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Fetal HemoglobinPhase 2BTMNCT06490627

Unraveling the Impact of Thalidomide at Diverse Doses in Transfusion Dependent Beta Thalassemia

A Phase 2 study testing Thalidomide in people with Fetal Hemoglobin and Thalassemia Major, run by National Institute of Blood and Marrow Transplant (NIBMT), Pakistan at 1 site in Pakistan.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The project "Unraveling the Impact of Thalidomide at Diverse Doses in Transfusion Dependent Beta Thalassemia" investigates the safety and efficacy of low-dose thalidomide in managing beta thalassemia, a genetic disorder causing anemia. Read more about this study

Who is it for?
Ages 8 to 35 years
What is being tested?
Thalidomide
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
54 participants
Where
1 sitePakistan
Study dates
22 Apr 2024to 22 Apr 2026
Phase
Phase 2
Are there results?
Not yet: the study is under way

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 8 to 35 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Know case of beta thalassemia major/ intermediate ( transfusion dependent)
  • willing to give informed consent

Who cannot join

  • Patients with comorbidities such as liver dysfunction
  • Married patients
  • Lactating mother
  • H/O thrombosis and fits

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Pakistan1 site, 1 recruiting
  • National Institute of blood disease and bone marrow transplant

    Karachi, Sindh

    Safia Mehmood khan, PhD, 03342231644, rphsafia.nibd@gmail.com

    Recruiting

Other trials in Pakistan

About this study

The project "Unraveling the Impact of Thalidomide at Diverse Doses in Transfusion Dependent Beta Thalassemia" investigates the safety and efficacy of low-dose thalidomide in managing beta thalassemia, a genetic disorder causing anemia. Conducted over two years at NIBD hospital, the study involves 54 transfusion-dependent patients aged 8-35. The primary objective is to correlate thalidomide doses with disease severity, adverse effects, and treatment response, aiming to optimize treatment strategies and reduce side effects.

Data will be collected through clinical interviews and medical record reviews and analyzed using SPSS. Key variables include hemoglobin levels, leukocyte and reticulocyte counts, platelets, liver and spleen size, genetic modifiers, and transfusion frequency. Inclusion criteria are specific to beta thalassemia patients, while exclusion criteria rule out those with liver dysfunction, married patients, lactating mothers, and those with a history of thrombosis or fits.

Read the detailed description

Thalassemia is an inherited monogenic blood disorder caused by improper synthesis of the hemoglobin chain, inherited in an autosomal recessive pattern. Hemoglobin is essential for oxygen transport from the lungs to body tissues. Initially observed in individuals of Italian descent, thalassemia is characterized by anemia, enlarged spleen, and bone abnormalities. It affects approximately 1.5% of the global population, with 60,000 infants born annually with severe forms such as homozygous alpha thalassemia, beta-thalassemia, and HbH disease. Patients with thalassemia major require frequent blood transfusions and iron chelation therapy to manage iron overload, which can lead to complications like cirrhosis, heart failure, and growth retardation. Iron chelators such as deferasirox, deferiprone, and deferoxamine are used in Pakistan either as solo or combination therapy based on iron levels. Bone marrow transplantation from HLA-identical siblings offers a curative option with high success rates, but non-HLA identical cases are less promising. Emerging therapies like HbF production reactivation, cell therapy, and gene therapy show potential for better management of thalassemia.

Beta thalassemia is a prevalent genetic disorder, especially in the Mediterranean, Middle East, and Southeast Asia. It causes reduced hemoglobin production, severe anemia, and dependence on regular blood transfusions, which lead to iron overload and associated complications. Thalidomide, initially marketed as a sedative in 1954 and later withdrawn due to teratogenic effects, has shown efficacy in hematologic disorders. Its potential in beta thalassemia, particularly for reducing transfusion requirements and managing iron overload, remains underexplored. Preliminary studies suggest thalidomide could reduce transfusion needs, but comprehensive dose-dependent research is lacking. This study aims to evaluate the effects of thalidomide at various doses in transfusion-dependent beta thalassemia patients, hypothesizing that optimal dosing can improve disease management and quality of life.

Preliminary research indicates thalidomide might reduce transfusion frequency and manage iron overload in beta thalassemia patients. However, detailed dose-dependent studies are necessary. This research aims to fill the gap by exploring thalidomide's benefits and safety profiles at diverse doses, potentially revolutionizing the therapeutic approach to beta thalassemia.

The study aims to evaluate the impact of diverse thalidomide doses on reducing transfusion dependency in beta thalassemia patients. Primary objectives include assessing the efficacy of thalidomide in reducing transfusion needs. Secondary objectives involve evaluating the impact on complete blood count, liver function, spleen size, serum ferritin levels, and iron overload, alongside monitoring safety profiles and adverse events. Impact of genetic modifiers on thalidomide and beta thalassemia phenotype will also monitor in this study.

