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Defibrotide for the Treatment of Severe Hepatic Veno-Occlusive Disease in Hematopoetic Stem Cell Transplant Patients

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT00358501
Recruitment Status : Completed
First Posted : August 1, 2006
Results First Posted : January 30, 2017
Last Update Posted : January 30, 2017
Sponsor:
Collaborator:
FDA Office of Orphan Products Development
Information provided by (Responsible Party):
Jazz Pharmaceuticals

Brief Summary:
The purpose of this study is to (1) demonstrate the efficacy and safety (toxicity) of 25 mg/kg/day of Defibrotide in patients with severe veno-occlusive disease (sVOD) and (2) evaluate serum and endothelial markers of veno-occlusive disease (VOD) through the analysis of blood samples.

Condition or disease Intervention/treatment Phase
Severe Hepatic Veno-Occlusive Disease Drug: Defibrotide Phase 3

Detailed Description:

This is a historically-controlled, multicenter, open label Phase 3 study to determine the safety and efficacy of 25 mg/kg/day of Defibrotide (DF) for the treatment of severe VOD in hematopoietic stem cell transplantation (HSCT) patients.

In this study, the term "severe VOD" is defined as those patients who meet the Baltimore diagnostic criteria for VOD (total bilirubin >/= 2.0 mg/dL plus two of the following: ascites, >/=5% weight gain and hepatomegaly), who also have multi-organ failure (i.e., pulmonary and/or renal dysfunction). This represents a group of patients in whom mortality at Day+100 has been estimated to be >80%.

Comparisons: The primary parameter is Complete Response at 100 days following stem cell transplant, utilizing historical controls as a comparator. The historical control database will be generated through a retrospective medical chart review performed at participating centers; the survival outcome of patients who would otherwise have met eligibility criteria for this trial will be compared to the survival observed in patients prospectively treated with Defibrotide. Secondary parameters include survival rate at 100 days and 6 months post stem cell transplantation (SCT), and special studies of endothelial and serum markers for VOD. This study will assess safety of the dose and schedule in this setting.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 134 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Defibrotide for the Treatment of Severe Hepatic Veno-Occlusive Disease in Hematopoetic Stem Cell Transplant Patients: A Historically-Controlled, Multi-Center Phase 3 Study to Determine Safety & Efficacy
Study Start Date : July 2006
Actual Primary Completion Date : September 2008
Actual Study Completion Date : March 2015

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Defibrotide
Defibrotide treatment
Drug: Defibrotide
Defibrotide 6.25 mg/kg i.v. administered four times a day via 2 hour continuous infusion. Minimum duration 21 days.

No Intervention: Historical Control
Historical control group



Primary Outcome Measures :
  1. Survival at Day+100 Following Hematopoietic Stem Cell Transplant [ Time Frame: Day+100 post hematopoietic stem cell transplant ]
    The 95.1% CI instead of 95% CI is used for the final analysis to provide a small adjustment for the fact that an interim analysis was performed.

  2. Complete Response by Day+100 Post Hematopoietic Stem Cell Transplant [ Time Frame: Day+100 post hematopoietic stem cell transplant ]
    The 95.1% CI instead of 95% CI is used for the final analysis to provide a small adjustment for the fact that an interim analysis was performed.


Secondary Outcome Measures :
  1. Survival at Day+180 Post Hematopoietic Stem Cell Transplantation [ Time Frame: 180 days post hematopoietic stem cell transplant ]
    The 95.1% CI instead of 95% CI is used for the final analysis to provide a small adjustment for the fact that an interim analysis was performed.

  2. Percentage of Participants With Treatment-Emergent Adverse Events [ Time Frame: Through 30 days from the last dose of Defibrotide ]

Other Outcome Measures:
  1. Historical Control Group Adverse Event Information [ Time Frame: Through 30 days from the last dose of Defibrotide ]
    Historical Control group was not assessed for severity



Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Clinical diagnosis of VOD, defined by jaundice (bilirubin >/= 2 mg/dL) and at least 2 of the following clinical findings, by Day+21 post stem cell transplant: ascites; weight gain >/= 5% above baseline weight; hepatomegaly.
  • Severe VOD, defined as VOD with multi-organ failure, i.e., presence of one or both of the following, by Day+28 post stem cell transplant: renal or pulmonary dysfunction.
  • Provide voluntary written informed consent.

Exclusion Criteria:

  • Pre-existing (prior to SCT) cirrhosis
  • An alternative diagnosis for weight gain, ascites and jaundice
  • Graft-versus-host disease (GVHD) grade B or higher involving liver or gut or grade C or higher involving skin
  • Prior solid organ transplant
  • Dependent on dialysis prior to and/or at the time of SCT
  • Dependent on oxygen supplementation prior to SCT
  • Significant acute bleeding or hemodynamic instability
  • Requirement for the use of any medications that increase risk of hemorrhage will be excluded from the treatment group

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00358501


Locations
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United States, California
Duarte, California, United States
Palo Alto, California, United States
United States, Colorado
Denver, Colorado, United States
United States, Georgia
Atlanta, Georgia, United States
United States, Illinois
Chicago, Illinois, United States
Maywood, Illinois, United States
United States, Indiana
Indianapolis, Indiana, United States
United States, Maryland
Baltimore, Maryland, United States
United States, Massachusetts
Boston, Massachusetts, United States
United States, Michigan
Ann Arbor, Michigan, United States
United States, Minnesota
Minneapolis, Minnesota, United States
Rochester, Minnesota, United States
United States, Missouri
St. Louis, Missouri, United States
United States, Nebraska
Omaha, Nebraska, United States
United States, New Jersey
Hackensack, New Jersey, United States
United States, New York
New York, New York, United States
United States, North Carolina
Durham, North Carolina, United States
United States, Ohio
Columbus, Ohio, United States
United States, Oregon
Portland, Oregon, United States
United States, Pennsylvania
Philadelphia, Pennsylvania, United States
United States, Texas
Houston, Texas, United States
United States, Washington
Seattle, Washington, United States
Canada, British Columbia
Vancouver, British Columbia, Canada
Canada, Ontario
Toronto, Ontario, Canada
Canada, Quebec
Montreal, Quebec, Canada
Sponsors and Collaborators
Jazz Pharmaceuticals
FDA Office of Orphan Products Development
Investigators
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Principal Investigator: Paul Richardson, M.D. Dana-Farber Cancer Institute
Additional Information:
Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Jazz Pharmaceuticals
ClinicalTrials.gov Identifier: NCT00358501    
Obsolete Identifiers: NCT00410917
Other Study ID Numbers: 2005-01
First Posted: August 1, 2006    Key Record Dates
Results First Posted: January 30, 2017
Last Update Posted: January 30, 2017
Last Verified: December 2016
Keywords provided by Jazz Pharmaceuticals:
Defibrotide
Severe veno occlusive disease
Multi organ failure
Stem cell transplant
Liver
Regimen related toxicity
Day 100 survival
Additional relevant MeSH terms:
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Hepatic Veno-Occlusive Disease
Liver Diseases
Digestive System Diseases
Vascular Diseases
Cardiovascular Diseases
Defibrotide
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action
Platelet Aggregation Inhibitors