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Acute Lymphoblastic Leukaemias (ALL)Phase 2NCT02333058

Treosulfan-based Conditioning in Paediatric Patients With Haematological Malignancies

A Phase 2 study testing Treosulfan in people with Acute Lymphoblastic Leukaemias (ALL) and Acute Myeloid Leukaemias (AML), run by medac GmbH at 24 sites in 6 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

The primary goal of this study is to evaluate an alternative myeloablative, but reduced toxicity conditioning regimen in children, to describe the safety and efficacy of intravenous (i.v.) Treosulfan administered as part of a standardised Fludarabine-containing conditioning and to contribute to the current… Read more about this study

Who is it for?
Ages 28 days to 17 years
What is being tested?
Treosulfan
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
70 participants
Where
24 sitesin 6 countries
Study dates
21 Nov 2014to 30 Sep 2019
Phase
Phase 2
Are there results?
None posted in the registry

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 28 days to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Haematological malignant disease i.e. ALL, AML, MDS or JMML, indicated for allo-HSCT.
  • Indication for first allo-HSCT or second allo-HSCT due to disease relapse, graft failure, or secondary malignancy after previous HSCT.
  • Available matched sibling donor (MSD), matched family donor (MFD) or matched unrelated donor (MUD). For bone marrow (BM) and peripheral blood (PB) match is defined as 9/10 or 10/10 allele match after four digit typing in human leucocyte antigens (HLA)-A, B, C, DRB1 and DQB1.
  • Patients with ALL or AML in complete morphologic remission (blast counts <5 % in BM) and patients with MDS or JMML with blast counts < 20 % in BM at study entry.
  • Age at time of registration from 28 days to less than 18 years of age.
  • Lansky (patients aged <16 years) or Karnofsky (patients aged ≥ 16 years) performance score of at least 70 %.
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  • Written informed consent of the parents/ legal guardians and patient's assent/consent according to national regulations.
  • Females of child-bearing potential or male patients' partners with child-bearing potential must use a highly effective method of contraception (pearl index < 1 %) such as complete sexual abstinence, combined oral contraceptive, hormone intrauterine contraceptive device (IUCD), vaginal hormone ring, transdermal contraceptive patch, contraceptive implant or depot contraceptive injection in combination with a second method of contraception like a condom or a cervical cap / diaphragm with spermicide or surgical sterilisation (vasectomy) in male patients or male partners during the study and at least 6 months thereafter.
  • Negative pregnancy test for females of child-bearing potential.

Who cannot join

  • Third or later allo-HSCT.
  • HSCT from haploidentical or umbilical cord blood donor.
  • Symptomatic involvement of central nervous system (CNS) at study entry.
  • Treatment with cytotoxic drugs within 10 days prior to day 7.
  • Obese paediatric patients with body mass index: weight (kg)/[height (m)]² > 30 kg/m².
  • Solid tumours (e.g. neuroblastoma, peripheral neuroectodermal tumour [PNET], Ewing sarcoma).
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  • Fanconi anaemia and other deoxyribonucleic acid (DNA) breakage repair disorders.
  • Impaired liver function indicated by Bilirubin > three times the upper limit of normal (ULN) or aspartate aminotransferase/alanine aminotransferase (AST/ALT) > five times ULN, or active infectious hepatitis.
  • Impaired renal function indicated by estimated glomerular filtration rate ([GFR], according to the Schwartz formula) < 60 mL/min/1,73m2.
  • Impaired cardiac function: severe cardiac insufficiency indicated by left ventricle ejection fraction (LVEF) < 35 %.
  • Requirement for supplementary continuous oxygen.
  • Severe active infection requiring deferral of conditioning.
  • Human immunodeficiency virus (HIV) positivity.
  • Known pregnancy, breast feeding.
  • Known hypersensitivity to Treosulfan and/or Fludarabine.

Trial locations and contacts

24 sites in 6 countries.