The study will be a single-center randomized controlled clinical trial at the National Institute of Blood Disease and Bone Marrow Transplant Hospital in Karachi, Pakistan, specializing in genetic disorders and hematology-oncology. Participants will be divided into treatment (with two dose groups) and control groups, with a total sample size of 54 calculated using OpenEpi. The study will span two years, from May 2024 to May 2026, involving data collection through medical records, interviews, and questionnaires. Ethical approval and informed consent will be obtained, ensuring patient confidentiality and adherence to ethical standards.

Data will include patient demographics (age, gender, ethnicity, marital status, weight, height), clinical variables (type of thalassemia, comorbidities, previous treatment), laboratory variables (hemoglobin, leukocyte count, reticulocyte count, platelets, lactate dehydrogenase, ferritin, d-dimer, bilirubin levels, SGPT), genetic modifiers (HBB mutation, XMN polymorphism, BCL11A polymorphism, alpha chain co-inheritance), and others (spleen and liver size, fibroscan, T2 star, transfusion frequency).

Being tested
Thalidomide
Keywords
thalidomide, safety and efficacy, thalassemia, fetal hemoglobin inducer
Medical subject headings
beta-Thalassemia, Genetic Diseases, Inborn, Thalassemia

What participants receive

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

  • ThalidomideDrug

    Thalidomide is being investigated for its therapeutic efficacy and safety profile in transfusion-dependent beta thalassemia patients.

    Participants in this arm received thalidomide. Thalidomide was administered orally at a dosage of 5-6mg/kg/day. The medication was taken continuously or on a specified schedule (e.g., daily,) for the duration of the study period, which lasted 2 years. Participants were monitored for adherence to the medication regimen and for any adverse effects throughout the intervention period.

  • ThalidomideDrug

    Thalidomide is being investigated for its therapeutic efficacy and safety profile in transfusion-dependent beta thalassemia patients.

    Participants in this arm received thalidomide. Thalidomide was administered orally at a dosage of 7-8mg/kg/day. The medication was taken continuously or on a specified schedule (e.g., daily,) for the duration of the study period, which lasted 2 years. Participants were monitored for adherence to the medication regimen and for any adverse effects throughout the intervention period.

Study groups in NCT06490627
Study groupRoleWhat they receive
ControlNo interventionin this group, patient will not receive any interventional drug or treatment drug so simply they will blood transfusion dependent.
Group 1 ThalidomideExperimentalIn this group , thalassemia patients will receive thalidomide at the dose of 5-6mg/kg/day at night with aspirin.
Receives: Drug: Thalidomide
Group 2 ThalidomideActive comparatorIn this group , thalassemia patients will receive thalidomide at the dose of 7-8mg/kg/day at night with aspirin
Receives: Drug: Thalidomide

What is being measured

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

  1. transfusion dependency

    Transfusion frequency will be assessed by recording the number of blood transfusions a patient receives over a specified period, such as weekly, monthly, or annually. This data will be collected from patient medical records and/or transfusion logs, ensuring accurate tracking of each transfusion event

    Measured: 1 year

Secondary outcomes (16)
  1. hemoglobin levels.

    Hemoglobin levels will be assessed using a complete blood count (CBC) test, measured in grams per deciliter (g/dL) of blood. This test is conducted through a venous blood sample, which is then analyzed using an automated hematology analyzer to determine the hemoglobin concentration.

    Measured: 2 years

  2. total leukocyte count.

    Leukocyte count will be assessed using a complete blood count (CBC) test, measured in thousands of cells per microliter (thousand cells/µL) of blood. This test involves analyzing a venous blood sample with an automated hematology analyzer to determine the total number of white blood cells present.

    Measured: 2 years

  3. reticulocyte count

    Reticulocyte count will be assessed using a complete blood count (CBC) test, measured as a percentage of the total red blood cells or as an absolute number per microliter (µL) of blood. This test involves analyzing a venous blood sample with an automated hematology analyzer, which identifies and quantifies reticulocytes using specific staining techniques.

    Measured: 2 years

  4. Platelets

    Platelet count will be assessed using a complete blood count (CBC) test, measured in thousands of cells per microliter (thousand cells/µL) of blood. This test involves analyzing a venous blood sample with an automated hematology analyzer to determine the number of platelets.

    Measured: 2 years

  5. impact of genetic modifiers (e.g., HBB mutation, XMN polymorphism, BCL11A polymorphism, and co-inheritance of alpha chain) on the treatment outcomes with thalidomide.

    Genetic modifiers will be assessed through genetic testing E.g thalassemia genetic profile, focusing on specific genes or genetic variations known to influence the expression or function of proteins related to the condition under study. This analysis helps identify how genetic factors may modify disease progression, treatment response, or other relevant outcomes.

    Measured: 2 years

  6. Spleen Size

    Spleen size will be assessed using imaging techniques such as ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI). Measurements will be reported in centimeters (cm).

