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Validation of a Predictive Model of Response to Romiplostim in Patients With IPSS Low or Intermediate-1 Risk MDS and Thrombocytopenia (EUROPE)

Primary Purpose

Myelodysplastic Syndromes

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
N-Plate / romiplostim
Sponsored by
Gesellschaft fur Medizinische Innovation - Hamatologie und Onkologie mbH
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Myelodysplastic Syndromes focused on measuring MDS classified as IPSS low/int-1

Eligibility Criteria

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

Inclusion Criteria:

  • Subjects must meet the following inclusion/exclusion criteria to be eligible for the study.
  • Must understand and voluntarily sign the informed consent form
  • Age older 18 years at the time of signing the informed consent form
  • Must be able to adhere to the study visit schedule and other protocol requirements
  • Diagnosis of MDS using the 2008 WHO classification for myeloid neoplasms as assessed during the screening period
  • Per MDS IPSS, low or intermediate-1 risk MDS as assessed during the screening period
  • The mean of the 2 platelet counts taken within 4 weeks prior to stratification must be:
  • ≤ 30 x 109/L (with no individual count > 30 x 109/L during the screening period), with or without a history of bleeding associated with the diagnosis of MDS, OR
  • < 50 x 109/L (with no individual count >60 x 109/L during the screening period), with a history of bleeding associated with the diagnosis of MDS (A standard of care platelet count taken prior to Informed consent may be used as 1 of the 2 counts taken within 4 weeks prior to stratification)
  • Adequate liver function, as evidenced by ALT ≤ 3 times the laboratory normal range, AST ≤ 3 times the laboratory normal range and total bilirubin ≤ 2 times the laboratory normal range
  • Bone marrow aspirate (central diagnostics) with cytogenetics (local) within 8 weeks of starting first dose of investigational product
  • Female subjects of childbearing potential† must:
  • Agree to use, and be able to comply with, effective contraception without interruption, 4 weeks before starting study drug, throughout study drug therapy and for 4 weeks after the end of study drug therapy, even if she has amenorrhoea. This applies unless the subject commits to absolute and continued abstinence confirmed on a monthly basis. Male patients who wish to participate in the study and their partner may become pregnant must agree also to reliable contraception during the study and for three months thereafter.

The following are effective methods of contraception*

  • Implant, - Levonorgestrel-releasing intrauterine system (IUS), Medroxyprogesterone acetate depot, Tubal sterilization, Sexual intercourse with a vasectomised male partner only; Ovulation inhibitory progesterone-only pills (i.e., desogestrel)
  • Agree to have a medically supervised pregnancy test with a minimum sensitivity of 25 mIU/ml not more than 3 days before the start of study medication once the subject has been on effective contraception for at least 4 weeks. This requirement also applies to women of childbearing potential who practice complete and continued abstinence.

Exclusion Criteria:

  • Pregnant or lactating females
  • IPSS intermediate-2 or high-risk
  • ≥ 5% blasts in the bone marrow as determined by central morphology during screening
  • Previous treatment with any thrombopoietic growth factor
  • Prior history of hematopoietic stem cell transplantation, leukemia, aplastic anemia or other non-MDS related bone marrow stem cell disorder
  • Active or uncontrolled disease including infections or cancer
  • Unstable angina, congestive heart failure (NYHA > class II), uncontrolled hypertension
  • History of arterial thrombosis (e.g., stroke or transient ischemic attack) within the past year
  • History of venous thrombosis that currently requires anti-coagulation therapy
  • Prior use of sc or iv AZA.
  • Receipt of G-CSF, peg-G-CSF, or GM-CSF,IL-11, ESA or LEN within 4 weeks of the first dose of romiplostim
  • Planned receipt of peg-G-CSF or GM-CSF after the first dose of investigational product
  • Subjects of reproductive potential who are not using adequate contraceptive precautions, in the judgment of the investigator. A double barrier method is defined as 2 methods of contraception, for example 2 actual barrier methods, or 1 actual barrier method and 1 hormonal method.
  • Known hypersensitivity to any recombinant E. coli-derived product (eg, Nplate, Infergen, Neupogen, Somatropin, and Actimmune)
  • Inability to comply with study procedures.
  • Subject currently is enrolled in or has not yet completed at least 30 days since ending other investigational device or drug study(s)
  • Any serious medical condition or psychiatric illness that will prevent the subject from signing the informed consent form or will place the subject at unacceptable risk if he/she participates in the study.

