A Study of the Safety and Effectiveness of Apixaban in Preventing Blood Clots in Children With Leukemia Who Have a Central Venous Catheter and Are Treated With Asparaginase
Lymphoma, Acute Lymphoblastic Leukemia
About this trial
This is an interventional prevention trial for Lymphoma focused on measuring Anticoagulation
Eligibility Criteria
For more information regarding BMS clinical trial participation, please visit www.BMSStudyConnect.com
Inclusion Criteria:
- New diagnosis of de novo ALL, lymphomas (T or B cell), or mixed-phenotype acute leukemia
- Planned 3-4 drug systemic induction chemotherapy with a corticosteroid, vincristine and a single dose or multiple doses of asparaginase, with or without daunorubicin
- Functioning Central Venous Access Device
- Must be able to tolerate oral medication or have it administered via an Nasogastric tube (NGT) or GT tube
- Males and females,age 1 year(365 days) to < 18 (17 years and 364 days) years.
Exclusion Criteria:
- Subjects scheduled to have > 3 Lumbar Punctures over the course of the study treatment period
- Prior history of documented DVT or PE in the past 3 months
- Known inherited bleeding disorder or coagulopathy
- Major surgery [excluding Central Venous Access Device (CVAD) replacement and bone marrow aspiration and non-open biopsy] within the last 7 days prior to enrollment that may be associated with a risk of bleeding. Open biopsy is considered a major surgery.
- Uncontrolled severe hypertension at enrollment. Severe hypertension is defined as a systolic or diastolic blood pressure (BP) > 5 mm Hg above the 95th percentile as defined by the National High Blood Pressure Education Program Working Group (NHBPEP) established guidelines for the definition of normal and elevated blood pressure in children
- Extreme hyperleukocytosis, white blood cell (WBC) counts over 200 x 109/L (200,000/microL) at the time of enrollment
- Liver dysfunction manifested by SGTP (ALT) > 5X Upper limit of normal (ULN) and/or Aspartate aminotransferase (AST) >5 X ULN and/or direct (conjugated) bilirubin > 2X ULN
- Renal function < 30% of normal for age and size as determined by the Schwartz formula
- International normalized ratio (INR) > 1.4 and activated partial thromboplastin time (aPTT) > 3 seconds above the upper limit of normal for age, within 1 week prior to enrollment.
- History of allergy to apixaban or Factor Xa inhibitors
- History of significant adverse reaction or major bleeding related adverse reaction to other anticoagulant or antiplatelet agents
- History of any significant drug allergy (such as anaphylaxis or hepatotoxicity
- Any investigational drug being administered during the study
Other protocol inclusion/exclusion criteria may apply
Sites / Locations
- Phoenix Children'S Hospital/Ctr. For Cancer & Blood Ctr.
- City of Hope
- Loma Linda University Cancer Center
- Childrens Hospital Of La
- Children'S Hospital Of Orange County
- Lucile Packard Children's Hospital (LPCH)
- Rady Children'S Hospital - San Diego
- Connecticut Children's Medical Center
- Yale University School Of Medicine
- Nemours / A. I. duPont Hospital for Children
- Golisano Childrens Hospital of Southwest Florida
- Shands Hospital At University Of Florida
- Nemours Children'S Clinic
- Nemours Children'S Clinic - Orlando
- Nemours Children'S Clinic-Pensacola
- All Childrens Hospital Specialty Physicians
- St. Marys Medical Center
- Childrens Healthcare Of Atlanta - E
- Navicent Health Physician Group
- St. Luke'S Mountain State Tumor Institute
- Children'S Center For Cancer And Blood Diseases
- Blank Childrens Hospital
- University of Iowa Hospitals and Clinics
- University of Kentucky
- University Of Louisville
- Childrens Hospital New Orleans
- Ochsner Medical Center
- Sinai Hospital Of Baltimore
- Johns Hopkins University
- University Of Michigan Cancer Center
- Childrens Hospitals And Clinics Of Minnesota
- University Of Minnesota
- Mayo Clinic Rochester
- University Of Mississippi Medical Center
- Hackensack University Medical Center
- Rutgers Cancer Institute of New Jersey
- Valerie Fund Children's Center at St. Joseph's Children's Hospital
- Albany Medical Center
- Roswell Park Cancer Institute
- University Of Rochester General Clinical Research Center
- SUNY Upstate Medical University
- New York Medical College
- Unv. Of Nc At Chapel Hill
- Wake Forest Baptist Health
- Akron Children'S Hospital
- Cincinnati Children'S Hospital Medical Center
- University Hospitals
- Nationwide Children'S Hospital
- Lehigh Valley Hospital - Muhlenberg
- Geisinger Medical Center
- Penn State Hershey Medical Center
- Childrens Hospital Of Philadelphia
- Children's Hospital Of Pittsburgh Of UPMC
- Children's Hospital at TriStar Centennial
- Monroe Carell Jr Children'S Hosp. At Vanderbilt Tower
- Dell Children'S Medical Center Of Central Texas
- Driscoll Children'S Hospital
- Texas Children's Cancer and Hematology Centers
- Children's Hospital of San Antonio
- University Hospital
- Scott & White - McLane Children's Specialty Clinic
- Providence Sacred Heart Medical Center
- MultiCare Institute for Research & Innovation
- Medical College of Wisconsin
- Local Institution
- Queensland Children's Hospital
- Monash Medical Centre Clayton
- Local Institution
- Local Institution
- Local Institution
- Local Institution
- Local Institution
- Local Institution
- Alberta Children'S Hospital
- Local Institution
- Local Institution
- Children'S Hospital London Health Sciences Centre
- Children'S Hospital Of Eastern Ontario
- Klinika detske onkologie
- Local Institution
- Local Institution
- Local Institution
- Local Institution
- Local Institution
- Local Institution
- Local Institution
- Local Institution
- Local Institution
- Klinika Transplantacji Szpiku Onkologii i Hematologii Dzieciecej
- Oddzial Hematologii i Onkologii Dzieciecej
- Local Institution
- Local Institution
- Local Institution
- Local Institution
- Local Institution
- Local Institution
Arms of the Study
Arm 1
Arm 2
Experimental
Placebo Comparator
Apixaban
No systemic anticoagulant prophylaxis
Children aged 1 to <18 years weighing 6 to <35 kg randomized to apixaban will receive a fixed dose apixaban based on body weight tier twice a day for approximately 28 days. Children aged 1 to <18 years weighing ≥ 35 kg will receive 2.5 mg of apixaban twice a day for approximately 28 days. Subjects ≥ 5 years may be administered either 2.5-mg, 0.5-mg tablets or oral solution apixaban. Subjects < 5years and < 35 kg may be administered 0.5-mg tablets only
No systemic anticoagulant prophylaxis