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Efficacy of Mirasol-treated Apheresis Platelets in Patients With Hypoproliferative Thrombocytopenia (MIPLATE)

Primary Purpose

Hematologic Malignancies, Hypoproliferative Thrombocytopenia

Status
Terminated
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Mirasol platelets (MIR PLTs)
Reference platelets (REF PLTs)
Sponsored by
Terumo BCTbio
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Hematologic Malignancies focused on measuring hypoproliferative thrombocytopenia, hematologic malignancies, thrombocytopenia, platelet therapy, apheresis, pathogen reduction therapy

Eligibility Criteria

undefined - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Weight > 10 kg (22 lbs)
  2. Subject has a hematologic malignancy with hypoproliferative thrombocytopenia and is expected to have PLT count(s) ≤ 10,000/µL requiring ≥ 2 PLT transfusions
  3. Laboratory results within 5 days prior to anticipated initiation of the first post randomization PLT transfusion:

    1. Prothrombin time (PT) and/or international normalized ratio (INR) ≤ 1.3 × the upper limit of normal (ULN)
    2. Activated partial thromboplastin time (aPTT) ≤ 1.3 × ULN
    3. Fibrinogen ≥ 100 mg/dL
  4. Women of childbearing potential must have a negative pregnancy test and agree to practice a medically acceptable contraception regimen for the study duration. Women who are postmenopausal for at least 1 year (> 12 months since last menses) or are surgically sterilized do not require this test
  5. IC from the subject or assent from the subject and consent from a parent or guardian, if the subject is < 18 years of age

Exclusion Criteria:

  1. Treatment with pathogen-reduced blood products within previous 6 months
  2. Subject has been previously enrolled in this study and received at least 1 per protocol PLT transfusion
  3. a.) Subject is receiving therapeutic doses of antiplatelet agents, antifibrinolytics, and/or PLT specific growth factors within 10 days prior to randomization or b.) Subject is receiving therapeutic doses of anticoagulant, pro-coagulant or antithrombotic agents within 10 days prior to randomization. Subjects can be included if receiving the following: prophylactic dosing of anticoagulants (heparin, any low molecular weight heparin, enoxaparin, or fondaparinux), anticoagulants/thrombolytic agents used to maintain or re-establish the patency of catheters (heparin flushes or tissue-plasminogen activase [TPA], therapeutic doses of anticoagulants with a half-life of < 24 hours if it will be discontinued at least 24 hours prior to the first study transfusion, single periprocedural doses of anticoagulants with a half-life of < 24 hours or low dose aspirin (81 mg per day)
  4. Subject has ≥ grade 2 bleeding at the time of randomization
  5. Planned administration of bedside LR PLT transfusion(s)
  6. Presently with or a history of acute promyelocytic leukemia (APML), idiopathic thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), or hemolytic uremic syndrome (HUS)
  7. HLA and/or HPA-alloimmunization and/or platelet refractory as determined by the investigator
  8. Hypersplenism as evidenced by splenomegaly based on investigator assessment at baseline
  9. History or diagnosis of a disease affecting hemostasis
  10. Currently taking, or participating in a clinical study involving PLT substitutes, PLT growth factors, or pharmacologic agents intended to enhance (i.e, antifibrinolytic agents) or decrease PLT hemostatic function
  11. Acute or chronic medical disorder that, in the opinion of the investigator, would impair the ability of the subject to receive protocol treatment
  12. Subject is pregnant or lactating
  13. Inability of the subject to comply with study procedures and/or follow-up

Sites / Locations

  • Children's National Medical Center
  • University of Florida Health Shands Hospital
  • Emory University/Children's Hospital of Atlanta
  • University of Iowa
  • John Hopkins University School of Medicine/Johns Hopkins Kimmel Cancer Center
  • Boston Children's Hospital
  • Washington University in St. Louis
  • University of Nebraska Medical Center
  • Robert Wood Johnson Medical School/RWJ University Hospital
  • University of Washington Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Mirasol platelets (MIR PLTs)

Reference platelets (REF PLTs)

Arm Description

Leukoreduced, Trima Accel® apheresis platelets stored in 100% plasma, pathogen reduced with the Mirasol® Pathogen Reduction Technology (PRT) System

Leukoreduced, apheresis platelets stored in 100% plasma

Outcomes

Primary Outcome Measures

Days of ≥ Grade 2 Bleeding
Number of days of Grade 2 or higher bleeding recorded from treatment start date through 28 days following the first transfusion, until transfusion independence (10 days without PLT transfusion) prior to Day 28, or study termination, whichever occurred first. Subjects who obtained transfusion independence prior to Day 28 were assumed to have zero bleeding events between the date of transfusion independence and Day 28. Observed and simulated data for off-protocol transfusion intervals were included.

