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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT02393859
Registration number
NCT02393859
Ethics application status
Date submitted
16/03/2015
Date registered
20/03/2015
Titles & IDs
Public title
Phase 3 Trial of Blinatumomab vs Standard Chemotherapy in Pediatric Subjects With HIgh-Risk (HR) First Relapse B-precursor Acute Lymphoblastic Leukemia (ALL)
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Scientific title
Phase 3 Trial to Investigate the Efficacy, Safety, and Tolerability of Blinatumomab as Consolidation Therapy Versus Conventional Consolidation Chemotherapy in Pediatric Subjects With HR First Relapse B-precursor ALL
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Secondary ID [1]
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2014-002476-92
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Secondary ID [2]
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20120215
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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:
Leukemia, Acute Lymphoblastic
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Condition category
Condition code
Cancer
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0
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0
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Leukaemia - Acute leukaemia
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Cancer
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0
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0
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Leukaemia - Chronic leukaemia
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Cancer
0
0
0
0
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Children's - Leukaemia & Lymphoma
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Cancer
0
0
0
0
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Lymphoma (non Hodgkin's lymphoma) - High grade lymphoma
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Cancer
0
0
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0
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Lymphoma (non Hodgkin's lymphoma) - Low grade lymphoma
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Other
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0
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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 - Blinatumomab
Treatment: Drugs - Dexamethasone
Treatment: Drugs - Vincrisitne
Treatment: Drugs - Daunorubicin
Treatment: Drugs - Methotrexate
Treatment: Drugs - Ifosfamide
Treatment: Drugs - PEG-asparaginase
Treatment: Drugs - Erwinia-asparaginase
Active comparator: High Risk Consolidation 3 (HC3) Chemotherapy - One week of treatment with HC3 followed by 3 weeks of no treatment. The standard intensive consolidation chemotherapy course HC3 includes dexamethasone (10 mg/m\^2/day intravenous \[IV\] on Days 1-6), vincrisitne (1.5 mg/m\^2/day IV on Days 1 and 6), daunorubicin (30 mg/m\^2 IV over 24 hours on Day 5), methotrexate (1 g/m\^2 IV over 36 hours on Day 1), ifosfamide (800 mg/m\^2 IV for 1 hour on Days 2-4), and pegylated \[PEG\]-asparaginase (1000 U/m\^2 IV for 2 hours or intramuscularly \[IM\] on Day 6) or, if allergic, erwinia-asparaginase (20,000 units/m\^2 IV or IM every 48 hours for a total of 6 doses).
Experimental: Blinatumomab - 15 µg/m\^2/day as a continuous intravenous infusion (CIVI) for 4 weeks
Treatment: Drugs: Blinatumomab
15 µg/m\^2/day as a continuous intravenous infusion (CIVI) for 4 weeks
Treatment: Drugs: Dexamethasone
10 mg/m\^2/day intravenous (IV) on Days 1-6
Treatment: Drugs: Vincrisitne
1.5 mg/m\^2/day IV on Days 1 and 6
Treatment: Drugs: Daunorubicin
30 mg/m\^2 IV over 24 hours on Day 5
Treatment: Drugs: Methotrexate
1 g/m\^2 IV over 36 hours on Day 1
Treatment: Drugs: Ifosfamide
800 mg/m\^2 IV for 1 hour on Days 2-4
Treatment: Drugs: PEG-asparaginase
1000 U/m\^2 IV for 2 hours or intramuscularly (IM) on Day 6
Treatment: Drugs: Erwinia-asparaginase
In case of allergic reaction to PEG-asparaginase, participants could change to erwinia-asparaginase, 20,000 units/m2 every 48 hours for a total of 6 doses
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Intervention code [1]
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Treatment: Drugs
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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 Estimate: Event-Free Survival (EFS; Primary Analysis)
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Assessment method [1]
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EFS is calculated from the time of randomization until the date of relapse or M2 marrow (representative bone marrow aspirate or biopsy with = 5% and \< 25% blasts) after having achieved a complete remission (CR), failure to achieve a CR at the end of treatment, second malignancy, or death due to any cause, whichever occurs first. Participants who failed to achieve a CR following treatment with investigational product (IP) or who died before the disease assessment at the end of treatment were considered treatment failures and assigned an EFS duration of 1 day. Participants still alive and event-free were censored on their last disease assessment date.
