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Protocol in Acute Myeloid Leukemia With FLT3-ITD

Primary Purpose

Acute Myeloid Leukemia

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Midostaurin
Cytarabine
Daunorubicin
Sponsored by
University of Ulm
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Myeloid Leukemia focused on measuring Acute myeloid leukemia, FLT3-ITD, midostaurin (PKC412)

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients with suspected diagnosis of AML or related precursor neoplasm, or acute leukemia of ambiguous lineage (classified according to the World Health Organization (WHO) 2008 classification)
  • Presence of FLT3-ITD assessed in the central AMLSG reference laboratories
  • Patients considered eligible for intensive chemotherapy
  • WHO performance status of ≤ 2
  • Age ≥ 18 years and ≤ 70 years
  • No prior chemotherapy for leukemia except hydroxyurea to control hyperleukocytosis (≤ 7 days)
  • Non-pregnant and non-nursing. Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test within a sensitivity of at least 25 mIU/mL within 72 hours prior to registration ("Women of childbearing potential" is defined as a sexually active mature woman who has not undergone a hysterectomy or who has had menses at any time in the preceding 24 consecutive months)
  • Female patients in the reproductive age and male patients must agree to avoid getting pregnant or to father a child while on therapy and for 5 months after the last dose of chemotherapy
  • Women of child-bearing potential must either commit to continued abstinence from heterosexual intercourse or begin one acceptable method of birth control (IUD, tubal ligation, or partner's vasectomy). Hormonal contraception is an inadequate method of birth control
  • Men must use a latex condom during any sexual contact with women of childbearing potential, even if they have undergone a successful vasectomy (while on therapy and for 5 months after the last dose of chemotherapy)
  • Signed written informed consent.

Exclusion Criteria:

•AML with the following recurrent genetic abnormalities (according to WHO 2008): AML with t(8;21)(q22;q22); RUNX1-RUNX1T1 AML with inv(16)(p13.1q22) or t(16;16)(p13.1;q22); CBFB-MYH11 AML with t(15;17)(q22;q12); PML-RARA (or variant translocations with other RARA gene fusions)

  • Performance status WHO >2
  • Patients with ejection fraction < 50% by MUGA or ECHO scan within 14 days of day 1
  • Organ insufficiency (creatinine >1.5x upper normal serum level; bilirubin, AST or ALP >2.5x upper normal serum level, not attributable to AML; heart failure NYHA III/IV; severe obstructive or restrictive ventilation disorder)
  • Uncontrolled infection
  • Severe neurological or psychiatric disorder interfering with ability of giving an informed consent
  • Patients with a "currently active" second malignancy other than non-melanoma skin cancers. Patients are not considered to have a "currently active" malignancy if they have completed therapy and are considered by their physician to be at less than 30% risk of relapse within one year
  • Known positive for HIV; active HBV, HCV, or Hepatitis A infection
  • Bleeding disorder independent of leukemia
  • No consent for registration, storage and processing of the individual disease-characteristics and course as well as information of the family physician and/or other physicians involved in the treatment of the patient about study participation.
  • No consent for biobanking.

