Eculizumab in Treating Patients With Paroxysmal Nocturnal Hemoglobinuria
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Purpose
RATIONALE: Chemoprevention is the use of certain drugs to keep cancer from forming, growing, or coming back. The use of eculizumab may prevent leukemia and stop the destruction of red blood cells in patients with paroxysmal nocturnal hemoglobinuria.
PURPOSE: This randomized phase III trial is studying how well eculizumab works in treating patients with paroxysmal nocturnal hemoglobinuria.
| Condition | Intervention | Phase |
|---|---|---|
|
Leukemia |
Biological: eculizumab |
Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Masking: Double-Blind Primary Purpose: Prevention |
| Official Title: | TRIUMPH: A Hemoglobin Stabilization and Transfusion Reduction Efficacy and Safety Clinical Investigation, Randomized, Multi-Center, Double-Blind, Placebo-Controlled, Using Eculizumab in Paroxysmal Nocturnal Hemoglobinuria Patients |
| Study Start Date: | November 2004 |
OBJECTIVES:
Primary
- Determine the safety of eculizumab in patients with transfusion-dependent hemolytic paroxysmal nocturnal hemoglobinuria.
- Determine the efficacy of this drug, in terms of hemoglobin stabilization and the number of packed red blood cell units transfused during the 26-week treatment period, in these patients.
Secondary
- Compare the occurrence of transfusion avoidance, hemolysis (measured by lactate dehydrogenase [LDH] area under the curve), and the changes in fatigue during the 26-week treatment period in patients treated with this drug vs placebo.
- Compare LDH changes, quality of life changes, thrombosis, platelet activity, nitric oxide, and free hemoglobin measures during the 26-week treatment period in patients treated with these regimens.
OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are stratified according to the number of packed red blood cell (PRBC) units transfused 1 year prior to screening (< 15 units vs 15-25 units vs > 25 units). Patients are randomized to 1 of 2 treatment arms.
- Arm I: Within 10 days after PRBC transfusion (administered during the study observation period), patients receive placebo IV over 30 minutes once a week for 5 weeks and then once every 2 weeks for 21 weeks.
- Arm II: Within 10 days after PRBC transfusion (administered during the study observation period), patients receive eculizumab IV over 30 minutes once a week for 5 weeks and then once every 2 weeks for 21 weeks.
Quality of life is assessed at baseline; at weeks 0-4, 12, 20, and 26 during study treatment; then at weeks 1, 2, 4, and 8 after completion of study treatment.
After completion of study treatment, patients are followed at weeks 1, 2, 4, and 8.
PROJECTED ACCRUAL: Approximately 75 patients (37 per treatment arm) will be accrued for this study.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
DISEASE CHARACTERISTICS:
- Diagnosis of paroxysmal nocturnal hemoglobinuria
Must have required ≥ 4 episodes of transfusions for anemia or anemia-related symptoms within the past year
- Mean pre-transfusion hemoglobin ≤ 10. 5 g/dL over the past year
- Glycosylphosphatidylinositol (GPI)-deficient red blood cell clone (type III cells) of ≥ 10% by flow cytometry
Must have received 1 packed red blood cell transfusion during the study observation period (within 48 hours of the hemoglobin level that precipitated the transfusion) and within 1.5 g/dL of the mean pre-transfusion hemoglobin level over the past year
- Pre-transfusion hemoglobin ≤ 9 g/dL with symptoms
- Pre-transfusion hemoglobin ≤ 7 g/dL without symptoms
- Received Neisseria meningitidis vaccination at least 2 weeks before initiation of study therapy
PATIENT CHARACTERISTICS:
Age
- 18 and over
Performance status
- Not specified
Life expectancy
- Not specified
Hematopoietic
- See Disease Characteristics
- Absolute neutrophil count > 500/mm^3
- Platelet count ≥ 100,000/mm^3
Hepatic
- Lactate dehydrogenase ≥ 1.5 times upper limit of normal
Renal
- Not specified
Immunologic
- No known or suspected active bacterial infection
- No recurrent bacterial infections
- No history of meningococcal disease
Other
- No known or suspected hereditary complement deficiency
- No other condition that would increase the patient's risk or confound the outcome of the study
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY:
Biologic therapy
- See Disease Characteristics
- No prior bone marrow transplantation
- Concurrent epoetin alfa allowed*
Chemotherapy
- Not specified
Endocrine therapy
- Concurrent corticosteroids allowed**
Radiotherapy
- Not specified
Surgery
- Not specified
Other
- More than 30 days since prior participation in another investigational drug trial
- More than 30 days since prior investigational agents, devices, or procedures
- Concurrent immunosuppressants allowed*
- Concurrent warfarin allowed provided INR level is stable for the past 4 weeks and expected to remain stable during observation and study treatment
- Concurrent iron supplements or folic acid allowed**
- Concurrent low-molecular weight heparin allowed** NOTE: *Provided dose is stable for the past 26 weeks and during study observation and treatment
NOTE: **Provided dose is stable for the past 4 weeks and expected to remain stable (or decrease for corticosteroids) during study observation and treatment
Contacts and Locations| United States, California | |
| Jonsson Comprehensive Cancer Center at UCLA | |
| Los Angeles, California, United States, 90095-1678 | |
| Principal Investigator: | Ronald Paquette, MD | Jonsson Comprehensive Cancer Center |
More Information
Additional Information:
No publications provided
| ClinicalTrials.gov Identifier: | NCT00112983 History of Changes |
| Other Study ID Numbers: | CDR0000409569, UCLA-0406101-01, ALEXION-C04-001 |
| Study First Received: | June 2, 2005 |
| Last Updated: | February 6, 2009 |
| Health Authority: | United States: Federal Government |
Keywords provided by National Cancer Institute (NCI):
|
adult acute lymphoblastic leukemia adult acute myeloid leukemia |
Additional relevant MeSH terms:
|
Hemoglobinuria Leukemia Hemoglobinuria, Paroxysmal Proteinuria Urination Disorders Urologic Diseases Urological Manifestations Signs and Symptoms |
Neoplasms by Histologic Type Neoplasms Anemia, Hemolytic Anemia Hematologic Diseases Myelodysplastic Syndromes Bone Marrow Diseases |
ClinicalTrials.gov processed this record on May 19, 2013