Secondary Outcome Measures

Number and Percentage of Subjects With Human Leukocyte Antigen (HLA) Alloimmunization
The outcome was the development of a new HLA Class I antibodies among subjects negative at baseline within each treatment group. Positivity for Class I HLA antibodies was determined by the 5 SD normalized background ratio cutoffs assay threshold (>59.2, LABScreen Mixed LSM12, One Lambda).
Number and Percentage of Subjects With ≥ Grade 2 Bleeding
The number and percentage of subjects with at least 1 day of ≥ Grade 2 bleeding from Day 0 through Day 27 (or until transfusion independence was achieved) by treatment group
Number and Percentage of Subjects at the First Timepoint of ≥ Grade 2 Bleeding
The time to first ≥ Grade 2 bleeding was analyzed using a log-rank test comparing survival curves stratified by treatment group.
Number and Percentage of Subjects With ≥ Grade 3 Bleeding
The number and percentage of subjects with at least 1 day of ≥ Grade 3 bleeding from Day 0 through Day 27 (or until transfusion independence was achieved).
Number and Percentage of Subjects With PLT Refractoriness
The number and percentage of subjects with PLT refractoriness defined as 2 sequential transfusions, each with corrected count increments (CCIs) < 5000 measured 1 hour post-transfusion.
Number and Percentage of Subjects With Immune Platelet Refractoriness
The number and percentage of subjects with PLT refractoriness for each treatment group. Subjects were defined as immune PLT refractoriness based on 2 sequential transfusion episodes, each with CCIs < 5000 measured 1 hour post transfusion, and who also had a positive antibody test within 14 days before or after the onset of PLT refractoriness.

Full Information

First Posted
November 9, 2016
Last Updated
July 28, 2021
Sponsor
Terumo BCTbio
Collaborators
Biomedical Advanced Research and Development Authority
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1. Study Identification

Unique Protocol Identification Number
NCT02964325
Brief Title
Efficacy of Mirasol-treated Apheresis Platelets in Patients With Hypoproliferative Thrombocytopenia
Acronym
MIPLATE
Official Title
Clinical Effectiveness of Conventional Versus Mirasol-treated Apheresis Platelets in Patients With Hypoproliferative Thrombocytopenia
Study Type
Interventional

2. Study Status

Record Verification Date
July 2021
Overall Recruitment Status
Terminated
Why Stopped
Based interim analysis results, Data Monitoring Committee did not believe the primary efficacy endpoint would be met. No patient safety concerns.
Study Start Date
May 5, 2017 (Actual)
Primary Completion Date
June 25, 2020 (Actual)
Study Completion Date
June 25, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Terumo BCTbio
Collaborators
Biomedical Advanced Research and Development Authority

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a prospective, multi-center, controlled, randomized, non-inferiority study to evaluate the clinical effectiveness of Conventional versus Mirasol-treated apheresis platelets in subjects with hypoproliferative thrombocytopenia who are expected to have platelet count(s) ≤ 10,000/μL requiring ≥ 2 platelet transfusions.
Detailed Description
Patients will be randomized 1:1 to Mirasol-treated platelets (test platelets) or to conventional, untreated platelets (control platelets). The blood centers will collect the apheresis donor platelets and supply the test platelets to the hospital sites for transfusion into patients. Hospital sites will order control platelets as per their normal process, from their standard vendor. The target population for the MIPLATE study are patients with hematologic malignancies with hypoproliferative thrombocytopenia who are expected to have platelet (PLT) count(s) of ≤ 10,000/μL requiring ≥ 2 PLT transfusions. The primary objective of MIPLATE is to determine if the hemostatic efficacy of Mirasol-treated plasma stored Trima Accel® Aph PLTs are non-inferior to Conventional plasma stored Aph PLTs in subjects with hypoproliferative thrombocytopenia requiring PLT transfusions. The secondary objectives include comparing other efficacy and safety endpoints between the treatment groups. Subjects with hematologic malignancies with hypoproliferative thrombocytopenia are anticipated to experience a "transfusion episode" where they will require PLT transfusion support until bone marrow recovery. During this period all PLT transfusions required for a study subject will be given according to the subject's treatment allocation for 28 days after the initial PLT transfusion OR until transfusion independence (10 days without PLT transfusion) prior to Day 28. Additionally, serum samples for HLA antibody testing will be collected on Days 14, 28 and 56. At a minimum, the initial post-randomization prophylactic PLT transfusion will be initiated for a PLT count ≤ 10,000/µL. Thereafter, indications for PLT transfusions may be PLT count-related prophylaxis, intervention-related prophylaxis, or therapeutic (treatment of active bleeding) as determined by the treating physician(s). The indication(s) for the transfusion(s) will be captured.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hematologic Malignancies, Hypoproliferative Thrombocytopenia
Keywords
hypoproliferative thrombocytopenia, hematologic malignancies, thrombocytopenia, platelet therapy, apheresis, pathogen reduction therapy