Sites / Locations

  • CH
  • CH Victor Dupouy
  • CH Henri Duffaut
  • CHU de Haut Lévèque
  • CHRU Côte de Nacre
  • CHU Estaing
  • CHU
  • CH
  • CHRU
  • CH Lyon sud
  • IPC
  • CH
  • Clinique Beausoleil
  • CHU Brabois
  • Centre Catherine de Sienne
  • Polyclinique Le Languedoc
  • CHR
  • Hôpital Cochin
  • Hôpital Saint Louis
  • CHU
  • Centre Henri Becquerel
  • Hôpital Bretonneau
  • MVZ Onkologischer Schwerpunkt am Oskar-Helene-Heim
  • Vivantes Klinikum am Urban / Hämatologie Onkologie
  • Klinikum Chemnitz gGmbH / Klinik für Innere Medizin III
  • Universitätsklinikum Dresden / Medizinische Klinik I
  • Marienhospital Düsseldorf GmbH / Innere Medizin u. Hämatologie
  • Universitätsklinikum Halle (Saale) / Klinik für Innere Medizin IV
  • Universitätsklinikum Hamburg-Eppendorf /Onkologisches Zentrum
  • Medizinische Hochschule Hannover / Hämatologie u. Onkologie
  • Universitätsklinikum Mannheim / Klinik III / Hämatologie, Onkologie
  • Klinikum Rechts der Isar, Tumortherapiezentrum
  • MVZ für Blut u. Krebserkrankungen
  • Universitätsklinikum Ulm / Klinik Innere Medizin III
  • Onkologische Gemeinschaftspraxis
  • Rems-Murr-Kliniken Winnenden / Hämatologie, Onkologie

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Group 1

Group 2

Group 3

Arm Description

Stratification into group 1 if Score (Baseline-TPO Level and previous thrombocyte transfusions) are +3 TPO based model to predict subsequent response to romiplostim in MDS patients with IPSS Low/Int-1 according to a model developed by Sekeres et. al./ BJH 2014

Stratification into group 2 if Score (Baseline-TPO Level and previous thrombocyte transfusions) are -1 or -2 TPO based model to predict subsequent response to romiplostim in MDS patients with IPSS Low/Int-1 according to a model developed by Sekeres et. al./ BJH 2014

Stratification into group 3 if Score (Baseline-TPO Level and previous thrombocyte transfusions) are -6 TPO based model to predict subsequent response to romiplostim in MDS patients with IPSS Low/Int-1 according to a model developed by Sekeres et. al./ BJH 2014

Outcomes

Primary Outcome Measures

Hematologic Improvement of Platelets (HI-P) After 4 Months on Therapy
The primary efficacy endpoint was the rate of HI-P defined as an absolute increase of platelet count to ≥ 30/nL for patients starting at > 20/nL or an increase of platelets from < 20/nL to > 20/nL and by at least 100%, according to IWG 2006 criteria lasting for ≥ 8 weeks after at least 16 Weeks of romiplostim treatment.

Secondary Outcome Measures

Cumulative Hematologic Improvement
Cumulative rate of hematologic improvement of platelets (HI-P), erythrocytes (HI-E) and neutrophil granulocytes (HI-N). None of the patients achieved simultaneous response of HI-P, HI-E and HI-N.
The Incidence of Disease Progression to Higher Stage MDS or AML
The incidence of disease progression to higher stage MDS or AML according to WHO (increase in blast percentage of ≥ 20 %)
Increase of Peripheral Blasts During Therapy
Association of the Presence of Certain Mutations With Disease Progression in a Retrospective Analysis
Incidence of Bleeding Events
Type, Incidence and Severity of All Adverse Events Including Clinically Significant Changes in Laboratory Values

Full Information

First Posted
January 7, 2015
Last Updated
July 26, 2023
Sponsor
Gesellschaft fur Medizinische Innovation - Hamatologie und Onkologie mbH
Collaborators
Amgen
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1. Study Identification

