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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/ct2/show/NCT00071799
Registration number
NCT00071799
Ethics application status
Date submitted
31/10/2003
Date registered
5/11/2003
Date last updated
29/10/2019
Titles & IDs
Public title
A Survival Study in Patients With High Risk Myelodysplastic Syndromes Comparing Azacitidine Versus Conventional Care
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Scientific title
A Multicenter, Randomized, Open-label, Parallel-group, Phase 3 Trial of Subcutaneous Azacitidine Plus Best Supportive Care Versus Conventional Care Regimens Plus Best Supportive Care for the Treatment of Myelodysplastic Syndromes (MDS)
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Secondary ID [1]
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AZA PH GL 2003 CL001
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Myelodysplastic Syndromes
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Condition category
Condition code
Blood
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0
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Haematological diseases
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Blood
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Other blood disorders
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Other
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Research that is not of generic health relevance and not applicable to specific health categories listed above
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Azacitidine
Other interventions - Physician Choice
Experimental: Azacitidine - Study Drug plus best supportive care. Treatment with erythropoietin was not permitted
Active Comparator: Conventional Care - Physician choice of low dose cytarabine (plus best supportive care), standard chemotherapy (plus best supportive care) or best supportive care (only). Treatment with erythropoietin was not permitted
Treatment: Drugs: Azacitidine
Azacitidine was injected subcutaneously (SC) at an initial dose of 75mg/m^2/day for 7 days. The 7-day dosing was repeated every 28 days with dose adjustment based on predefined hematology and renal laboratory results. Number of cycles: Azacitidine treatment was to be continued until the end of the study unless treatment was discontinued due to unacceptable toxicity, relapse after complete or partial response, transformation to AML or disease progression.
Other interventions: Physician Choice
Physician Choice was one of three options:
Best supportive care (BSC) alone,
Low-dose cytarabine subcutaneously for 14 days every 28 to 42 days, or
Standard chemotherapy administered for induction as a continuous intravenous infusion of cytarabine over 7 days plus an anthracycline (daunorubicin, idarubicin, or mitoxantrone) on Days 1, 2, and 3; and, for those eligible, 1 or 2 consolidation cycles administered as continuous intravenous infusions of cytarabine for 3 to 7 days with the same anthracycline that was used at induction on Days 1 and 2 (each cycle between 28 to 70 days from the start of the previous cycle).
All three options included best supportive care
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Intervention code [1]
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Treatment: Drugs
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Intervention code [2]
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Other interventions
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Kaplan-Meier Estimates for Median Time to Death From Any Cause
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Assessment method [1]
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Kaplan-Meier estimates for the median months until death from any cause within the intent-to-treat population. Patients surviving at the end of the follow-up period were censored at the date of last contact. If a patient withdrew consent to follow-up or was lost to follow-up, the patient was censored as of the last date of contact.
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Timepoint [1]
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Day 1 (randomization) to 42 months
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Primary outcome [2]
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Summary of Subgroup Analyses for Kaplan-Meier Estimates for Time to Death From Any Cause
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Assessment method [2]
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Kaplan-Meier estimates for the median months until death from any cause within the intent-to-treat population. Patients surviving at the end of the follow-up period were censored at the date of last contact. If a patient withdrew consent to follow-up or was lost to follow-up, the patient was censored as of the last date of contact.
Subgroups that were analyzed are age, gender, French-American-British (FAB) classification, World Health Organization (WHO) classification and International Prognostic Scoring System (IPSS) classification.
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Timepoint [2]
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Day 1 (randomization) to 42 months
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Primary outcome [3]
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Number of Participants Who Died
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Assessment method [3]
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Count of participants who died during the study
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Timepoint [3]
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42 months
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Secondary outcome [1]
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Kaplan-Meier Estimate for Median Time to Transformation to Acute Myeloid Leukemia (AML) or Death From Any Cause, Whichever Occurred First
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Assessment method [1]
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The time to transformation to AML or death from any cause (whichever occurred first) was defined as the number of days from the date of randomization until the date of documented AML transformation or death from any cause. Patients who did not transform to AML or die were censored at the date of last follow-up.