7. Study Design

Primary Purpose
Supportive Care
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
InvestigatorOutcomes Assessor
Masking Description
Though this is not a blinded study, treatment assignment is obtained through electronic system and should not be shared those performing the primary outcome assessment or assessors of adverse events.
Allocation
Randomized
Enrollment
422 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Mirasol platelets (MIR PLTs)
Arm Type
Experimental
Arm Description
Leukoreduced, Trima Accel® apheresis platelets stored in 100% plasma, pathogen reduced with the Mirasol® Pathogen Reduction Technology (PRT) System
Arm Title
Reference platelets (REF PLTs)
Arm Type
Active Comparator
Arm Description
Leukoreduced, apheresis platelets stored in 100% plasma
Intervention Type
Device
Intervention Name(s)
Mirasol platelets (MIR PLTs)
Intervention Description
The final product to be transfused to the subject will be leukoreduced (LR), apheresis (Aph) single-donor platelets (PLTs) at the standard therapeutic dose of 1 unit of Aph PLTs containing ≥ 3.0 × 1.0E11 PLTs. MIR PLTs will be treated with the Mirasol pathogen reduction technology system.
Intervention Type
Device
Intervention Name(s)
Reference platelets (REF PLTs)
Intervention Description
The final product to be transfused to the subject will be LR-Aph single-donor PLTs at the standard therapeutic dose of 1 unit of Aph PLTs containing ≥ 3.0 × 1.0E11 PLTs.
Primary Outcome Measure Information:
Title
Days of ≥ Grade 2 Bleeding
Description
Number of days of Grade 2 or higher bleeding recorded from treatment start date through 28 days following the first transfusion, until transfusion independence (10 days without PLT transfusion) prior to Day 28, or study termination, whichever occurred first. Subjects who obtained transfusion independence prior to Day 28 were assumed to have zero bleeding events between the date of transfusion independence and Day 28. Observed and simulated data for off-protocol transfusion intervals were included.
Time Frame
From the first post-randomization platelet transfusion through 28 days following the first transfusion.
Secondary Outcome Measure Information:
Title
Number and Percentage of Subjects With Human Leukocyte Antigen (HLA) Alloimmunization
Description
The outcome was the development of a new HLA Class I antibodies among subjects negative at baseline within each treatment group. Positivity for Class I HLA antibodies was determined by the 5 SD normalized background ratio cutoffs assay threshold (>59.2, LABScreen Mixed LSM12, One Lambda).
Time Frame
HLA antibodies were measured at Baseline and Days 14, 28, and 56.
Title
Number and Percentage of Subjects With ≥ Grade 2 Bleeding
Description
The number and percentage of subjects with at least 1 day of ≥ Grade 2 bleeding from Day 0 through Day 27 (or until transfusion independence was achieved) by treatment group
Time Frame
From the first post-randomization platelet transfusion through 28 days following the first transfusion.
Title
Number and Percentage of Subjects at the First Timepoint of ≥ Grade 2 Bleeding
Description
The time to first ≥ Grade 2 bleeding was analyzed using a log-rank test comparing survival curves stratified by treatment group.
Time Frame
From the first post-randomization platelet transfusion through 28 days following the first transfusion.
Title
Number and Percentage of Subjects With ≥ Grade 3 Bleeding
Description
The number and percentage of subjects with at least 1 day of ≥ Grade 3 bleeding from Day 0 through Day 27 (or until transfusion independence was achieved).
Time Frame
From the first post-randomization platelet transfusion through 28 days following the first transfusion.
Title
Number and Percentage of Subjects With PLT Refractoriness
Description
The number and percentage of subjects with PLT refractoriness defined as 2 sequential transfusions, each with corrected count increments (CCIs) < 5000 measured 1 hour post-transfusion.
Time Frame
From the first post-randomization platelet transfusion through 28 days following the first transfusion.
Title
Number and Percentage of Subjects With Immune Platelet Refractoriness
Description
The number and percentage of subjects with PLT refractoriness for each treatment group. Subjects were defined as immune PLT refractoriness based on 2 sequential transfusion episodes, each with CCIs < 5000 measured 1 hour post transfusion, and who also had a positive antibody test within 14 days before or after the onset of PLT refractoriness.
Time Frame
Initial post-randomization platelet transfusion through high Class I HLA development.
Other Pre-specified Outcome Measures:
Title
Number and Percentage of Subjects With Unanticipated Adverse Device Effects (UADEs)
Description
UADEs are identified as treatment emergent adverse events reported by the investigator as serious, unanticipated, at least possibly related to study device or at least possibly related to treatment. UADEs were coded using Medical Dictionary for Regulatory Activities (MedDRA) Version 19.1
Time Frame
From initial post-randomization PLT transfusion through 72 hours following the last per protocol PLT transfusion.