24 sites in 6 countries

Germany13 sites
  • University Clinic Düsseldorf

    Düsseldorf, 40225

  • University Clinic Erlangen-Nürnberg

    Erlangen, 91054

  • Universitätsklinikum Essen

    Essen, 45147

  • University Hospital Johann Wolfgang Goethe

    Frankfurt, 60590

  • University Clinic Hamburg-Eppendorf

    Hamburg, 20246

  • Medical University Hannover

    Hanover, 30625

  • University Clinic Heidelberg

    Heidelberg, 69120

  • University Clinic Jena

    Jena, 07740

  • University Clinic München

    München, 80804

  • University Clinic Münster

    Münster, 48129

  • University Clinic Regensburg

    Regensburg, 93053

  • University Clinic Ulm

    Ulm, 89075

  • University Clinic Würzburg

    Würzburg, 97080

Other trials in Germany

Poland4 sites
  • Bydgoszcz Medical University

    Bydgoszcz, 85-094

  • Kraków Medical University

    Krakow, 30-663

  • Lublin Medical University

    Lublin, 20-093

  • Wroclaw Medical University

    Wroclaw, 50-368

Other trials in Poland

United Kingdom3 sites
  • Birmingham Children's Hospital

    Birmingham, B4 6NH

  • Central Manchester University Hospital

    Manchester, M13 9WL

  • Sheffield Children's Hospital

    Sheffield, S10 2TH

Other trials in United Kingdom

Italy2 sites
  • Ospedale Bambino Gesu Roma

    Rome, 00165

  • Ospedale Infantile Regina Margherita Torino

    Turin, 10126

Other trials in Italy

Austria1 site
  • St. Anna Children Hospital

    Vienna, A-1090

Other trials in Austria

Czechia1 site
  • University Hospital Motol, Charles University, Prague

    Prague, 150-06

Other trials in Czechia

About this study

Official title: Clinical Phase II Trial to Describe the Safety and Efficacy of Treosulfan-based Conditioning Therapy Prior to Allogeneic Haematopoietic Stem Cell Transplantation in Paediatric Patients With Haematological Malignancies

The primary goal of this study is to evaluate an alternative myeloablative, but reduced toxicity conditioning regimen in children, to describe the safety and efficacy of intravenous (i.v.) Treosulfan administered as part of a standardised Fludarabine-containing conditioning and to contribute to the current pharmacokinetic model to be able to finally give age (or body surface area) dependent dose recommendations. The treatment regimens given in the protocol MC-FludT.17/M are based on sufficient clinical safety and efficacy data. Considering the vital indication for allogeneic haematopoietic stem cell transplantation of the selected patient population, the risk-benefit assessment is therefore reasonably in favour of the study conduct.

Read the detailed description

The protocol MC-FludT.17/M is a clinical phase II trial to describe the safety and efficacy of Treosulfan-based conditioning therapy prior to allogeneic haematopoietic stem cell transplantation (allo-HSCT) in at least 70 paediatric patients with haematological malignancies (male and female children with haematological malignant diseases as acute lymphoblastic leukaemias (ALL), acute myeloid leukaemias (AML), myelodysplastic syndromes (MDS) and juvenile myelomonocytic leukaemias (JMML), requiring myeloablative conditioning treatment with following allo-HSCT).

Treosulfan dose per day is to be calculated by using body surface area (BSA). Two background conditioning regimens with Treosulfan are allowed: One regimen consists of a standardised Fludarabine-containing regimen and the other consists of an intensified regimen with Fludarabine and ThioTEPA.

Freedom from transplant (treatment)-related mortality (TRM), defined as death from any transplant-related cause from the day of first administration of study medication until day +100 after HSCT is the primary objective of the trial.

Moreover, the current pharmacokinetic (PK) model should be contributed to be able to finally give age (or BSA) dependent dose recommendations.

Being tested
Treosulfan
Keywords
ALL, AML, MDS, JMML
Medical subject headings
Myelodysplastic Syndromes

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • TreosulfanDrug

    Also called Treograft®, Ovastat®

    Treosulfan dose per day is to be calculated by using BSA:

    One dose of Treosulfan per day on three consecutive days (day -6, day -5 and day -4) as intravenous (i.v.) infusion, given over 2 hours.

    Two background conditioning regimens with Treosulfan are allowed: One regimen consists of a standardised Fludarabine-containing regimen (regimen A) and the other consists of an intensified regimen with Fludarabine and ThioTEPA (regimen B). The investigator decides for each individual patient whether to treat the patient with regimen A or with regimen B.

    Treosulfan: i.v., BSA adapted: 10, 12 or 14 g/m²/day within 120 min to be administered prior to Fludarabine; Fludarabine: i.v., 30 mg/m2/day on days from -7 to -3 prior to HSCT; ThioTEPA (Regimen B): i.v., 2 x 5mg/kg/day on day -2.

Study groups in NCT02333058
Study groupRoleWhat they receive
TreosulfanExperimentalTreosulfan dose per day is to be calculated by using BSA. One dose of Treosulfan per day on three consecutive days (day -6, day -5 and day -4) as intravenous (i.v.) infusion, given over 2 hours. Two background conditioning regimens with Treosulfan are allowed: One regimen consists of a standardised Fludarabine-containing regimen (regimen A) and the other consists of an intensified regimen with Fludarabine and ThioTEPA (regimen B). The investigator decides for each individual patient whether to treat the patient with regimen A or with regimen B. Treosulfan: i.v., BSA adapted: 10, 12 or 14 g/m²/day within 120 min to be administered prior to Fludarabine; Fludarabine: i.v., 30 mg/m2/day on days from -7 to -3 prior to HSCT; ThioTEPA (Regimen B): i.v., 2 x 5mg/kg/day on day -2.
Receives: Drug: Treosulfan

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Freedom from transplant (treatment)-related mortality (TRM)