Sites / Locations

  • Medizinische Universität Innsbruck
  • Krankenhaus der Barmherzigen Schwestern Linz
  • Krankenhaus der Elisabethinen Linz GmbH
  • Universitätsklinik für Innere Medizin III Salzburg
  • Hanuschkrankenhaus Wien
  • Helios Klinikum Bad Saarow
  • Vivantes Klinikum Neukölln
  • Charité Universitätsmedizin Berlin
  • Marienhospital Bochum-Herne
  • Medizinische Universitätsklinik Bochum
  • Universitätsklinikum Bonn
  • Städtisches Klinikum Braunschweig gGmbH
  • Klinikum Bremen-Mitte gGmbH
  • Klinikum Darmstadt
  • Universitätsklinkum Düsseldorf
  • Kliniken Essen-Süd
  • Klinik für Onkologie, Gastroenterologie und Allg. Innere Medizin Esslingen
  • Malteser Krankenhaus St. Franziskus Hospital Flensburg
  • Medizinische Universitätsklinik Freiburg
  • MVZ Osthessen
  • Klinik der Justus-Liebig-Universität Gießen
  • Wilhelm-Anton-Hospital gGmbH Goch
  • Universitätsmedizin Göttingen
  • Universitätsklinikum Eppendorf
  • Asklepios Klinik Altona
  • Evangelisches Krankenhaus Hamm
  • Klinikum Region Hannover GmbH
  • Medizinische Hochschule Hannover
  • SLK Kliniken Heilbronn GmbH
  • Universitätskliniken des Saarlandes
  • Städtisches Klinikum Karlsruhe
  • Städtisches Krankenhaus Kiel GmbH
  • Caritas Krankenhaus Lebach
  • Klinikum Lippe-Lemgo
  • Märkische Kliniken GmbH Lüdenscheid
  • Universitätsklinikum der Otto-von-Guericke Universität Magdeburg
  • Universitätsklinikum der Johannes Gutenberg-Universität Mainz
  • Johannes Wesling Klinikum Minden
  • Stauferklinikum Mutlangen
  • Klinikum Schwabing
  • Klinikum rechts der Isar der TU München
  • Ortenau Klinikum
  • Pius Hospital Oldenburg
  • Klinikum Oldenburg
  • Klinikum Passau
  • Universitätsklinikum Regensburg
  • Caritasklinik St. Theresia Saarbrücken
  • Klinikum Stuttgart
  • Diakonie-Klinikum Stuttgart
  • Klinikum Mutterhaus der Borromäerinnen gGmbH Trier
  • Krankenhaus der Barmherzigen Brüder Trier
  • Medizinische Universitätsklinik Tübingen
  • University Hospital of Ulm
  • Schwarzwald-Baar Klinikum Villingen-Schwenningen
  • Helios Klinikum Wuppertal

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Midostaurin

Arm Description

Outcomes

Primary Outcome Measures

Event-free Survival
To perform two predefined subgroup analyses in the age-groups 18-60 years and 61-70 years evaluating the impact of midostaurin given in combination with intensive induction, consolidation including allogeneic hematopoietic stem cell transplantation and single agent maintenance therapy on event-free survival (EFS) in adult patients with AML exhibiting a FLT3-ITD.

Secondary Outcome Measures

Rate of complete remission (CR)
Relapse-free survival
overall survival
Cumulative incidence of relapse
cumulative incidence of death in CR
Target (FLT3) inhibition by measuring the FLT3 plasma inhibitory activity
Evaluation of target (FLT3) inhibition by continuous dosing of midostaurin
Quality of life
Quality of life assessed by the EORTC Quality of Life Core Questionnaire (QLQ-C30), supplemented by information on self-assessed concomitant diseases, late treatment effects, and demographics initially, in first CR, after one year,3 and 5 years after initial diagnosis.
Rate of early deaths and hypoplastic deaths (ED/HD)
Death in CR
Toxicities
Type, frequency, severity (graded using the National Cancer Institute Common Terminology Criteria for Adverse Events [NCI CTCAE] Version 3.0), timing and relatedness of hematological and non-hematological toxicities observed during the different treatment cycles
Impact of allogeneic HSCT
Assessment of the relative impact of allogeneic HSCT analyzed as time-dependent variable on survival endpoints.

Full Information

First Posted
November 17, 2011
Last Updated
June 3, 2020
Sponsor
University of Ulm
Collaborators
Novartis Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT01477606
Brief Title
Protocol in Acute Myeloid Leukemia With FLT3-ITD
Official Title
Phase-II Study Evaluating Midostaurin in Induction, Consolidation and Maintenance Therapy Also After Allogeneic Blood Stem Cell Transplantation in Patients With Newly Diagnosed Acute Myeloid Leukemia Exhibiting a FLT3 Internal Tandem Duplication
Study Type
Interventional