Participants were said to be in CR when they had the following:
* M1 marrow
* Peripheral blood without blasts
* Absence of extramedullary leukemic involvement
Months are calculated as days from randomization date to event/censor date, divided by 30.5.
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Timepoint [1]
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As of the primary analysis data cutoff date (17 July 2019), overall median follow-up time for EFS was 22.4 months.
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Primary outcome [2]
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Kaplan Meier Estimate: EFS (Final Analysis)
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Assessment method [2]
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EFS is calculated from the time of randomization until the date of relapse or M2 marrow after having achieved a CR, failure to achieve a CR at the end of treatment, second malignancy, or death due to any cause, whichever occurs first. Participants who failed to achieve a CR following treatment with IP or who died before the disease assessment at the end of treatment were considered treatment failures and assigned an EFS duration of 1 day. Participants still alive and event-free were censored on their last disease assessment date.
Participants were said to be in CR when they had the following:
* M1 marrow
* Peripheral blood without blasts
* Absence of extramedullary leukemic involvement
Months are calculated as days from randomization date to event/censor date, divided by 30.5.
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Timepoint [2]
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At final analysis, overall median follow-up time for EFS was 51.9 months.
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Secondary outcome [1]
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Kaplan Meier Estimate: Overall Survival (OS)
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Assessment method [1]
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OS was calculated from time of randomization until death due to any cause. Participants still alive were censored at the date they were last known to be alive.
Months were calculated as days from randomization date to event/censor date, divided by 30.5.
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Timepoint [1]
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At final analysis, overall median follow-up time for OS was 55.2 months.
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Secondary outcome [2]
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Percentage of Participants With an MRD Response Within 29 Days of Treatment Initiation
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Assessment method [2]
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At the end of the first treatment cycle (Day 29) a bone marrow aspiration/biopsy was performed and evaluated by the central MRD laboratory.
MRD response was defined as MRD level \< 10\^-4, by polymerase chain reaction (PCR) or flow cytometry, at the end of treatment (Cycle 1 Day 29) with study drug. Participants who were part of the MRD Evaluable Set and were missing the end of treatment (Cycle 1 Day 29) assessment for a respective MRD assessment method were considered not to have achieved a response.
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Timepoint [2]
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Up to End of Treatment (Cycle 1, Day 29)
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Secondary outcome [3]
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Cumulative Incidence of Relapse (CIR)
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Assessment method [3]
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CIR estimate, presented as median months to relapse, calculated from date of achievement of first CR, using the cumulative incidence method (Fine JP, Gray RJ:1999). Deaths prior to relapse not considered related to an otherwise undocumented relapse were treated as a competing risk. Participants still alive without a date of relapse were censored at the time of last follow-up.
Relapse=presence of =1 of the following:
* isolated bone marrow relapse (M3 marrow \[representative bone marrow aspirate or biopsy with =25% blasts\] in the absence of extramedullary involvement)
* combined bone marrow relapse (M2 \[representative bone marrow aspirate or biopsy with =5% and \<25% blasts\] or M3 marrow and =1 extramedullary manifestation of acute lymphoblastic leukemia)
* central nervous system extramedullary relapse
* testicular extramedullary relapse
* extramedullary relapse at other sites
Months were calculated as days from randomization to event/censor date, divided by 30.5.
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Timepoint [3]
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At final analysis, the overall maximum follow-up time was 82.0 months.
