CSA) to Achieve Red Cell Transfusion Independence in Subjects With Low- or Intermediate-1 Risk IPSS MDS Without a Del (5q31-33) Cytogenetic Abnormality.
Efficacy of lenalidomide + CSA will be evaluated as a function of red blood cell transfusion independence.
Measured: 12 months
Efficacy of Lenalidomide in Combination With Cyclosporine A (CSA) to Achieve Red Cell Transfusion Independence in Subjects With Low- or Intermediate-1 Risk IPSS MDS Without a Del (5q31-33) Cytogenetic Abnormality by Hemoglobin Change.
Efficacy of lenalidomide + CSA will be evaluated as a function of change of hemoglobin concentration from baseline to 12 months.
Measured: Baseline and 12 months
Secondary outcomes (7)
Safety of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by Type of Adverse Events.
Safety will be evaluated by type of adverse events to lenalidomide in combination with CSA
Measured: 12 months
Tolerability of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by Frequency of Adverse Events.
Tolerability will be evaluated by the frequency of adverse events to lenalidomide in combination with CSA
Measured: 12 months
Tolerability of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by Severity of Adverse Events.
Tolerability will be evaluated by the severity of adverse events to lenalidomide in combination with CSA
Measured: 12 months
Tolerability of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by the Relatedness of Adverse Events.
Tolerability will be evaluated by the relatedness of adverse events to lenalidomide in combination with CSA
Measured: 12 months
Safety of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by Frequency of Adverse Events.
Safety will be evaluated by frequency of each type of adverse event to lenalidomide in combination with CSA
Measured: 12 months
Safety of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by Relatedness of Adverse Events to the Combination of Treatments.
Safety will be evaluated by the relatedness of each type of adverse event to lenalidomide in combination with CSA
Measured: 12 months
Safety of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by Severity of Adverse Events.
Safety will be evaluated by the severity of each type of adverse event to lenalidomide in combination with CSA
Measured: 12 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 Feb 2009 (estimated)
- Study startDec 2008
- Primary completionDec 2010
- Study completionDec 2010
Why it stopped: Lack of efficacy.
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Other trials for Myelodysplastic SyndromeStudies of the same condition, open and under way.
- More trials run by Weill Medical College of Cornell UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 6 participants (actual)
Sponsor and investigators
- Lead sponsor
- Weill Medical College of Cornell University
- Sponsor type
- University, hospital or other
- Collaborators
- Celgene
- Responsible party
- Sponsor
- Investigators
- Eric Feldman, MD, Principal investigator, Weill Medical College of Cornell University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00840827
- Sponsor's protocol ID
- 0810010063
- Status last verified
- Nov 2019
- First submitted
- 21 Jan 2009
- Last updated
- 19 Nov 2019
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 19 Nov 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Single-Arm, Open-Label Study of the Efficacy and Safety of Lenalidomide in Combination With Cyclosporine A in Patients With Red Blood Cell Transfusion-Dependent Myelodysplastic Syndromes
- ClinicalTrials.gov ID
- NCT00840827
- Acronym / sponsor ID
- 0810010063
- Conditions
- Myelodysplastic Syndrome
- Keywords
- stage (IPSS low and INT-1), RBC transfusion-dependent, non-del 5q MDS
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- TerminatedReason stopped: Lack of efficacy.
- Enrolment
- 6 participants (actual)
- Lead sponsor
- Weill Medical College of Cornell UniversityUniversity, hospital or other
- Collaborators
- Celgene
- Study start
- Dec 2008
- Primary completion
- Dec 2010 (actual)
- Study completion
- Dec 2010 (actual)
- First posted
- 10 Feb 2009 (estimated)
- Results
- Posted 19 Nov 2019
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Lenalidomide has shown significant efficacy in the treatment of anemia associated with both 5q- and non 5q- MDS patients. The mechanism(s) of action of lenalidomide in MDS is still to be determined, but given the differences in response rates seen, it is probable that the mechanism is different for patients with 5q- disease compared to non 5q- patients. T-cell mediated activation of intramedullary apoptosis in patients with early MDS leading to impaired hematopoiesis has been well described. Immunomodulation with agents such as ATG, cyclosporine and thalidomide have demonstrated clear activity in some patients with MDS. Lenalidomide, among its many effects, is a potent immunomodulator, which may contribute to its ability to improve red blood cell counts in patients with MDS. It is possible that this effect could be augmented with the addition of cyclosporine A (CSA), in a similar manner to CSA effects in patients with other bone marrow failure syndromes such as aplastic anemia.