2. Study Status

Record Verification Date
June 2020
Overall Recruitment Status
Completed
Study Start Date
May 2012 (undefined)
Primary Completion Date
February 26, 2020 (Actual)
Study Completion Date
February 26, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Ulm
Collaborators
Novartis Pharmaceuticals

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a phase II, single-arm, open-label, multi-center study in adult patients with Acute Myeloid Leukemia (AML) and FLT3-ITD as defined in inclusion/exclusion criteria. The primary efficacy object is to evaluate the impact of midostaurin given in combination with intensive induction, consolidation including allogeneic hematopoietic stem cell transplantation and single agent maintenance therapy on event-free survival (EFS) in adult patients with AML exhibiting a FLT3-ITD. Sample size: 440 patients The treatment duration of an individual patient is between 18 and 24 months. Duration of the study for an individual patient including treatment (induction, consolidation [chemotherapy or allogeneic SCT], maintenance and follow-up period: Maximum 8 years

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia
Keywords
Acute myeloid leukemia, FLT3-ITD, midostaurin (PKC412)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
451 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Midostaurin
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Midostaurin
Other Intervention Name(s)
PKC412
Intervention Description
Induction therapy: 50 mg, oral, twice daily, starting on day 8, thereafter continuous dosing until 48h before start of subsequent chemotherapy cycle. Consolidation therapy: 50 mg, oral twice daily, starting on day 6, thereafter continuous dosing until 48h before start of conditioning therapy for allogeneic HSCT or 48h before start of subsequent consolidation chemotherapy. Maintenance therapy: 50 mg oral twice daily over one year.
Intervention Type
Drug
Intervention Name(s)
Cytarabine
Intervention Description
Induction therapy: 200 mg/m2/day by continuous i.v. infusion on days 1-7 (total dose 1400 mg/m²) Consolidation therapy: Younger adult patients (18 to 65 yrs): 3 g/m2 by i.v infusion over 3 hours every 12 hours on days 1, 3, and 5 (total dose 18 g/m2). Older patients (>65 yrs): 1 g/m2 by i.v. infusion over 3 hours every 12 hours on days 1, 3, and 5 (total dose 6 g/m2).
Intervention Type
Drug
Intervention Name(s)
Daunorubicin
Intervention Description
Induction therapy: 60 mg/m², by 1-hour i.v. infusion, day 1-3 (total dose 180 mg/m²)
Primary Outcome Measure Information:
Title
Event-free Survival
Description
To perform two predefined subgroup analyses in the age-groups 18-60 years and 61-70 years evaluating the impact of midostaurin given in combination with intensive induction, consolidation including allogeneic hematopoietic stem cell transplantation and single agent maintenance therapy on event-free survival (EFS) in adult patients with AML exhibiting a FLT3-ITD.
Time Frame
8years
Secondary Outcome Measure Information:
Title
Rate of complete remission (CR)
Time Frame
Two months
Title
Relapse-free survival
Time Frame
8 years
Title
overall survival
Time Frame
8 years
Title
Cumulative incidence of relapse
Time Frame
8 years
Title
cumulative incidence of death in CR
Time Frame
8 years
Title
Target (FLT3) inhibition by measuring the FLT3 plasma inhibitory activity
Description
Evaluation of target (FLT3) inhibition by continuous dosing of midostaurin
Time Frame
8 years
Title
Quality of life
Description
Quality of life assessed by the EORTC Quality of Life Core Questionnaire (QLQ-C30), supplemented by information on self-assessed concomitant diseases, late treatment effects, and demographics initially, in first CR, after one year,3 and 5 years after initial diagnosis.
Time Frame
5 years
Title
Rate of early deaths and hypoplastic deaths (ED/HD)
Time Frame
two months
Title
Death in CR
Time Frame
8 years
Title
Toxicities
Description
Type, frequency, severity (graded using the National Cancer Institute Common Terminology Criteria for Adverse Events [NCI CTCAE] Version 3.0), timing and relatedness of hematological and non-hematological toxicities observed during the different treatment cycles
Time Frame
between 18 and 24 months
Title
Impact of allogeneic HSCT
Description