Unique Protocol Identification Number
NCT02335268
Brief Title
Validation of a Predictive Model of Response to Romiplostim in Patients With IPSS Low or Intermediate-1 Risk MDS and Thrombocytopenia
Acronym
EUROPE
Official Title
Prospective Validation of a Predictive Model of Response to Romiplostim in Patients With IPSS Low or Intermediate-1 Risk Myelodysplastic Syndrome (MDS) and Thrombocytopenia - the EUROPE-trial
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Completed
Study Start Date
May 21, 2015 (Actual)
Primary Completion Date
July 1, 2021 (Actual)
Study Completion Date
July 1, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Gesellschaft fur Medizinische Innovation - Hamatologie und Onkologie mbH
Collaborators
Amgen

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
There are currently no licensed drugs in the EU to treat thrombocytopenia in MDS patients classified as IPSS low/int-1. Prior studies with romiplostim (a TPO receptor agonist) in MDS found that baseline concentration of TPO as well as transfusion history were predictive of subsequent response in a retrospective model. The current prospective study has the aim to explore whether both pretreatment variables (endogenous TPO, TPO-level, platelet transfusion history) can predict the response to subsequent short-term treatment with romiplostim.
Detailed Description
Myelodysplastic syndromes (MDS) are a heterogeneous group of hematologic malignancies of the pluripotent hematopoietic stem cells characterized by clonal hematopoiesis, progressive bone marrow failure, and the propensity to transform to acute myeloid leukemia (AML) (Malcovati et al., 2013). There are currently no licensed drugs in the EU to treat thrombocytopenia in MDS patients classified as IPSS low/int-1. Prior studies with romiplostim (a TPO receptor agonist) in MDS found that baseline concentration of TPO as well as transfusion history were predictive of subsequent response in a retrospective model. Classically, MDS is associated with apoptosis and excessive proliferation, resulting in a combination of a hyper-cellular marrow and peripheral cytopenia. The rationale for using romiplostim in MDS is to stimulate normal progenitor cells to increase platelet counts. Upon correction of thrombocytopenia, responding MDS patients should have a decreased risk of bleeding and a reduction in platelet transfusions (Giagounidis et al., 2014). This reduction in platelet transfusions may in turn decrease the risks of alloimmunization and the resultant morbidity and costs associated with that condition.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Myelodysplastic Syndromes
Keywords
MDS classified as IPSS low/int-1