Subjects will be treated with lenalidomide 10 mg PO daily days 1-28 of a 28-day cycle. Cyclosporine A will be started on day 1 of cycle 2 (day 29) at a dose of 5 mg/kg per day given orally in 2 divided doses. Cyclosporine A levels will be assessed weekly and doses will be adjusted to maintain a serum trough level between 100-450 mg/ml. Patients will continue on therapy for minimum of 16 weeks unless toxicity occurs which precludes continuation on therapy, disease progression and/or patient withdrawal of consent. Patients not achieving response after completing 16 weeks of therapy will discontinue treatment. Patients achieving response will continue therapy until disease progression, unacceptable toxicity or loss of response.
Study design
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| all patients | Experimental | Drug: lenalidomide, Drug: cyclosporine ALenalidomide 10mg po daily/ CSA 250mg orally twice daily |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (15 listed)
- Understand and voluntarily sign an informed consent form.
- Age ≥ 18 years at the time of signing the informed consent form.
- Able to adhere to the study visit schedule and other protocol requirements.
- Diagnosis of low or intermediate-1 risk IPSS (MDS without an abnormality of chromosome 5 involving a deletion between bands q31 and q33. Red blood cell (RBC) transfusion-dependent anemia as having received ≥ 2 units of RBCs within 8 weeks on the first day of study treatment.
- ECOG performance status of ≤ 2 at study entry
Key exclusion criteria (27 listed)
- Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
- Pregnant or breast feeding females. (Lactating females must agree not to breast feed while taking lenalidomide).
- Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.
- Use of any other experimental drug or therapy within 28 days of baseline.
- Known hypersensitivity to thalidomide. Prior ≥ grade 3 NCI CTCAE (Version 3.0) allergic reaction/hypersensitivity.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| lenalidomideAlso: revlimidLenalidomide 10mg po daily | Drug | all patients |
| cyclosporine AAlso: SandimmuneCSA 250mg orally twice daily | Drug | all patients |
Primary outcome
Efficacy of Lenalidomide in Combination With Cyclosporine A (CSA) to Achieve Red Cell Transfusion Independence in Subjects With Low- or Intermediate-1 Risk IPSS MDS Without a Del (5q31-33) Cytogenetic Abnormality.
Time frame: 16 weeks
Efficacy of lenalidomide + CSA will be evaluated as a function of red blood cell transfusion needs improvement (≥ 50% decrease in RBC transfusion requirements after 16 weeks of study treatment).
Efficacy of Lenalidomide in Combination With Cyclosporine A (CSA) to Achieve Red Cell Transfusion Independence in Subjects With Low- or Intermediate-1 Risk IPSS MDS Without a Del (5q31-33) Cytogenetic Abnormality.
Time frame: 12 months
Efficacy of lenalidomide + CSA will be evaluated as a function of red blood cell transfusion independence.
Efficacy of Lenalidomide in Combination With Cyclosporine A (CSA) to Achieve Red Cell Transfusion Independence in Subjects With Low- or Intermediate-1 Risk IPSS MDS Without a Del (5q31-33) Cytogenetic Abnormality by Hemoglobin Change.
Time frame: Baseline and 12 months
Efficacy of lenalidomide + CSA will be evaluated as a function of change of hemoglobin concentration from baseline to 12 months.
7 secondary outcomes
Safety of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by Type of Adverse Events.
Time frame: 12 months
Tolerability of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by Frequency of Adverse Events.
Time frame: 12 months
Tolerability of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by Severity of Adverse Events.
Time frame: 12 months
Tolerability of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by the Relatedness of Adverse Events.
Time frame: 12 months
Safety of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by Frequency of Adverse Events.
Time frame: 12 months
Safety of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by Relatedness of Adverse Events to the Combination of Treatments.
Time frame: 12 months
Safety of Lenalidomide in Combination With CSA in Subjects With Low- or Intermediate-1 Risk MDS Without a Del (5q31-33) Cytogenetic Abnormality by Severity of Adverse Events.
Time frame: 12 months
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 19 Nov 2019.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Eric Feldman, MD principal investigator
Weill Medical College of Cornell University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing lenalidomide and cyclosporine A in people with Myelodysplastic Syndrome, run by Weill Medical College of Cornell University at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 15 inclusion and 27 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: stopped early, as of the sponsor's last update on 19 Nov 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 19 Nov 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Efficacy of Lenalidomide in Combination With Cyclosporine A (CSA) to Achieve Red Cell Transfusion Independence in Subjects With Low- or Intermediate-1 Risk IPSS MDS Without a Del (5q31-33) Cytogenetic Abnormality. (time frame: 16 weeks). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Nov 2019.