Assessment of the relative impact of allogeneic HSCT analyzed as time-dependent variable on survival endpoints.
Time Frame
8 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with suspected diagnosis of AML or related precursor neoplasm, or acute leukemia of ambiguous lineage (classified according to the World Health Organization (WHO) 2008 classification) Presence of FLT3-ITD assessed in the central AMLSG reference laboratories Patients considered eligible for intensive chemotherapy WHO performance status of ≤ 2 Age ≥ 18 years and ≤ 70 years No prior chemotherapy for leukemia except hydroxyurea to control hyperleukocytosis (≤ 7 days) Non-pregnant and non-nursing. Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test within a sensitivity of at least 25 mIU/mL within 72 hours prior to registration ("Women of childbearing potential" is defined as a sexually active mature woman who has not undergone a hysterectomy or who has had menses at any time in the preceding 24 consecutive months) Female patients in the reproductive age and male patients must agree to avoid getting pregnant or to father a child while on therapy and for 5 months after the last dose of chemotherapy Women of child-bearing potential must either commit to continued abstinence from heterosexual intercourse or begin one acceptable method of birth control (IUD, tubal ligation, or partner's vasectomy). Hormonal contraception is an inadequate method of birth control Men must use a latex condom during any sexual contact with women of childbearing potential, even if they have undergone a successful vasectomy (while on therapy and for 5 months after the last dose of chemotherapy) Signed written informed consent. Exclusion Criteria: •AML with the following recurrent genetic abnormalities (according to WHO 2008): AML with t(8;21)(q22;q22); RUNX1-RUNX1T1 AML with inv(16)(p13.1q22) or t(16;16)(p13.1;q22); CBFB-MYH11 AML with t(15;17)(q22;q12); PML-RARA (or variant translocations with other RARA gene fusions) Performance status WHO >2 Patients with ejection fraction < 50% by MUGA or ECHO scan within 14 days of day 1 Organ insufficiency (creatinine >1.5x upper normal serum level; bilirubin, AST or ALP >2.5x upper normal serum level, not attributable to AML; heart failure NYHA III/IV; severe obstructive or restrictive ventilation disorder) Uncontrolled infection Severe neurological or psychiatric disorder interfering with ability of giving an informed consent Patients with a "currently active" second malignancy other than non-melanoma skin cancers. Patients are not considered to have a "currently active" malignancy if they have completed therapy and are considered by their physician to be at less than 30% risk of relapse within one year Known positive for HIV; active HBV, HCV, or Hepatitis A infection Bleeding disorder independent of leukemia No consent for registration, storage and processing of the individual disease-characteristics and course as well as information of the family physician and/or other physicians involved in the treatment of the patient about study participation. No consent for biobanking.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hartmut Doehner, MD
Organizational Affiliation
University Hospital of Ulm
Official's Role
Principal Investigator
Facility Information:
Facility Name
Medizinische Universität Innsbruck
City
Innsbruck
ZIP/Postal Code
3020
Country
Austria
Facility Name
Krankenhaus der Barmherzigen Schwestern Linz
City
Linz
ZIP/Postal Code
4010
Country
Austria
Facility Name
Krankenhaus der Elisabethinen Linz GmbH
City
Linz
ZIP/Postal Code
4020
Country
Austria
Facility Name
Universitätsklinik für Innere Medizin III Salzburg
City
Salzburg
ZIP/Postal Code
5020
Country
Austria
Facility Name
Hanuschkrankenhaus Wien
City
Wien
ZIP/Postal Code
1140
Country
Austria
Facility Name
Helios Klinikum Bad Saarow
City
Bad Saarow
ZIP/Postal Code
15526
Country
Germany
Facility Name
Vivantes Klinikum Neukölln
City
Berlin
ZIP/Postal Code
12351
Country
Germany
Facility Name
Charité Universitätsmedizin Berlin
City
Berlin
ZIP/Postal Code
13353
Country
Germany
Facility Name
Marienhospital Bochum-Herne
City
Bochum
ZIP/Postal Code
44625
Country
Germany
Facility Name
Medizinische Universitätsklinik Bochum
City
Bochum
ZIP/Postal Code
44892
Country
Germany
Facility Name
Universitätsklinikum Bonn
City
Bonn
ZIP/Postal Code
53105
Country
Germany
Facility Name
