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A Prospective, One-arm and Open Clinical Study of Obinutuzumab in the Treatment of Pediatric Primary Immune Thrombocytopenia (ITP)

Primary Purpose

Immune Thrombocytopenia, Treatment

Status
Not yet recruiting
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
Obinutuzumab Injection [Gazyva]
Sponsored by
Institute of Hematology & Blood Diseases Hospital, China
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Immune Thrombocytopenia

Eligibility Criteria

12 Years - 18 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Age 12-18 years old, male or female Conform to the diagnostic criteria of persistent or chronic immune Thrombocytopenia (ITP) With a platelet count of <30 X 10^9/L measured within 2 days prior to administration(Platelet counts were measured at least 2 times during screening (at least 1 week apart) with platelets<30 X 10^9/L) Failure or recurrence of previous hormonal therapy or hormone dependence The previous emergency treatment of ITP (e.g. methylprednisolone, platelet transfusion, IVIG transfusion) must be completed at least 2 weeks before the first administration Signed and dated written informed consent With Liver and kidney function<1.5×upper limit of normal, such as ALT、AST,BUN,Cre,etc. ECOG physical state score ≤ 2 points Cardiac function of the New York Society of Cardiac Function ≤ 2 Patients receiving maintenance treatment (including corticosteroids (less than or equal to 0.5mg/kg prednisone), TPO receptor agonists, etc.) must have a stable dose at least 4 weeks before the first administration, and azathioprine, danazol, cyclosporin A, tacrolimus, sirolimus, etc. must be stopped at least 4 weeks before the first administration; The end of rituximab treatment was>3 months;More than 6 months after splenectomy. Exclusion Criteria: Subjects with primary disease of important organs (liver, kidney, heart, etc.), or with immune system diseases; Secondary thrombocytopenia caused by various reasons, such as connective tissue disorders, bone marrow hematopoietic failure disease, myelodysplastic syndrome, malignancy, drugs, inherited thrombocytopenia, common variable immune deficiency, lymphoma, etc.; Subjects infected with human immunodeficiency virus (HIV); Uncontrollable or active infections during the screening period, including hepatitis B, hepatitis C, cytomegalovirus, EB virus, or positive syphilis antigen; Subjects with extensive and severe bleeding, such as hemoptysis, upper gastrointestinal hemorrhage, intracranial hemorrhage; Subjects with heart disease that requires treatment or hypertension that has been judged by researchers to be poorly controlled currently; Subjects with any venous or arterial thrombosis, atherosclerosis, and other diseases; Subjects with a history of malignant solid tumor or have received allogeneic stem cell transplantation or organ transplantation; Subjects with mental disorders who are unable to sign normal informed consent and conduct trials and follow-up; Subjects whose toxic symptoms caused by pre-trial treatment have not disappeared; Subjects with other serious diseases that may limit their participation in this trial (diabetes; severe cardiac insufficiency; myocardial obstruction or unstable arrhythmia or unstable angina pectoris in the last 6 months; gastric ulcer; active autoimmune disease, etc.); Subjects with septicemia or other irregular bleeding; Patients taking antiplatelet drugs at the same time; Any medical history or condition that the investigator deems unsuitable for participation in the study.

Sites / Locations

  • Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Intervention (Obinutuzumab)

Arm Description

60 enrolled subjects: one infusion

Outcomes

Primary Outcome Measures

Evaluation of overall efficacy response after Obinutuzumab treatment within 12 weeks
Overall response rate defined as proportion of subjects with a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile within 12 weeks after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period