    Measured: 2 years

  7. Serum Glutamate Pyruvate Transaminase,

    Serum Glutamate Pyruvate Transaminase, also known as alanine aminotransferase (ALT), will be assessed through a blood test, measured in units per liter (U/L). This test analyzes a venous blood sample to determine the concentration of ALT, an enzyme primarily found in the liver cells.

    Measured: 2 years

  8. Serum Ferritin Levels

    Serum ferritin levels will be assessed using a blood test, measured in nanograms per milliliter (ng/mL). A venous blood sample will be analyzed in a clinical laboratory using immunoassay techniques to determine the concentration of ferritin, providing an indicator of the body's iron stores.

    Measured: 2 years

  9. lactate dehydrogenase

    Lactate dehydrogenase (LDH) levels will be assessed through a blood test, measured in units per liter (U/L). This test analyzes a venous blood sample to determine the concentration of LDH, an enzyme involved in cellular metabolism. Elevated LDH levels may indicate tissue damage or disease,

    Measured: 2 years

  10. Nucleated red blood cells

    Nucleated red blood cells (NRBCs) will be assessed using a complete blood count (CBC) test with a differential, measured as the number of NRBCs per 100 white blood cells (WBCs) or as an absolute number per microliter (µL) of blood. This test involves analyzing a venous blood sample with an automated hematology analyzer, which can differentiate and count NRBCs to provide insights into bone marrow function and potential hematologic disorders.

    Measured: 2 years

  11. D-dimer

    D-dimer levels will be assessed through a blood test, typically measured in nanograms per milliliter (ng/mL) or micrograms per liter (µg/L). This test analyzes a venous blood sample to determine the concentration of D-dimer, a fibrin degradation product.

    Measured: 2 years

  12. Total bilirubin

    Total bilirubin (TBIL) levels will be assessed through a blood test, measured in milligrams per deciliter (mg/dL). This test analyzes a venous blood sample to determine the total concentration of bilirubin, including both direct (conjugated) and indirect (unconjugated) bilirubin.

    Measured: 2 years

  13. Indirect bilirubin

    Indirect bilirubin (IBIL) levels will be assessed through a blood test, measured in milligrams per deciliter (mg/dL). This test analyzes a venous blood sample to determine the concentration of unconjugated bilirubin, which is a byproduct of red blood cell breakdown before it is processed by the liver.

    Measured: 2 years

  14. Fibroscan

    FibroScan will be used to assess liver stiffness and steatosis, which can be indicative of liver iron overload. Elevated serum ferritin levels may suggest iron accumulation in the liver, and FibroScan provides a non-invasive method to evaluate the extent of liver fibrosis and fat content.

    Measured: 2 years

  15. T2 star imaging

    T2* (T2 star) magnetic resonance imaging (MRI) will be used to assess liver iron concentration in relation to serum ferritin levels. This imaging technique measures the rate of signal decay in liver tissue, which is inversely correlated with iron content. A shorter T2* value indicates higher iron concentration. T2* MRI provides a non-invasive, quantitative assessment of liver iron overload.

    Measured: 2 years

  16. transfusion dependency

    Transfusion frequency will be assessed by recording the number of blood transfusions a patient receives over a specified period, such as weekly, monthly, or annually. This data will be collected from patient medical records and/or transfusion logs, ensuring accurate tracking of each transfusion event

    Measured: 2 year

Timeline

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

  1. First posted8 Jul 2024
  2. Study start22 Apr 2024
  3. Primary completion22 Apr 2025
  4. Study completion22 Apr 2026 (estimated)

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
Randomised
Intervention model
Parallel groups
Model description
in this study three groups have been made. one is control group which received no intervention and on transfusion only. whereas other two groups are interventional both received thalidomide. one received thalidomide at 5-6mg/kg/day and second at 7-8 mg/kg/day.
Masking
None (open label)
Enrolment
54 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06490627
Sponsor's protocol ID
NIBD/IRB-266/01-2024
Acronym
BTM
Status last verified
May 2025
First submitted
20 Jun 2024
Last updated
30 May 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: Maybe i will share the IPD upon request

Publications

  • Yang K, Wu Y, Zhou Y, Long B, Lu Q, Zhou T, Wang L, Geng Z, Yin X. Thalidomide for Patients with beta-Thalassemia: A Multicenter Experience. Mediterr J Hematol Infect Dis. 2020 May 1;12(1):e2020021. doi: 10.4084/MJHID.2020.021. eCollection 2020.

    PubMed 32395210

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Thalidomide in people with Fetal Hemoglobin and Thalassemia Major, run by National Institute of Blood and Marrow Transplant (NIBMT), Pakistan at 1 site in Pakistan.

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 2 inclusion and 4 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: looking for participants now, as of the sponsor's last update on 30 May 2025. 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 Pakistan. 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?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Each site lists its own contact: choose the nearest one under Trial locations. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

transfusion dependency (time frame: 1 year). 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 NCT06490627, 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 30 May 2025.

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