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Secondary outcome [4]
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Number of Participants With Treatment-Emergent Adverse Events (TEAEs) and Treatment-Related Adverse Events (TRAEs)
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Assessment method [4]
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Adverse event (AE): any untoward medical occurrence. Serious AE: an AE meeting at least 1 of the following serious criteria: fatal; life-threatening; requires in-patient hospitalization or prolongation of existing hospitalization; results in persistent or significant disability/incapacity; congenital anomaly/birth defect; other medically important serious event. Severity was graded according to the Common Terminology Criteria for AEs (CTCAE) version 4.03: 1=mild, 2=moderate, 3=severe, 4=life-threatening, 5=death. Investigational product (IP) in the HC3 arm refers to dexamethasone, methotrexate, daunorubicin, erwinase, ifosfamide, asparaginase, and vincristine, and in the blinatumomab arm refers to blinatumomab. Treatment-related refers to the assessment of a relationship between IP and the event.
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Timepoint [4]
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From first dose of IP through the last dose of IP (up to Day 29) plus 30 days.
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Secondary outcome [5]
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Number of Participants With TEAEs of Interest
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Assessment method [5]
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TEAEs of interest included capillary leak syndrome (CLS), cytokine release syndrome (CRS), decreased immunoglobulins (DI), elevated liver enzymes (ELE), embolic and thrombotic events (ETE), infections (INF), infusion reactions without considering duration (IRWCD), medication errors (ME), neurologic events (NE), neutropenia and febrile neutropenia (NFN), pancreatitis (PNC), tumor lysis syndrome, leukoencephalopathy, immunogenicity. Severity was graded according to the CTCAE version 4.03: 1=mild, 2=moderate, 3=severe, 4=life-threatening, 5=death.
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Timepoint [5]
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From first dose of IP through the last dose of IP (up to Day 29) plus 30 days.
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Secondary outcome [6]
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Number of Participants With Shifts From Baseline Grade 0 or 1 to Worst Postbaseline Grade 3 or 4 Clinical Chemistry and Hematology Values
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Assessment method [6]
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Severity was graded according to the CTCAE version 4.03: 1=mild, 2=moderate, 3=severe, 4=life-threatening, 5=death. Increases (?) or decreases (?) in laboratory value grades (Gr) from baseline (BL) to worst postbaseline (? PB) grade are presented. NA=not available.
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Timepoint [6]
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Up to Day 29 (± 2 days).
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Secondary outcome [7]
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Kaplan-Meier Estimate of 100-Day Mortality After Allogeneic Hematopoietic Stem Cell Transplantation (alloHSCT)
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Assessment method [7]
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The analysis of 100-day mortality after alloHSCT was assessed for participants who received an alloHSCT while in remission and did not receive any additional anti-leukemic treatment. 100-day mortality after alloHSCT was calculated relative to the date of alloHSCT.
The 100-day mortality rate after alloHSCT was defined as the percentage of participants having died up to 100 days after alloHSCT, estimated using the estimated time to death in percent calculated by Kaplan-Meier methods. Participants still alive were censored at the date they were last known to be alive.
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Timepoint [7]
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From the date of alloHSCT until death/censor date; median follow up time was 1742.0 days for blinatumomab and 1619.0 days for HC3.
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Secondary outcome [8]
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Number of Participants With Anti-Blinatumomab Antibodies Postbaseline (Blinatumomab Arm Only)
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Assessment method [8]
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Participants receiving blinatumomab had blood samples analyzed for binding antibodies. Samples testing positive for binding antibodies were also tested for neutralizing antibodies.
Participants who were binding antibody-positive or neutralizing antibody-positive post-baseline with a negative or no result at baseline are presented.
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Timepoint [8]
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Day 1 to Day 29.