Secondary Outcome Measures

Evaluation of overall efficacy response after Obinutuzumab treatment within 8 weeks
Overall response rate defined as proportion of subjects with a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile within 8 weeks after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Evaluation of overall efficacy response after Obinutuzumab treatment within 6 months
Overall response rate defined as proportion of subjects with a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile within 6 months after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Evaluation of overall efficacy response after Obinutuzumab treatment within 12 months
Overall response rate defined as proportion of subjects with a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile within 12 months after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Evaluation of sustained response rate after Obinutuzumab treatment within 6 months
Sustained response rate defined as proportion of subjects who keep a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile at 6 months after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Evaluation of sustained response rate after Obinutuzumab treatment within 12 months
Sustained response rate defined as proportion of subjects who keep a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile at 12 months after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Time to onset response
Time to onset response defined as the time needed for subjects to have a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Duration of response
The longest duration for which the subject sustained a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Emergency treatment after Obinutuzumab treatment within 12 weeks
Percentage of subjects who received emergency treatment after Obinutuzumab treatment within 12 weeks
Reduction of concomitant drug after Obinutuzumab treatment within 12 weeks
Percentage of patients with reduced doses of corticosteroids and/or other concomitant immunosuppressive drugs at baseline by 12 weeks of Obinutuzumab treatment
Number of subjects with clinically significant bleeding as assessed using the world health organization (WHO) bleeding scale after Obinutuzumab treatment within 12 weeks
Changes of the subjects' numbers in WHO bleeding score after Anti-CD20 antibody treatment according to the reported World Health Organization's Bleeding Scale. The WHO Bleeding Scale is a measure of bleeding severity with the following grades: grade 0 = no bleeding, grade 1= petechiae, grade 2= mild blood loss, grade 3 = gross blood loss, and grade 4 = debilitating blood loss.
Number of subjects with clinically significant bleeding as assessed using the bleeding scale for pediatric patients with ITP after Obinutuzumab treatment within 12 weeks
Changes of the subjects' numbers in bleeding score after Anti-CD20 antibody treatment according to the reported bleeding scale for pediatric patients with ITP. The bleeding scale for pediatric patients with ITP is a measure of bleeding severity with the following grades: Grade 1 (minor) Minor bleeding, few petechiae (≤100 total) and/or ≤5 small bruises (≤3 cm in diameter), no mucosal bleeding;Grade 2 (mild) Mild bleeding, many petechiae (>100 total) and/or >5 large bruises (>3 cm in diameter), no mucosal bleeding;Grade 3 (moderate) Moderate bleeding, overt mucosal bleeding, troublesome lifestyle;Grade 4 (severe) Severe bleeding, mucosal bleeding leading to decrease in Hb>2 g/dL or suspected internal hemorrhage;
One-year recurrence-free survival rate
Time from the start of treatment to the occurrence of a relapse or death event
Safety of Anti-CD20 antibody treatment
Incidence, severity, and relationship of treatment emergent adverse events after Anti-CD20 antibody treatment
Health-related quality of life survey of subjects(HRQoL)-1
In all participants ,use ITP-PAQ (ITP Patient Assessment Questionnaire) to assess the HRQoL before and after treatment.
Health-related quality of life survey of subjects(HRQoL)-2
In all participants ,use FACIT-F(functional assessment of chronic illness therapy- fatigue)to assess the HRQoL before and after treatment.
Health-related quality of life survey of subjects(HRQoL)-3
In all participants ,use Kids' ITP tool KIT、to assess the HRQoL before and after treatment.
Health-related quality of life survey of subjects(HRQoL)-4
In all participants ,use Pediatric Quality of Life Inventory PedsQL to assess the HRQoL before and after treatment.