Städtisches Klinikum Braunschweig gGmbH
City
Braunschweig
ZIP/Postal Code
38114
Country
Germany
Facility Name
Klinikum Bremen-Mitte gGmbH
City
Bremen
ZIP/Postal Code
64276
Country
Germany
Facility Name
Klinikum Darmstadt
City
Darmstadt
ZIP/Postal Code
64276
Country
Germany
Facility Name
Universitätsklinkum Düsseldorf
City
Düsseldorf
ZIP/Postal Code
40225
Country
Germany
Facility Name
Kliniken Essen-Süd
City
Essen
ZIP/Postal Code
45239
Country
Germany
Facility Name
Klinik für Onkologie, Gastroenterologie und Allg. Innere Medizin Esslingen
City
Esslingen
ZIP/Postal Code
73730
Country
Germany
Facility Name
Malteser Krankenhaus St. Franziskus Hospital Flensburg
City
Flensburg
ZIP/Postal Code
24939
Country
Germany
Facility Name
Medizinische Universitätsklinik Freiburg
City
Freiburg
ZIP/Postal Code
79106
Country
Germany
Facility Name
MVZ Osthessen
City
Fulda
ZIP/Postal Code
36043
Country
Germany
Facility Name
Klinik der Justus-Liebig-Universität Gießen
City
Gießen
ZIP/Postal Code
35385
Country
Germany
Facility Name
Wilhelm-Anton-Hospital gGmbH Goch
City
Goch
ZIP/Postal Code
47574
Country
Germany
Facility Name
Universitätsmedizin Göttingen
City
Göttingen
ZIP/Postal Code
37075
Country
Germany
Facility Name
Universitätsklinikum Eppendorf
City
Hamburg
ZIP/Postal Code
20246
Country
Germany
Facility Name
Asklepios Klinik Altona
City
Hamburg
ZIP/Postal Code
22763
Country
Germany
Facility Name
Evangelisches Krankenhaus Hamm
City
Hamm
ZIP/Postal Code
59063
Country
Germany
Facility Name
Klinikum Region Hannover GmbH
City
Hannover
ZIP/Postal Code
30449
Country
Germany
Facility Name
Medizinische Hochschule Hannover
City
Hannover
ZIP/Postal Code
30625
Country
Germany
Facility Name
SLK Kliniken Heilbronn GmbH
City
Heilbronn
ZIP/Postal Code
74078
Country
Germany
Facility Name
Universitätskliniken des Saarlandes
City
Homburg/Saar
ZIP/Postal Code
66421
Country
Germany
Facility Name
Städtisches Klinikum Karlsruhe
City
Karlsruhe
ZIP/Postal Code
76133
Country
Germany
Facility Name
Städtisches Krankenhaus Kiel GmbH
City
Kiel
ZIP/Postal Code
24116
Country
Germany
Facility Name
Caritas Krankenhaus Lebach
City
Lebach
ZIP/Postal Code
66822
Country
Germany
Facility Name
Klinikum Lippe-Lemgo
City
Lemgo
ZIP/Postal Code
32657
Country
Germany
Facility Name
Märkische Kliniken GmbH Lüdenscheid
City
Lüdenscheid
ZIP/Postal Code
58515
Country
Germany
Facility Name
Universitätsklinikum der Otto-von-Guericke Universität Magdeburg
City
Magdeburg
ZIP/Postal Code
39120
Country
Germany
Facility Name
Universitätsklinikum der Johannes Gutenberg-Universität Mainz
City
Mainz
ZIP/Postal Code
55131
Country
Germany
Facility Name
Johannes Wesling Klinikum Minden
City
Minden
ZIP/Postal Code
32429
Country
Germany
Facility Name
Stauferklinikum Mutlangen
City
Mutlangen
ZIP/Postal Code
73557
Country
Germany
Facility Name
Klinikum Schwabing
City
München
ZIP/Postal Code
80804
Country
Germany
Facility Name
Klinikum rechts der Isar der TU München
City
München
ZIP/Postal Code
81675
Country
Germany
Facility Name
Ortenau Klinikum
City
Offenburg
ZIP/Postal Code
77654
Country
Germany
Facility Name
Pius Hospital Oldenburg
City
Oldenburg
ZIP/Postal Code
26121
Country
Germany
Facility Name
Klinikum Oldenburg
City
Oldenburg
ZIP/Postal Code
26133
Country
Germany
Facility Name
Klinikum Passau
City
Passau
ZIP/Postal Code
94032
Country
Germany
Facility Name
Universitätsklinikum Regensburg
City
Regensburg
ZIP/Postal Code
93053
Country
Germany
Facility Name
Caritasklinik St. Theresia Saarbrücken
City
Saarbrücken
ZIP/Postal Code
66113
Country
Germany
Facility Name
Klinikum Stuttgart
City
Stuttgart
ZIP/Postal Code
70174
Country
Germany
Facility Name
Diakonie-Klinikum Stuttgart
City
Stuttgart
ZIP/Postal Code
70176
Country
Germany
Facility Name
Klinikum Mutterhaus der Borromäerinnen gGmbH Trier
City
Trier
ZIP/Postal Code
54290
Country
Germany
Facility Name
Krankenhaus der Barmherzigen Brüder Trier
City
Trier
ZIP/Postal Code
54292
Country
Germany
Facility Name
Medizinische Universitätsklinik Tübingen
City
Tübingen
ZIP/Postal Code
72076
Country
Germany
Facility Name
University Hospital of Ulm
City
Ulm
ZIP/Postal Code
89081
Country
Germany
Facility Name
Schwarzwald-Baar Klinikum Villingen-Schwenningen
City
Villingen-Schwenningen
ZIP/Postal Code
78050
Country
Germany
Facility Name
Helios Klinikum Wuppertal
City
Wuppertal
ZIP/Postal Code
42283
Country
Germany