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Timepoint [1]
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Day 1 (randomization) to 42 months
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Secondary outcome [2]
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Kaplan-Meier Estimates for Median Time to Transformation to Acute Myeloid Leukemia (AML)
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Assessment method [2]
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The time to transformation to AML was defined as the number of days from the date of randomization until the date of documented AML transformation, defined as a bone marrow blast count = 30% independent of baseline bone marrow count. Patients who did not transform to AML were censored at the date of last follow-up or date of death.
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Timepoint [2]
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Day 1 (randomization) to 42 months
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Secondary outcome [3]
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Summary of Participants' Red Blood Cell (RBC) Transfusion Status for Participants Who Were Transfusion Dependent at Baseline
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Assessment method [3]
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Summary of dependence and independence from red blood cell (RBC) transfusion at baseline and during treatment, for patients who were dependent at baseline. A patient was considered transfusion independent at baseline if the patient had no transfusions during the 56 days prior to randomization. During study, a patient was considered transfusion independent during the on-treatment period if the patient had no transfusions during any 56 consecutive days or more. Otherwise, the patient was considered transfusion dependent.
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Timepoint [3]
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Day 1 (randomization) to 42 months
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Secondary outcome [4]
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Summary of Participants' Red Blood Cell (RBC) Transfusion Status for Participants Who Were Transfusion Independent at Baseline
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Assessment method [4]
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Summary of dependence and independence from red blood cell (RBC) transfusion at baseline and during treatment, for patients who were independent at baseline. A patient was considered transfusion independent at baseline if the patient had no transfusions during the 56 days prior to randomization. During study, a patient was considered transfusion independent during the on-treatment period if the patient had no transfusions during any 56 consecutive days or more. Otherwise, the patient was considered transfusion dependent.
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Timepoint [4]
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Day 1 (randomization) to 42 months
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Secondary outcome [5]
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Summary of Participants' Platelet Transfusion Status for Participants Who Were Transfusion Dependent at Baseline
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Assessment method [5]
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Summary of dependence and independence from platelet transfusion at baseline and during treatment for patients who were dependent at baseline. A patient was considered transfusion independent at baseline if the patient had no transfusions during the 56 days prior to randomization. During study, a patient was considered transfusion independent during the on-treatment period if the patient had no transfusions during any 56 consecutive days or more. Otherwise, the patient was considered transfusion dependent.
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Timepoint [5]
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Day 1 (randomization) to 42 months
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Secondary outcome [6]
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Summary of Participants' Platelet Transfusion Status for Participants Who Were Transfusion Independent at Baseline
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Assessment method [6]
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Summary of dependence and independence from platelet transfusion at baseline and during treatment for patients who were independent at baseline. A patient was considered transfusion independent at baseline if the patient had no transfusions during the 56 days prior to randomization. During study, a patient was considered transfusion independent during the on-treatment period if the patient had no transfusions during any 56 consecutive days or more. Otherwise, the patient was considered transfusion dependent.
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Timepoint [6]
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Day 1 (randomization) to 42 months
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Secondary outcome [7]
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Number of Participants Considered Hematologic Responders by Investigator Determinations Using International Working Group (IWG 2000) Criteria for Myelodysplastic Syndrome (MDS)
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Assessment method [7]
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Investigator determined responses followed IWG criteria for
complete remission(CR): repeat bone marrow show <5% myeloblasts, and peripheral blood evaluations lasting >=2 months of hemoglobin(>110 g/L), neutrophils(>=1.5x10^9/L), platelets(>=100x10^9/L), blasts (0%) and no dysplasia
partial remission(PR) is the same as CR for peripheral blood: bone marrow shows blasts decrease by >=50% or a less advanced FAB classification from pretreatment
stable disease(SD) is a failure to achieve at least a partial remission, but with no evidence of progression for at least 2 months.