Full Information

First Posted
October 13, 2023
Last Updated
October 17, 2023
Sponsor
Institute of Hematology & Blood Diseases Hospital, China
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1. Study Identification

Unique Protocol Identification Number
NCT06094881
Brief Title
A Prospective, One-arm and Open Clinical Study of Obinutuzumab in the Treatment of Pediatric Primary Immune Thrombocytopenia (ITP)
Official Title
A Prospective, One-arm and Open Clinical Study to Assess Safety and Efficacy of Anti-Human CD20 Monoclonal Antibody Obinutuzumab in the Treatment of Pediatric Primary Immune Thrombocytopenia
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
November 2023 (Anticipated)
Primary Completion Date
November 2025 (Anticipated)
Study Completion Date
November 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Institute of Hematology & Blood Diseases Hospital, China

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To evaluate the safety and efficacy of Obinutuzumab in the treatment of pediatric primary immune thrombocytopenia in patients who have not responded adequately or relapsed after first-line glucocorticoid treatment.
Detailed Description
Immune thrombocytopenia (ITP) is an organ-specific autoimmune disease, which is characterized by decreased platelet count and skin and mucosal bleeding. ITP is a kind of disease with increased platelet destruction and impaired platelet production caused by autoimmunity. Conventional treatment of adult ITP includes first-line glucocorticoid and immunoglobulin therapy, second line TPO and TPO receptor agonist, splenectomy and other immunosuppressive treatments (such as rituximab, vincristine, azathioprine, etc.). ITP is one of the most common hemorrhagic diseases. At present, the treatment response of ITP is not good, and a considerable number of patients need drug maintenance treatment, which seriously affects the quality of life of patients and increases the economic burden of patients. Therefore, there is still a lack of effective treatment for adult ITP, especially for recurrent and refractory ITP patients, which is one of the problems that have attracted more attention and need to be solved urgently. Obinutuzumab is the first personalized type Ⅱ glycosylation engineered CD20 monoclonal antibody. Studies have shown that compared with rituximab, obinutuzumab may improve its efficacy in lymphoma by increasing DCD and ADCC effects and reducing drug resistance by reducing CDC effects. In view of this, Obinutuzumab may have the same effect in the treatment of ITP, and may be more effective in the treatment of ITP, but there is also a risk of poor efficacy. At present, there is a lack of data on the efficacy and safety of Obinutuzumab in the treatment of ITP in China, especiallly pediatric ITP. Therefore, the investigators designed this clinical trial to evaluate the safety and efficacy of Obinutuzumab in the treatment of pediatric immune thrombocytopenia in patients who have not responded adequately or relapsed after first-line glucocorticoid treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Immune Thrombocytopenia, Treatment