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
77 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Group 1
Arm Type
Experimental
Arm Description
Stratification into group 1 if Score (Baseline-TPO Level and previous thrombocyte transfusions) are +3 TPO based model to predict subsequent response to romiplostim in MDS patients with IPSS Low/Int-1 according to a model developed by Sekeres et. al./ BJH 2014
Arm Title
Group 2
Arm Type
Experimental
Arm Description
Stratification into group 2 if Score (Baseline-TPO Level and previous thrombocyte transfusions) are -1 or -2 TPO based model to predict subsequent response to romiplostim in MDS patients with IPSS Low/Int-1 according to a model developed by Sekeres et. al./ BJH 2014
Arm Title
Group 3
Arm Type
Experimental
Arm Description
Stratification into group 3 if Score (Baseline-TPO Level and previous thrombocyte transfusions) are -6 TPO based model to predict subsequent response to romiplostim in MDS patients with IPSS Low/Int-1 according to a model developed by Sekeres et. al./ BJH 2014
Intervention Type
Drug
Intervention Name(s)
N-Plate / romiplostim
Intervention Description
medical intervention in 3 patient groups (MDS patients with IPSS Low/Int-1) that are stratified according to their baseline TPO-Level and previous transfusions
Primary Outcome Measure Information:
Title
Hematologic Improvement of Platelets (HI-P) After 4 Months on Therapy
Description
The primary efficacy endpoint was the rate of HI-P defined as an absolute increase of platelet count to ≥ 30/nL for patients starting at > 20/nL or an increase of platelets from < 20/nL to > 20/nL and by at least 100%, according to IWG 2006 criteria lasting for ≥ 8 weeks after at least 16 Weeks of romiplostim treatment.
Time Frame
after 4 months on therapy (week 16)
Secondary Outcome Measure Information:
Title
Cumulative Hematologic Improvement
Description
Cumulative rate of hematologic improvement of platelets (HI-P), erythrocytes (HI-E) and neutrophil granulocytes (HI-N). None of the patients achieved simultaneous response of HI-P, HI-E and HI-N.
Time Frame
week 16
Title
The Incidence of Disease Progression to Higher Stage MDS or AML
Description
The incidence of disease progression to higher stage MDS or AML according to WHO (increase in blast percentage of ≥ 20 %)
Time Frame
week 16
Title
Increase of Peripheral Blasts During Therapy
Time Frame
week 16
Title
Association of the Presence of Certain Mutations With Disease Progression in a Retrospective Analysis
Time Frame
week 16
Title
Incidence of Bleeding Events
Time Frame
up to 12 months
Title
Type, Incidence and Severity of All Adverse Events Including Clinically Significant Changes in Laboratory Values
Time Frame
up to 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects must meet the following inclusion/exclusion criteria to be eligible for the study. Must understand and voluntarily sign the informed consent form Age older 18 years at the time of signing the informed consent form Must be able to adhere to the study visit schedule and other protocol requirements Diagnosis of MDS using the 2008 WHO classification for myeloid neoplasms as assessed during the screening period Per MDS IPSS, low or intermediate-1 risk MDS as assessed during the screening period The mean of the 2 platelet counts taken within 4 weeks prior to stratification must be: ≤ 30 x 109/L (with no individual count > 30 x 109/L during the screening period), with or without a history of bleeding associated with the diagnosis of MDS, OR < 50 x 109/L (with no individual count >60 x 109/L during the screening period), with a history of bleeding associated with the diagnosis of MDS (A standard of care platelet count taken prior to Informed consent may be used as 1 of the 2 counts taken within 4 weeks prior to stratification) Adequate liver function, as evidenced by ALT ≤ 3 times the laboratory normal range, AST ≤ 3 times the laboratory normal range and total bilirubin ≤ 2 times the laboratory normal range Bone marrow aspirate (central diagnostics) with cytogenetics (local) within 8 weeks of starting first dose of investigational product Female subjects of childbearing potential† must: Agree to use, and be able to comply with, effective contraception without interruption, 4 weeks before starting study drug, throughout study drug therapy and for 4 weeks after the end of study drug therapy, even if she has amenorrhoea. This applies unless the subject commits to absolute and continued abstinence confirmed on a monthly basis. Male patients who wish to participate in the study and their partner may become pregnant must agree also to reliable contraception during the study and for three months thereafter. The following are effective methods of contraception* Implant, - Levonorgestrel-releasing intrauterine system (IUS), Medroxyprogesterone acetate depot, Tubal sterilization, Sexual intercourse with a vasectomised male partner only; Ovulation inhibitory progesterone-only pills (i.e., desogestrel) Agree to have a medically supervised pregnancy test with a minimum sensitivity of 25 mIU/ml not more than 3 days before