    TRM is defined as death from any transplant-related cause

    Measured: from the day of first administration of study medication until day +100 after HSCT

Secondary outcomes (8)
  1. Engraftment after HSCT

    Engraftment is defined as first of three consecutive days for each of the following four criteria:

    • a leukocyte count of more than 1 x 109/L
    • an absolute neutrophil count (ANC) of more than 0.5 x 109/L
    • a platelet count of at least 20 x 109/L in the absence of platelet transfusion
    • a platelet count of at least 50 x 109/L in the absence of platelet transfusion

    Measured: until engraftment

  2. Safety including early toxicity until day +100 after HSCT, serious adverse reactions (SARs) until the end of the longer-term follow-up phase

    based on Common Terminology Criteria for Adverse Events (CTCAE) version 4.03

    Measured: until 12 months after HSCT

  3. Hepatic sinusoidal obstruction syndrome (HSOS), lung toxicity (CTCAE term pulmonary fibrosis), hepatic toxicity and infections of any CTCAE grade (non-serious and serious)

    Measured: until day +100 after HSCT

  4. Donor-type chimerism

    The incidences of complete donor-type chimerism will be estimated as the number of patients with complete chimerism divided by the total number of patients at risk.

    Measured: on day +28, day +100 and 12 months after HSCT

  5. Non relapse mortality (NRM), transplant related mortality (TRM), graft failure rate, incidence of relapse/progression, relapse-free/progression-free survival (RFS/PFS) and overall survival (OS)

    Non-relapse mortality will be defined as the probability of dying in the absence of persisting disease or previous occurrence of relapse/progression or graft failures.

    TRM is defined as the probability of dying from a transplant-related cause. The associated time span is defined as the interval from day 0 to death due to a transplant-related cause.

    The incidence of relapse/progression is defined as the probability of having relapse/progression of the underlying disease.

    Relapse-free/progression-free survival is defined as the time length between day 0 and the date of relapse/progression of the underlying disease or death due to any cause.

    OS after HSCT is defined as the probability of surviving. Survival time is defined as the time period between day 0 and the day of death due to any cause.

    Kaplan-Meier methods will be applied for estimating the probability of these parameters over time.

    Measured: after 12 months after HSCT and until the end of the longer-term follow-up phase

  6. Incidence and severity of acute (until day +100) and chronic (until 12 months after HSCT) graft versus host disease (aGvHD/cGvHD)

    The probability of grade I-IV and grade III-IV aGvHD will be estimated by cumulative incidence rates and summarised for selected time points together with their approximate 90 % confidence intervals.

    As for aGvHD, the probability of cGvHD will be estimated by cumulative incidence rates.

    Measured: until 12 months after HSCT

  7. Use of rescue therapies including donor-lymphocyte infusions (DLIs) and further conditioning regimens

    Measured: until 12 months after HSCT

  8. PK parameters of Treosulfan and its epoxides

    The following PK parameters of Treosulfan and its epoxides will be measured: Clearance (CL); volume of distribution (Vss); terminal elimination rate constant (λz); terminal elimination half-life (t1/2); area under the concentration time curve from time zero to infinity (AUC∞); maximum observed concentration (Cmax, i.e. C end of infusion).

    Measured: day -6 prior to HSCT

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Jan 2015 (estimated)
  2. Study start21 Nov 2014
  3. Primary completion24 Dec 2016
  4. Study completion30 Sep 2019

Resources

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
70 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02333058
Sponsor's protocol ID
MC-FludT.17/M
Status last verified
Apr 2020
First submitted
22 Dec 2014
Last updated
4 May 2020
Results posted
No
Data monitoring committee
Yes

Publications

  • Kalwak K, Mielcarek M, Patrick K, Styczynski J, Bader P, Corbacioglu S, Burkhardt B, Sykora KW, Drabko K, Gozdzik J, Fagioli F, Greil J, Gruhn B, Beier R, Locatelli F, Muller I, Schlegel PG, Sedlacek P, Stachel KD, Hemmelmann C, Moller AK, Baumgart J, Vora A. Treosulfan-fludarabine-thiotepa-based conditioning treatment before allogeneic hematopoietic stem cell transplantation for pediatric patients with hematological malignancies. Bone Marrow Transplant. 2020 Oct;55(10):1996-2007. doi: 10.1038/s41409-020-0869-6. Epub 2020 Mar 20.

    PubMed 32203268

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Treosulfan in people with Acute Lymphoblastic Leukaemias (ALL) and Acute Myeloid Leukaemias (AML), run by medac GmbH at 24 sites in 6 countries.

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 9 inclusion and 15 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: finished, as of the sponsor's last update on 4 May 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 24 sites in Germany, Poland, United Kingdom, Italy, Austria and 1 more country. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Freedom from transplant (treatment)-related mortality (TRM) (time frame: from the day of first administration of study medication until day +100 after HSCT). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02333058, which also lists 1 linked publication.

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 4 May 2020.

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