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Intervention (Obinutuzumab)
Arm Type
Experimental
Arm Description
60 enrolled subjects: one infusion
Intervention Type
Drug
Intervention Name(s)
Obinutuzumab Injection [Gazyva]
Intervention Description
intravenous Obinutuzumab administration This study adopts a prospective, single arm, open design method. 60 subjects were enrolled in the study and were treated with CD20 monoclonal antibody (Obinutuzumab: 1000mg) for once. The first stage is the main research stage (d1-w12), which is the core treatment period. The subjects will receive intravenous infusion of 1000mg Obinutuzumab for once to observe the safety and efficacy during treatment. The second stage (w12-w48) is the stage of withdrawal from the visit, mainly to observe the safety and continuous efficacy of Obinutuzumab after treatment.
Primary Outcome Measure Information:
Title
Evaluation of overall efficacy response after Obinutuzumab treatment within 12 weeks
Description
Overall response rate defined as proportion of subjects with a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile within 12 weeks after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Evaluation of overall efficacy response after Obinutuzumab treatment within 8 weeks
Description
Overall response rate defined as proportion of subjects with a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile within 8 weeks after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Time Frame
8 weeks
Title
Evaluation of overall efficacy response after Obinutuzumab treatment within 6 months
Description
Overall response rate defined as proportion of subjects with a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile within 6 months after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Time Frame
6 months
Title
Evaluation of overall efficacy response after Obinutuzumab treatment within 12 months
Description
Overall response rate defined as proportion of subjects with a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile within 12 months after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Time Frame
12 months
Title
Evaluation of sustained response rate after Obinutuzumab treatment within 6 months
Description
Sustained response rate defined as proportion of subjects who keep a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile at 6 months after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Time Frame
6 months
Title
Evaluation of sustained response rate after Obinutuzumab treatment within 12 months
Description
Sustained response rate defined as proportion of subjects who keep a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile at 12 months after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Time Frame
12 months
Title
Time to onset response
Description
Time to onset response defined as the time needed for subjects to have a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Time Frame
12 months
Title
Duration of response
Description
The longest duration for which the subject sustained a platelet count ≥ 30 × 10^9/L and at least 2-fold from baseline at the meanwhile after initial administration in absence of rescue therapy, and without having had dose increment of TPO-RA or corticosteroids during the study period
Time Frame
12 months
Title
Emergency treatment after Obinutuzumab treatment within 12 weeks
Description
Percentage of subjects who received emergency treatment after Obinutuzumab treatment within 12 weeks
Time Frame
12 weeks
Title
Reduction of concomitant drug after Obinutuzumab treatment within 12 weeks
Description
Percentage of patients with reduced doses of corticosteroids and/or other concomitant immunosuppressive drugs at baseline by 12 weeks of Obinutuzumab treatment
Time Frame
12 weeks
Title
Number of subjects with clinically significant bleeding as assessed using the world health organization (WHO) bleeding scale after Obinutuzumab treatment within 12 weeks
Description
Changes of the subjects' numbers in WHO bleeding score after Anti-CD20 antibody treatment according to the reported World Health Organization's Bleeding Scale. The WHO Bleeding Scale is a measure of bleeding severity with the following grades: grade 0 = no bleeding, grade 1= petechiae, grade 2= mild blood loss, grade 3 = gross blood loss, and grade 4 = debilitating blood loss.
Time Frame
12 weeks
Title
Number of subjects with clinically significant bleeding as assessed using the bleeding scale for pediatric patients with ITP after Obinutuzumab treatment within 12 weeks
Description
Changes of the subjects' numbers in bleeding score after Anti-CD20 antibody treatment according to the reported bleeding scale for pediatric patients with ITP. The bleeding scale for pediatric patients with ITP is a measure of bleeding severity with the following grades: Grade 1 (minor) Minor bleeding, few petechiae (≤100 total) and/or ≤5 small bruises (≤3 cm in diameter), no mucosal bleeding;Grade 2 (mild) Mild bleeding, many petechiae (>100 total) and/or >5 large bruises (>3 cm in diameter), no mucosal bleeding;Grade 3 (moderate) Moderate bleeding, overt mucosal bleeding, troublesome lifestyle;Grade 4 (severe) Severe bleeding, mucosal bleeding leading to decrease in Hb>2 g/dL or suspected internal hemorrhage;
Time Frame
12 weeks
Title
One-year recurrence-free survival rate
Description
Time from the start of treatment to the occurrence of a relapse or death event
Time Frame
12 months
Title
Safety of Anti-CD20 antibody treatment
Description