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Timepoint [7]
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Day 1 to 42 months
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Secondary outcome [8]
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Number of Participants Showing Hematologic Improvement Using International Working Group (IWG 2000) Criteria for Myelodysplastic Syndrome (MDS) Assessed by Independent Review Committee
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Assessment method [8]
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IWG 2000 Criteria: Pretreatment=hemoglobin <100g/L or RBC transfusion-dependent, platelet count <100x10^9/L or platelet transfusion dependent, absolute neutrophil count <1.5x10^9/L.
Erythroid response: Major->20g/L increase or transfusion independent. Minor- 10-20g/L increase or >=50% decrease in transfusion requirements.
Platelet response: Major-absolute increase of >=30x10^9/L or platelet transfusion independence. Minor->=50% increase.
Neutrophil response: Major->=100% increase or an absolute increase of >0.5x10^9/L. Minor->=100% increase and absolute increase of <0.5x10^9/L.
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Timepoint [8]
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Day 1 to 42 months
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Secondary outcome [9]
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Time to Disease Progression, Relapse After Complete or Partial Remission, or Death From Any Cause
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Assessment method [9]
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The time to disease progression, relapse after complete or partial remission (CR, PR), or death from any cause was defined as the time from the date of randomization until the first date of documented disease progression, relapse after CR or PR, or death from any cause.
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Timepoint [9]
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Day 1 (randomization) to 42 months
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Secondary outcome [10]
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Duration of Any Hematologic Improvement
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Assessment method [10]
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The duration of improvement was defined as the time from the date of hematologic improvement until the date of first documented progression or relapse after hematologic improvement or death from any cause.
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Timepoint [10]
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Day 1 (randomization) to 42 months
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Secondary outcome [11]
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Number of Infections Per Treatment Year Requiring Intravenous Antibiotics, Antifungals or Antivirals
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Assessment method [11]
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The on-treatment adverse event rate of infection requiring IV antibiotics, antifungals, or antivirals per patient-years. The on-treatment period was considered the period from the date of randomization to the last treatment study visit.
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Timepoint [11]
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Day 1 (randomization) to 42 months
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Secondary outcome [12]
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Number of Participants in Different Categories of Adverse Experiences During Core Study Period
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Assessment method [12]
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Patient counts for a variety of subsets of adverse experiences for the core study period (day 1 to 42 months). The individual options for Conventional Care Regimens (Best Supportive Care Only, Low-Dose Cytarabine, and Standard Chemotherapy) are presented as separate treatments.
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Timepoint [12]
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Day 1 (randomization) to 42 months
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Eligibility
Key inclusion criteria
- Have a diagnosis of refractory anemia with excess blasts or refractory anemia with
excess blasts in transformation according to the French-American-British
classification system for myelodysplastic syndromes (MDS) and a relatively high risk
of acute myeloid leukemia (AML) transformation, with an International Prognostic
Scoring System score of INT-2 or High.