the start of study medication once the subject has been on effective contraception for at least 4 weeks. This requirement also applies to women of childbearing potential who practice complete and continued abstinence. Exclusion Criteria: Pregnant or lactating females IPSS intermediate-2 or high-risk ≥ 5% blasts in the bone marrow as determined by central morphology during screening Previous treatment with any thrombopoietic growth factor Prior history of hematopoietic stem cell transplantation, leukemia, aplastic anemia or other non-MDS related bone marrow stem cell disorder Active or uncontrolled disease including infections or cancer Unstable angina, congestive heart failure (NYHA > class II), uncontrolled hypertension History of arterial thrombosis (e.g., stroke or transient ischemic attack) within the past year History of venous thrombosis that currently requires anti-coagulation therapy Prior use of sc or iv AZA. Receipt of G-CSF, peg-G-CSF, or GM-CSF,IL-11, ESA or LEN within 4 weeks of the first dose of romiplostim Planned receipt of peg-G-CSF or GM-CSF after the first dose of investigational product Subjects of reproductive potential who are not using adequate contraceptive precautions, in the judgment of the investigator. A double barrier method is defined as 2 methods of contraception, for example 2 actual barrier methods, or 1 actual barrier method and 1 hormonal method. Known hypersensitivity to any recombinant E. coli-derived product (eg, Nplate, Infergen, Neupogen, Somatropin, and Actimmune) Inability to comply with study procedures. Subject currently is enrolled in or has not yet completed at least 30 days since ending other investigational device or drug study(s) Any serious medical condition or psychiatric illness that will prevent the subject from signing the informed consent form or will place the subject at unacceptable risk if he/she participates in the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Uwe Platzbecker, Prof. Dr.
Organizational Affiliation
University of Dresden
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Lionel Ades, Prof. Dr.
Organizational Affiliation
Groupe Francophone des Myelodysplasies
Official's Role
Study Director
Facility Information:
Facility Name
CH
City
Annecy
Country
France
Facility Name
CH Victor Dupouy
City
Argenteuil
Country
France
Facility Name
CH Henri Duffaut
City
Avignon
Country
France
Facility Name
CHU de Haut Lévèque
City
Bordeaux
Country
France
Facility Name
CHRU Côte de Nacre
City
Caen
Country
France
Facility Name
CHU Estaing
City
Clermont-Ferrand
Country
France
Facility Name
CHU
City
Grenoble
Country
France
Facility Name
CH
City
Le Mans
Country
France
Facility Name
CHRU
City
Limoges
Country
France
Facility Name
CH Lyon sud
City
Lyon
Country
France
Facility Name
IPC
City
Marseille
Country
France
Facility Name
CH
City
Meaux
Country
France
Facility Name
Clinique Beausoleil
City
Montpellier
Country
France
Facility Name
CHU Brabois
City
Nancy
Country
France
Facility Name
Centre Catherine de Sienne
City
Nantes
Country
France
Facility Name
Polyclinique Le Languedoc
City
Narbonne
Country
France
Facility Name
CHR
City
Orléans
Country
France
Facility Name
Hôpital Cochin
City
Paris
Country
France
Facility Name
Hôpital Saint Louis
City
Paris
Country
France
Facility Name
CHU
City
Poitiers
Country
France
Facility Name
Centre Henri Becquerel
City
Rouen
Country
France
Facility Name
Hôpital Bretonneau
City
Tours
Country
France
Facility Name
MVZ Onkologischer Schwerpunkt am Oskar-Helene-Heim
City
Berlin
Country
Germany
Facility Name
Vivantes Klinikum am Urban / Hämatologie Onkologie
City
Berlin
Country
Germany
Facility Name
Klinikum Chemnitz gGmbH / Klinik für Innere Medizin III
City
Chemnitz
ZIP/Postal Code
09116
Country
Germany
Facility Name
Universitätsklinikum Dresden / Medizinische Klinik I
City
Dresden
ZIP/Postal Code
01307
Country
Germany
Facility Name
Marienhospital Düsseldorf GmbH / Innere Medizin u. Hämatologie
City
Düsseldorf
Country
Germany
Facility Name
Universitätsklinikum Halle (Saale) / Klinik für Innere Medizin IV
City
Halle
ZIP/Postal Code
06120
Country
Germany
Facility Name
Universitätsklinikum Hamburg-Eppendorf /Onkologisches Zentrum
City
Hamburg
ZIP/Postal Code
20246
Country
Germany
Facility Name
Medizinische Hochschule Hannover / Hämatologie u. Onkologie
City
Hannover
Country
Germany
Facility Name
Universitätsklinikum Mannheim / Klinik III / Hämatologie, Onkologie
City
Mannheim
Country
Germany
Facility Name
Klinikum Rechts der Isar, Tumortherapiezentrum
City
München
Country
Germany
Facility Name
MVZ für Blut u. Krebserkrankungen
City
Potsdam
Country
Germany
Facility Name
Universitätsklinikum Ulm / Klinik Innere Medizin III
City
Ulm
Country
Germany
Facility Name
Onkologische Gemeinschaftspraxis
City
Weilheim
Country
Germany
Facility Name
Rems-Murr-Kliniken Winnenden / Hämatologie, Onkologie
City
Winnenden
Country
Germany

12. IPD Sharing Statement

Learn more about this trial

Validation of a Predictive Model of Response to Romiplostim in Patients With IPSS Low or Intermediate-1 Risk MDS and Thrombocytopenia

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