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Secondary outcome [9]
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Pharmacokinetics: Concentration at Steady State (Css) (Blinatumomab Arm Only)
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Assessment method [9]
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Timepoint [9]
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Day 1: at least 10 hours after infusion start and up to 24 hours; Day 15
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Secondary outcome [10]
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Pharmacokinetics: Clearance (CL) (Blinatumomab Arm Only)
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Assessment method [10]
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Timepoint [10]
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Day 1: at least 10 hours after infusion start and up to 24 hours; Day 15
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Eligibility
Key inclusion criteria
* Subjects with Philadelphia chromosome negative (Ph-) high-risk (HR) first relapse B-precursor acute lymphoblastic leukemia (ALL; as defined by International Berlin-Frankfurt-Muenster study group/International study for treatment of childhood relapsed ALL [I-BFM SG/IntReALL] criteria)
* Subjects with bone marrow blast percentage < 5% (M1) or bone marrow blast percentage < 25% and =5% (M2) marrow at the time of randomization,
* Age > 28 days and < 18 years at the time of informed consent/assent
* Subject's legally acceptable representative has provided informed consent when the subject is legally too young to provide informed consent and the subject has provided written assent based on local regulations and/or guidelines prior to any study-specific activities/procedures being initiated
* Availability of the following material from relapse diagnosis for central analysis of minimal residual disease (MRD) by polymerase chain reaction (PCR): clone-specific primers and reference deoxyribonucleic acid (DNA), as well as primer sequences and analyzed sequences of clonal rearrangements (cases with isolated extramedullary relapse or cases with technical and/or logistic hurdles to obtain and process bone marrow material are exempt from providing this material. In these cases, central MRD analysis only by Flow is permitted).
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Minimum age
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Years
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Maximum age
17
Years
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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
* Clinically relevant central nervous system (CNS) pathology requiring treatment (eg, unstable epilepsy). Evidence of current CNS (CNS 2, CNS 3) involvement by ALL. Subjects with CNS relapse at the time of relapse are eligible if CNS is successfully treated prior to enrollment
* Peripheral neutrophils < 500/µL prior to start of treatment
* Peripheral platelets < 50,000/µL prior to start of treatment
* Currently receiving treatment in another investigational device or drug study or less than 4 weeks since ending treatment on another investigational device or drug study(s), procedures required by IntReALL high-risk (HR) guidelines are allowed
* Chemotherapy related toxicities that have not resolved to = grade 2 (except for parameters defined in Exclusion Criteria 202, 203, 204, and 217)
* Symptoms and/or clinical signs and/or radiological and/or sonographic signs that indicate an acute or uncontrolled chronic infection, any other concurrent disease or medical condition that could be exacerbated by the treatment or would seriously complicate compliance with the protocol
* Abnormal renal or hepatic function prior to start of treatment (day 1) as defined below
* Abnormal serum creatinine based on age/gender
* Total bilirubin > 3.0 mg/dL prior to start of treatment (unless related to Gilbert's or Meulengracht disease)
* Documented infection with human immunodeficiency virus (HIV)
* Known hypersensitivity to immunoglobulins or any of the products or components to be administered during dosing (excluding asparaginase)
* Post-menarchal female subject who is pregnant or breastfeeding, or is planning to become pregnant or breastfeed while receiving protocol-specified therapy and for at least 12 months after the last dose of chemotherapy
* Post-menarchal female subject who is not willing to practice true sexual abstinence or use a highly effective form of contraception while receiving protocol-specified therapy and for at least 12 months after the last dose of chemotherapy
* Sexually mature male subject who is not willing to practice true sexual abstinence or use a condom with spermicide while receiving protocol-specified therapy and for at least 6 months after last dose of chemotherapy. In countries where spermicide is not available, a condom without spermicide is acceptable
* Sexually mature male subject who is not willing to abstain from sperm donation while receiving protocol-specified therapy and for at least 6 months after last dose of chemotherapy
* Subject likely to not be available to complete all protocol-required study visits or procedures, including follow-up visits, and/or to comply with all required study procedures to the best of the subject's and investigator's knowledge
* History or evidence of any other clinically significant disorder, condition or disease (with the exception of those outlined above) that, in the opinion of the investigator or Amgen physician, if consulted, would pose a risk to subject safety or interfere with the study evaluation, procedures, or completion
* Placed into an institution due to juridical or regulatory ruling.