Incidence, severity, and relationship of treatment emergent adverse events after Anti-CD20 antibody treatment
Time Frame
12 months
Title
Health-related quality of life survey of subjects(HRQoL)-1
Description
In all participants ,use ITP-PAQ (ITP Patient Assessment Questionnaire) to assess the HRQoL before and after treatment.
Time Frame
12 months
Title
Health-related quality of life survey of subjects(HRQoL)-2
Description
In all participants ,use FACIT-F(functional assessment of chronic illness therapy- fatigue)to assess the HRQoL before and after treatment.
Time Frame
12 months
Title
Health-related quality of life survey of subjects(HRQoL)-3
Description
In all participants ,use Kids' ITP tool KIT、to assess the HRQoL before and after treatment.
Time Frame
12 months
Title
Health-related quality of life survey of subjects(HRQoL)-4
Description
In all participants ,use Pediatric Quality of Life Inventory PedsQL to assess the HRQoL before and after treatment.
Time Frame
12 months
Other Pre-specified Outcome Measures:
Title
Prognostic model establishment using multi-omics data such as transcriptome, proteome, metabolome, microbiome, et al.
Description
The prognosis related factors will be selected from multi-omics data such as transcriptome, proteome, metabolome, microbiome, et al. And then selected prognosis related factors will be used to establish prognosis prediction model
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Maximum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 12-18 years old, male or female Conform to the diagnostic criteria of persistent or chronic immune Thrombocytopenia (ITP) With a platelet count of <30 X 10^9/L measured within 2 days prior to administration(Platelet counts were measured at least 2 times during screening (at least 1 week apart) with platelets<30 X 10^9/L) Failure or recurrence of previous hormonal therapy or hormone dependence The previous emergency treatment of ITP (e.g. methylprednisolone, platelet transfusion, IVIG transfusion) must be completed at least 2 weeks before the first administration Signed and dated written informed consent With Liver and kidney function<1.5×upper limit of normal, such as ALT、AST,BUN,Cre,etc. ECOG physical state score ≤ 2 points Cardiac function of the New York Society of Cardiac Function ≤ 2 Patients receiving maintenance treatment (including corticosteroids (less than or equal to 0.5mg/kg prednisone), TPO receptor agonists, etc.) must have a stable dose at least 4 weeks before the first administration, and azathioprine, danazol, cyclosporin A, tacrolimus, sirolimus, etc. must be stopped at least 4 weeks before the first administration; The end of rituximab treatment was>3 months;More than 6 months after splenectomy. Exclusion Criteria: Subjects with primary disease of important organs (liver, kidney, heart, etc.), or with immune system diseases; Secondary thrombocytopenia caused by various reasons, such as connective tissue disorders, bone marrow hematopoietic failure disease, myelodysplastic syndrome, malignancy, drugs, inherited thrombocytopenia, common variable immune deficiency, lymphoma, etc.; Subjects infected with human immunodeficiency virus (HIV); Uncontrollable or active infections during the screening period, including hepatitis B, hepatitis C, cytomegalovirus, EB virus, or positive syphilis antigen; Subjects with extensive and severe bleeding, such as hemoptysis, upper gastrointestinal hemorrhage, intracranial hemorrhage; Subjects with heart disease that requires treatment or hypertension that has been judged by researchers to be poorly controlled currently; Subjects with any venous or arterial thrombosis, atherosclerosis, and other diseases; Subjects with a history of malignant solid tumor or have received allogeneic stem cell transplantation or organ transplantation; Subjects with mental disorders who are unable to sign normal informed consent and conduct trials and follow-up; Subjects whose toxic symptoms caused by pre-trial treatment have not disappeared; Subjects with other serious diseases that may limit their participation in this trial (diabetes; severe cardiac insufficiency; myocardial obstruction or unstable arrhythmia or unstable angina pectoris in the last 6 months; gastric ulcer; active autoimmune disease, etc.); Subjects with septicemia or other irregular bleeding; Patients taking antiplatelet drugs at the same time; Any medical history or condition that the investigator deems unsuitable for participation in the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ting Sun, MD
Phone
+8615822339131
Email
sunting@ihcams.ac.cn
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lei Zhang, MD
Organizational Affiliation
Chinese Academy of Medical Science and Blood Disease Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
City
Tianjin
Country
China
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ting Sun, MD
Phone
+8615822339131
Email
sunting@ihcams.ac.cn
First Name & Middle Initial & Last Name & Degree
Lei Zhang, MD

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Researchers qualified can request the dataset, including de-identified individual subject data. Data may be requested from PI from 12 months 36 months after study completion.
IPD Sharing Time Frame
12 months to 36 months after study completion
IPD Sharing Access Criteria
Upon request to PI

Learn more about this trial

A Prospective, One-arm and Open Clinical Study of Obinutuzumab in the Treatment of Pediatric Primary Immune Thrombocytopenia (ITP)

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