12. IPD Sharing Statement

Citations:
PubMed Identifier
35486475
Citation
Dohner H, Weber D, Krzykalla J, Fiedler W, Wulf G, Salih H, Lubbert M, Kuhn MWM, Schroeder T, Salwender H, Gotze K, Westermann J, Fransecky L, Mayer K, Hertenstein B, Ringhoffer M, Tischler HJ, Machherndl-Spandl S, Schrade A, Paschka P, Gaidzik VI, Theis F, Thol F, Heuser M, Schlenk RF, Bullinger L, Saadati M, Benner A, Larson R, Stone R, Dohner K, Ganser A. Midostaurin plus intensive chemotherapy for younger and older patients with AML and FLT3 internal tandem duplications. Blood Adv. 2022 Sep 27;6(18):5345-5355. doi: 10.1182/bloodadvances.2022007223.
Results Reference
derived
PubMed Identifier
30563875
Citation
Schlenk RF, Weber D, Fiedler W, Salih HR, Wulf G, Salwender H, Schroeder T, Kindler T, Lubbert M, Wolf D, Westermann J, Kraemer D, Gotze KS, Horst HA, Krauter J, Girschikofsky M, Ringhoffer M, Sudhoff T, Held G, Derigs HG, Schroers R, Greil R, Griesshammer M, Lange E, Burchardt A, Martens U, Hertenstein B, Marretta L, Heuser M, Thol F, Gaidzik VI, Herr W, Krzykalla J, Benner A, Dohner K, Ganser A, Paschka P, Dohner H; German-Austrian AML Study Group. Midostaurin added to chemotherapy and continued single-agent maintenance therapy in acute myeloid leukemia with FLT3-ITD. Blood. 2019 Feb 21;133(8):840-851. doi: 10.1182/blood-2018-08-869453. Epub 2018 Dec 18.
Results Reference
derived

Learn more about this trial

Protocol in Acute Myeloid Leukemia With FLT3-ITD

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