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Study design
Purpose of the study
Treatment
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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
10/11/2015
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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
21/11/2022
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Sample size
Target
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Accrual to date
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Final
111
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,VIC
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Recruitment hospital [1]
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Research Site - Randwick
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Recruitment hospital [2]
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Research Site - Westmead
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Recruitment hospital [3]
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Research Site - South Brisbane
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Recruitment hospital [4]
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Research Site - Parkville
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Recruitment postcode(s) [1]
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2031 - Randwick
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Recruitment postcode(s) [2]
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2145 - Westmead
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Recruitment postcode(s) [3]
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4101 - South Brisbane
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Recruitment postcode(s) [4]
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3052 - Parkville
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Recruitment outside Australia
Country [1]
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Argentina
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State/province [1]
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Buenos Aires
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Austria
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Graz
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Austria
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Innsbruck
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Austria
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Wien
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Belgium
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Brussels
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Belgium
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Gent
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Belgium
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Leuven
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Belgium
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Liege
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Brazil
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Paraná
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Brazil
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Rio Grande Do Sul
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Brazil
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São Paulo
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Czechia
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Praha 5
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Denmark
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Kobenhavn O
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France
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Bordeaux Cedex
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France
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Lille
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France
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Lyon
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France
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Marseille cedex 5
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France
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Montpellier cedex 05
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France
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Nantes cedex 1
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France
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Paris
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France
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Strasbourg Cedex
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France
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Vandoeuvre les Nancy
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Germany
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Berlin
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Germany
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Duesseldorf
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Germany
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Erlangen
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Germany
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Essen
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Germany
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Frankfurt am Main
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Germany
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Freiburg
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Germany
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Giessen
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Germany
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Hamburg
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Germany
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Hannover
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Germany
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Jena
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Germany
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Kiel
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Germany
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München
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Germany
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Münster
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Germany
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Tübingen
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Ulm
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Germany
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Würzburg
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Greece
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Goudi
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Israel
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Haifa
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Israel
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Jerusalem
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Israel
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Petah Tikva
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Israel
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Tel Aviv
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Israel
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Tel Hashomer
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Italy
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Bologna
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Italy
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Genova
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Italy
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Italy
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Napoli
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Italy
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Padova
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Italy
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Pavia
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Italy
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Roma
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Italy
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Torino
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Mexico
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Distrito Federal
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Mexico
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Jalisco
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Mexico
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Nuevo León
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Netherlands
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Rotterdam
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Netherlands
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Utrecht
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Norway
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Oslo
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Poland
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Bydgoszcz
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Poland
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Krakow
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Poland
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Sutton
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Funding & Sponsors
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Name
Amgen
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Summary
Brief summary
B-precursor ALL is an aggressive malignant disease. Therapy is usually stratified according to risk characteristics to ensure that appropriate treatment is administered to patients with high-risk of relapse. In general, pediatric treatment regimens are more intense than those employed in adults and include courses of combination chemotherapy. Standard of care chemotherapy is associated with considerable toxicity. There is a lack of novel treatment options for subjects who relapse or are refractory to treatment. Therefore, innovative therapeutic approaches are urgently needed. Blinatumomab is a bispecific single-chain antibody construct designed to link B cells and T cells resulting in T cell activation and a cytotoxic T cell response against CD19 expressing cells. This study will evaluate the event-free survival (EFS) after treatment with blinatumomab when compared to standard of care (SOC) chemotherapy. The effect of blinatumomab on overall survival and reduction of minimal residual disease compared to SOC chemotherapy will also be investigated.
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Trial website
https://clinicaltrials.gov/study/NCT02393859
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Trial related presentations / publications
Locatelli F, Eckert C, Hrusak O, Buldini B, Sartor M, Zugmaier G, Zeng Y, Pilankar D, Morris J, von Stackelberg A. Blinatumomab overcomes poor prognostic impact of measurable residual disease in pediatric high-risk first relapse B-cell precursor acute lymphoblastic leukemia. Pediatr Blood Cancer. 2022 Aug;69(8):e29715. doi: 10.1002/pbc.29715. Epub 2022 Apr 28. Blinatumomabe em pacientes pediátricos com leucemia linfoblástica aguda B em primeira recidiva de alto risco: um estudo de custo-efetividade. van Beurden-Tan CHY, Ribeiro RA, Seber A, de Martino Lee ML, