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Ixazomib in the Prophylaxis of Chronic Graft-versus-host Disease.

Primary Purpose

Hematopoietic Stem Cell Transplantation, Multiple Myeloma

Status
Active
Phase
Phase 1
Locations
Spain
Study Type
Interventional
Intervention
Ixazomib
Tacrolimus
Sirolimus
Any prophylaxis for GVHD
Sponsored by
Fundación Pública Andaluza para la gestión de la Investigación en Sevilla
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hematopoietic Stem Cell Transplantation focused on measuring Ixazomib

Eligibility Criteria

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

Inclusion Criteria:

  1. Male or female patients 18 years or older.
  2. Patients on the day +100 +/- 20 days who have received an allogeneic transplant with myeloablative or reduced intensity conditioning peripheral blood allogeneic stem cell transplantation.
  3. Patients who have received a hematopoietic bone marrow transplant hematopoietic progenitors of peripheral blood from histo / compatible donor as definition accepted by protocol.
  4. Patients receiving any prophylaxis for GVHD, except for antithymocyte globulin, cyclophosphamide or any in vitro or in vivo depletion protocol.
  5. Voluntary written consent must be given before performance of any study related procedure.
  6. Female patients who accomplish with requisitions for not possibility of pregnancy (menopausal, effective methods of contraception), as detailed by protocol.
  7. Eastern Cooperative Oncology Group performance status and/or other performance status 0, 1, or 2.
  8. Patients must meet the following clinical laboratory criteria:

    • Absolute neutrophil count 1,000/mm3 and platelet count 75,000/mm3. Platelet transfusions to help patients meet eligibility criteria are not allowed within 3 days before study enrollment.
    • Total bilirubin 1.5 the upper limit of the normal range .
    • Alanine aminotransferase and aspartate aminotransferase 3 upper limit of the normal range.
    • Calculated creatinine clearance 30 mL/min.
  9. Ability to swallow and tolerate oral medication.
  10. Absence of gastrointestinal symptoms that precludes oral intake and absorption.
  11. Off antibiotics and amphotericin B formulations, voriconazole or other anti-fungal therapy for the treatment of active proven, probable or possible infections.
  12. Ability to understand the nature of this study and give written informed consent.

Exclusion Criteria:

  1. Female patients who are lactating or have a positive serum pregnancy test during the screening period.
  2. Major surgery within 14 days before enrollment.
  3. Central nervous system involvement with malignant cells.
  4. Uncontrolled infection within 14 days before study enrollment.
  5. Evidence of current uncontrolled cardiovascular conditions, including uncontrolled hypertension, uncontrolled cardiac arrhythmias, symptomatic congestive heart failure, unstable angina, or myocardial infarction within the past 6 months.
  6. Systemic treatment, within 14 days before the first dose of ixazomib, with strong Cytochrome P450, family 3, subfamily A inducers (rifampin, rifapentine, rifabutin, carbamazepine, phenytoin, phenobarbital), or use of Ginkgo biloba or St. John's wort.
  7. Ongoing or active systemic infection, active hepatitis B or C virus infection, or known human immunodeficiency virus positive.
  8. Any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of treatment according to this protocol.
  9. Known allergy to any of the study medications, their analogues, or excipients in the various formulations of any agent.
  10. Diagnosed or treated for another malignancy within 2 years before study enrollment or previously diagnosed with another malignancy and have any evidence of residual disease. Patients with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection.
  11. Patient has Grade 1 with pain or ≥ grade 2 with or without pain peripheral neuropathy.
  12. Participation in other clinical trials, including those with other investigational agents not included in this trial, within 30 days of the start of this trial and throughout the duration of this trial.
  13. Patients that have previously been treated with ixazomib, or participated in a study with ixazomib whether treated with ixazomib or not.
  14. Active Graft versus host disease at the time of inclusion: patients are allowed to be included if acute Graft-versus-host Disease is in complete remission and are receiving systemic steroids at < 0.25 mg / kg.
  15. Active hematologic malignancy at the time of inclusion.
  16. Active microangiopathy at the time of inclusion (according to International Working Group criteria).
  17. Gastrointestinal disease or procedure than can interfere with oral absorption , intolerance to the ixazomib or difficulty to swallow.

Sites / Locations

  • ICO- Hospital Germans Trias i Pujol
  • Hospital Clinic de Barcelona
  • Hospital de la Santa Creu I Sant Pau
  • Hospital Universitario Vall D´Hebrón
  • Hospital Universitario Ramón y Cajal
  • Hospital Clinico Universitario Salamanca
  • Hospital Universitario Virgen del Rocío
  • Hospital Clínico Universitario de Valencia

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Other

Arm Label

Experimental group

Control group

Arm Description

Phase I: Ixazomib + Tacrolimus + Sirolimus. Ixazomib doses in this study is 3 to 4 mg of ixazomib on day +1, +8 and +15. Tacrolimus at a dose of 0.02 mg/kg/day and then 0.06 mg/kg/day. Sirolimus at a dose of 6 mg on day -5 and then 4 mg per day. Phase II: Ixazomib+ any prophylaxis for GVHD, except antithymocyte globulin, cyclophosphamide or any T depletion protocol in vitro or in vivo. Starting Dose of Ixazomib according to phase I.

Any prophylaxis for GVHD, except antithymocyte globulin, cyclophosphamide or any T depletion protocol in vitro or in vivo.

Outcomes

Primary Outcome Measures

Maximun tolerated dose
Maximun tolerated dose of the ixazomib in combination with sirolimus and tacrolimus in patients following allogeneic stem cell transplantation for the phase I study will be determinated
Efficacy of ixazomib for phase II study
Presence of moderate plus severe Chronic Graft-versus-host Disease according to NIH scale in patients receiving the maximum tolerated dose.

Secondary Outcome Measures

Event immune recovery for the phase I study
Quantification of time of event immune recovery in patients exposed and not exposed to ixazomib.
Event free survival for phase II study.
Quantification of time of event free survival for patients receiving the maximum tolerated dose.
Event immune recovery for phase II study.
Quantification of time of event immune recovery in patients exposed and not exposed to ixazomib.
Exposure to immunosuppressive treatment for phase II study.
Evaluation of needs of additional permitted immunosuppressive treatment administered as concomitant medication
Overall disease free survival for phase II study
Quantification of time of overall survival after study treatment
Serious adverse event for phase II study
Describe the serious adverse event notified during the study
Risk of moderate or severe GVHD for phase II study
To evaluate the risk of moderate or severe GVHD according to the NIH scale
Differences among patients receiving a reduced-intensity and myeloablative conditioning regimen for phase II study.
To evaluate differences in terms of chronic GVHD and treatment tolerance

Full Information

First Posted
April 4, 2017
Last Updated
May 2, 2023
Sponsor
Fundación Pública Andaluza para la gestión de la Investigación en Sevilla
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1. Study Identification

Unique Protocol Identification Number
NCT03225417
Brief Title
Ixazomib in the Prophylaxis of Chronic Graft-versus-host Disease.
Official Title
Phase Ib/II Trial to Evaluate Safety and Efficacy of Oral Ixazomib in the Prophylaxis of Chronic Graft-versus-host Disease.
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
May 16, 2017 (Actual)
Primary Completion Date
August 4, 2023 (Anticipated)
Study Completion Date
December 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Fundación Pública Andaluza para la gestión de la Investigación en Sevilla

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Allogeneic hematopoietic stem cell transplantation (HTC) is the only curative option for many patients with hematologic malignancies but >50% of this patients will develop extensive chronic graft-versus-host disease (cGVHD), which remains the most important complication after HTC. Classically, the most effective strategies to prevent GVHD have not improved survival; therefore, the new strategies are being sought. This study is designed in two phases: the main objective for phase I study is the more suitable dose for ixazomib search. Phase II study is designed to evaluate the efficacy of ixazomib at the doses stablished in phase I.
Detailed Description
The study design is based on a phase I / II trial in eight Spanish hospitals. In the phase I, a number of 3 to 12 patients will be included to evaluate the optimal dose of ixazomib in combination with sirolimus and tacrolimus. In the phase II, a total number of 130 patients will be randomized to receive ixazomib or the best medical recommendation added in order to evaluate the efficacy of ixazomib. This patients who will receive any prophylaxis for GVHD, except those patients who received antithymocyte globulin , cyclophosphamide or any T depletion protocol in vitro or in vivo.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hematopoietic Stem Cell Transplantation, Multiple Myeloma
Keywords
Ixazomib

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
142 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Experimental group
Arm Type
Experimental
Arm Description
Phase I: Ixazomib + Tacrolimus + Sirolimus. Ixazomib doses in this study is 3 to 4 mg of ixazomib on day +1, +8 and +15. Tacrolimus at a dose of 0.02 mg/kg/day and then 0.06 mg/kg/day. Sirolimus at a dose of 6 mg on day -5 and then 4 mg per day. Phase II: Ixazomib+ any prophylaxis for GVHD, except antithymocyte globulin, cyclophosphamide or any T depletion protocol in vitro or in vivo. Starting Dose of Ixazomib according to phase I.
Arm Title
Control group
Arm Type
Other
Arm Description
Any prophylaxis for GVHD, except antithymocyte globulin, cyclophosphamide or any T depletion protocol in vitro or in vivo.
Intervention Type
Drug
Intervention Name(s)
Ixazomib
Other Intervention Name(s)
X16082
Intervention Description
Ixazomib capsules. Phase I: Starting dose of Ixazomib: 3.0 or 4.0 mg by day +1, +8 and +15. Phase II: Starting Dose of Ixazomib: Maximum tolerated dose from Phase I.
Intervention Type
Drug
Intervention Name(s)
Tacrolimus
Other Intervention Name(s)
Prograf
Intervention Description
Tacrolimus at dose of 0.02 mg/kg/day and then 0.06 mg/kg/day.
Intervention Type
Drug
Intervention Name(s)
Sirolimus
Other Intervention Name(s)
Rapamune
Intervention Description
Sirolimus oral solution. Standing 6 mg orally on day -5 and continued 4mg per day. This drugs should be slowly tapered starting 3 months posttransplant in order to stop them at 9 to 12 months posttransplant according to physician criteria.
Intervention Type
Drug
Intervention Name(s)
Any prophylaxis for GVHD
Other Intervention Name(s)
Any prophylaxis for GVHD, except antithymocyte globulin, cyclophosphamide or any in vitro or in vivo.
Intervention Description
Except antithymocyte globulin, cyclophosphamide or any T depletion protocol in vitro or in vivo.
Primary Outcome Measure Information:
Title
Maximun tolerated dose
Description
Maximun tolerated dose of the ixazomib in combination with sirolimus and tacrolimus in patients following allogeneic stem cell transplantation for the phase I study will be determinated
Time Frame
3 months after transplantation (a total of 3 cycles of 28 days length of study treatment)
Title
Efficacy of ixazomib for phase II study
Description
Presence of moderate plus severe Chronic Graft-versus-host Disease according to NIH scale in patients receiving the maximum tolerated dose.
Time Frame
9 months after transplantation (a total of 9 cycles of 28 days length of study treatment)
Secondary Outcome Measure Information:
Title
Event immune recovery for the phase I study
Description
Quantification of time of event immune recovery in patients exposed and not exposed to ixazomib.
Time Frame
The post-transplant days +180, +270, +365, +545, +730
Title
Event free survival for phase II study.
Description
Quantification of time of event free survival for patients receiving the maximum tolerated dose.
Time Frame
Just after the time of transplantation and 1 and 2 years after transplantation
Title
Event immune recovery for phase II study.
Description
Quantification of time of event immune recovery in patients exposed and not exposed to ixazomib.
Time Frame
The post-transplant days +180, +270, +365, +545, +730
Title
Exposure to immunosuppressive treatment for phase II study.
Description
Evaluation of needs of additional permitted immunosuppressive treatment administered as concomitant medication
Time Frame
1 and 2 years after transplantation.
Title
Overall disease free survival for phase II study
Description
Quantification of time of overall survival after study treatment
Time Frame
2 years after transplantation.
Title
Serious adverse event for phase II study
Description
Describe the serious adverse event notified during the study
Time Frame
1 and 2 years after transplantation
Title
Risk of moderate or severe GVHD for phase II study
Description
To evaluate the risk of moderate or severe GVHD according to the NIH scale
Time Frame
2 years after transplantation
Title
Differences among patients receiving a reduced-intensity and myeloablative conditioning regimen for phase II study.
Description
To evaluate differences in terms of chronic GVHD and treatment tolerance
Time Frame