10. Eligibility

Sex
All
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Weight > 10 kg (22 lbs) Subject has a hematologic malignancy with hypoproliferative thrombocytopenia and is expected to have PLT count(s) ≤ 10,000/µL requiring ≥ 2 PLT transfusions Laboratory results within 5 days prior to anticipated initiation of the first post randomization PLT transfusion: Prothrombin time (PT) and/or international normalized ratio (INR) ≤ 1.3 × the upper limit of normal (ULN) Activated partial thromboplastin time (aPTT) ≤ 1.3 × ULN Fibrinogen ≥ 100 mg/dL Women of childbearing potential must have a negative pregnancy test and agree to practice a medically acceptable contraception regimen for the study duration. Women who are postmenopausal for at least 1 year (> 12 months since last menses) or are surgically sterilized do not require this test IC from the subject or assent from the subject and consent from a parent or guardian, if the subject is < 18 years of age Exclusion Criteria: Treatment with pathogen-reduced blood products within previous 6 months Subject has been previously enrolled in this study and received at least 1 per protocol PLT transfusion a.) Subject is receiving therapeutic doses of antiplatelet agents, antifibrinolytics, and/or PLT specific growth factors within 10 days prior to randomization or b.) Subject is receiving therapeutic doses of anticoagulant, pro-coagulant or antithrombotic agents within 10 days prior to randomization. Subjects can be included if receiving the following: prophylactic dosing of anticoagulants (heparin, any low molecular weight heparin, enoxaparin, or fondaparinux), anticoagulants/thrombolytic agents used to maintain or re-establish the patency of catheters (heparin flushes or tissue-plasminogen activase [TPA], therapeutic doses of anticoagulants with a half-life of < 24 hours if it will be discontinued at least 24 hours prior to the first study transfusion, single periprocedural doses of anticoagulants with a half-life of < 24 hours or low dose aspirin (81 mg per day) Subject has ≥ grade 2 bleeding at the time of randomization Planned administration of bedside LR PLT transfusion(s) Presently with or a history of acute promyelocytic leukemia (APML), idiopathic thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), or hemolytic uremic syndrome (HUS) HLA and/or HPA-alloimmunization and/or platelet refractory as determined by the investigator Hypersplenism as evidenced by splenomegaly based on investigator assessment at baseline History or diagnosis of a disease affecting hemostasis Currently taking, or participating in a clinical study involving PLT substitutes, PLT growth factors, or pharmacologic agents intended to enhance (i.e, antifibrinolytic agents) or decrease PLT hemostatic function Acute or chronic medical disorder that, in the opinion of the investigator, would impair the ability of the subject to receive protocol treatment Subject is pregnant or lactating Inability of the subject to comply with study procedures and/or follow-up
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert Cortes, MD
Organizational Affiliation
Terumo BCT
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Sherrill Slichter, MD
Organizational Affiliation
Bloodworks Northwest
Official's Role
Principal Investigator
Facility Information:
Facility Name
Children's National Medical Center
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010
Country
United States
Facility Name
University of Florida Health Shands Hospital
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32608
Country
United States
Facility Name
Emory University/Children's Hospital of Atlanta
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Facility Name
University of Iowa
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Facility Name
John Hopkins University School of Medicine/Johns Hopkins Kimmel Cancer Center
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21231
Country
United States
Facility Name
Boston Children's Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Facility Name
Washington University in St. Louis
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
University of Nebraska Medical Center
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68198
Country
United States
Facility Name
Robert Wood Johnson Medical School/RWJ University Hospital
City
New Brunswick
State/Province
New Jersey
ZIP/Postal Code
08903
Country
United States
Facility Name
University of Washington Medical Center
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Efficacy of Mirasol-treated Apheresis Platelets in Patients With Hypoproliferative Thrombocytopenia

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