- Be 18 years of age or older
- Have a life expectancy of at least 3 months
- Be unlikely to proceed to bone marrow or stem cell transplantation therapy following
remission
- Have serum bilirubin levels less than or equal to 1.5 times the upper limit of normal
range for the laboratory
- Have serum glutamic-oxaloacetic transaminase (aspartate aminotransferase) or serum
glutamic-pyruvic transaminase (alanine aminotransferase) levels less than or equal to
2 times the upper limit of normal (unless these are considered to be related to
transfusion-induced secondary hemosiderosis)
- Have serum creatinine levels less than or equal to 1.5 times the upper limit of normal
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
- Secondary myelodysplastic syndromes (MDS)
- Prior treatment with azacitidine;
- Prior history of acute myeloid leukemia (AML);
- Malignant disease diagnosed within prior 12 months;
- Metastatic disease;
- Hepatic tumors;
- Radiation, chemotherapy, cytotoxic therapy for non-MDS conditions within prior 12
months;
- Prior transplantation or cytotoxic therapy to treat MDS;
- Serious medical illness likely to limit survival to 12 months or less;
- Treatment with erythropoietin or myeloid growth factors during prior 21 days or
androgenic hormones during prior 13 days;
- Active HIV, viral hepatitis type B or C;
- Treatment with investigational drugs during prior 30 days;
- Within the 28-day screening period, documented red cell folate deficiency, as
evidenced by red blood cell folate (not serum folate) or vitamin B12 deficiency
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Study design
Purpose of the study
Other
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
1/11/2003
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
1/07/2007
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Sample size
Target
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Accrual to date
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Final
358
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,SA,VIC,WA
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Recruitment hospital [1]
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Liverpool Hospital - Liverpool
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Recruitment hospital [2]
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Royal North Shore Hospital - St. Leonards
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Recruitment hospital [3]
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The Newcastle Mater Miseriecordiae Hospital - Warratah
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Recruitment hospital [4]
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Royal Brisbane Hospital - Hersten
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Recruitment hospital [5]
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Princess Alexandra Hospital - Woolloongabba
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Recruitment hospital [6]
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Royal Adelaide Hospital - Adelaide
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Recruitment hospital [7]
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Peter MacCallum Cancer Institute - East Melbourne
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Recruitment hospital [8]
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Royal Melbourne Hospital - Melbourne
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Recruitment hospital [9]
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The Alfred Hospital - Melbourne
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Recruitment hospital [10]
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The Royal Perth Hospital - Perth
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Recruitment postcode(s) [1]
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2170 - Liverpool
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Recruitment postcode(s) [2]
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2065 - St. Leonards
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Recruitment postcode(s) [3]
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2298 - Warratah
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Recruitment postcode(s) [4]
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4029 - Hersten
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Recruitment postcode(s) [5]
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4102 - Woolloongabba
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Recruitment postcode(s) [6]
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5000 - Adelaide
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Recruitment postcode(s) [7]
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3002 - East Melbourne
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Recruitment postcode(s) [8]
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3050 - Melbourne
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Recruitment postcode(s) [9]
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3181 - Melbourne
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Recruitment postcode(s) [10]
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6847 - Perth
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Recruitment outside Australia
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United States of America
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State/province [1]
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Alabama
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United States of America
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Indiana
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Missouri
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New York
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Ohio
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Oregon
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United States of America
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Pennsylvania
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Wisconsin
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Bulgaria
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Pleven
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Bulgaria
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Plovdiv
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Bulgaria
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Sofia
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Bulgaria
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Varna
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Czechia
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Brno
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Czechia
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Hradec Kralove
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Olomouc
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Praha
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France
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Angers
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France
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Clichy
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France
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Lille
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Lyon
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Berlin
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Germany
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Bonn
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Chemnitz
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Ulm
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Italy
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Russian Federation
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Leon
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Spain
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Madrid
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Spain
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Palma de Mallorca
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Spain
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Salamanca
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Spain
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Valencia
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Sweden
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Goteborg
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Sweden
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Lund
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Sweden
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Malmo
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Sweden
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Stockholm
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Uppsala
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Bournemouth
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United Kingdom
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London
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United Kingdom
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Manchester
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Norwich
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United Kingdom
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Oxford
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United Kingdom
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Truro
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Funding & Sponsors
Primary sponsor type
Commercial sector/Industry
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Name
Celgene
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Summary
Brief summary
The purpose of this study is to determine whether patients with high-risk myelodysplastic
syndromes (MDS) treated with azacitidine have improved survival compared to conventional care
treatments. The study will also assess the effect of treatments on response, duration of
response, and transformation to acute myeloid leukemia (AML). The study will continue for 12
months following last patient enrolled.
See study AZA PH GL 2003 CL 001 E for information about the extension to this study.
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Trial website
https://clinicaltrials.gov/ct2/show/NCT00071799
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Public notes
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Contacts
Principal investigator
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CL Beach
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Celgene Corporation
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Contact person for scientific queries
Summary Results
For IPD and results data, please see
https://clinicaltrials.gov/ct2/show/NCT00071799
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