1 and 2 years after transplantation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female patients 18 years or older. Patients on the day +100 +/- 20 days who have received an allogeneic transplant with myeloablative or reduced intensity conditioning peripheral blood allogeneic stem cell transplantation. Patients who have received a hematopoietic bone marrow transplant hematopoietic progenitors of peripheral blood from histo / compatible donor as definition accepted by protocol. Patients receiving any prophylaxis for GVHD, except for antithymocyte globulin, cyclophosphamide or any in vitro or in vivo depletion protocol. Voluntary written consent must be given before performance of any study related procedure. Female patients who accomplish with requisitions for not possibility of pregnancy (menopausal, effective methods of contraception), as detailed by protocol. Eastern Cooperative Oncology Group performance status and/or other performance status 0, 1, or 2. Patients must meet the following clinical laboratory criteria: Absolute neutrophil count 1,000/mm3 and platelet count 75,000/mm3. Platelet transfusions to help patients meet eligibility criteria are not allowed within 3 days before study enrollment. Total bilirubin 1.5 the upper limit of the normal range . Alanine aminotransferase and aspartate aminotransferase 3 upper limit of the normal range. Calculated creatinine clearance 30 mL/min. Ability to swallow and tolerate oral medication. Absence of gastrointestinal symptoms that precludes oral intake and absorption. Off antibiotics and amphotericin B formulations, voriconazole or other anti-fungal therapy for the treatment of active proven, probable or possible infections. Ability to understand the nature of this study and give written informed consent. Exclusion Criteria: Female patients who are lactating or have a positive serum pregnancy test during the screening period. Major surgery within 14 days before enrollment. Central nervous system involvement with malignant cells. Uncontrolled infection within 14 days before study enrollment. Evidence of current uncontrolled cardiovascular conditions, including uncontrolled hypertension, uncontrolled cardiac arrhythmias, symptomatic congestive heart failure, unstable angina, or myocardial infarction within the past 6 months. Systemic treatment, within 14 days before the first dose of ixazomib, with strong Cytochrome P450, family 3, subfamily A inducers (rifampin, rifapentine, rifabutin, carbamazepine, phenytoin, phenobarbital), or use of Ginkgo biloba or St. John's wort. Ongoing or active systemic infection, active hepatitis B or C virus infection, or known human immunodeficiency virus positive. Any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of treatment according to this protocol. Known allergy to any of the study medications, their analogues, or excipients in the various formulations of any agent. Diagnosed or treated for another malignancy within 2 years before study enrollment or previously diagnosed with another malignancy and have any evidence of residual disease. Patients with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection. Patient has Grade 1 with pain or ≥ grade 2 with or without pain peripheral neuropathy. Participation in other clinical trials, including those with other investigational agents not included in this trial, within 30 days of the start of this trial and throughout the duration of this trial. Patients that have previously been treated with ixazomib, or participated in a study with ixazomib whether treated with ixazomib or not. Active Graft versus host disease at the time of inclusion: patients are allowed to be included if acute Graft-versus-host Disease is in complete remission and are receiving systemic steroids at < 0.25 mg / kg. Active hematologic malignancy at the time of inclusion. Active microangiopathy at the time of inclusion (according to International Working Group criteria). Gastrointestinal disease or procedure than can interfere with oral absorption , intolerance to the ixazomib or difficulty to swallow.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jose-Antonio Perez-Simon, MD-PhD
Organizational Affiliation
Hospitales Universitarios Virgen del Rocío
Official's Role
Principal Investigator
Facility Information:
Facility Name
ICO- Hospital Germans Trias i Pujol
City
Badalona
Country
Spain
Facility Name
Hospital Clinic de Barcelona
City
Barcelona
Country
Spain
Facility Name
Hospital de la Santa Creu I Sant Pau
City
Barcelona
Country
Spain
Facility Name
Hospital Universitario Vall D´Hebrón
City
Barcelona
Country
Spain
Facility Name
Hospital Universitario Ramón y Cajal
City
Madrid
ZIP/Postal Code
28034
Country
Spain
Facility Name
Hospital Clinico Universitario Salamanca
City
Salamanca
Country
Spain
Facility Name
Hospital Universitario Virgen del Rocío
City
Sevilla
ZIP/Postal Code
41013
Country
Spain
Facility Name
Hospital Clínico Universitario de Valencia
City
Valencia
Country
Spain

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Anonymized data for primary and secondary variables is planned to be shared with all participants within 6 months of data completion.
IPD Sharing Time Frame
6 months after data completion
IPD Sharing Access Criteria
Investigators participating in the study until the final publication is done

Learn more about this trial

Ixazomib in the Prophylaxis of Chronic Graft-versus-host Disease.

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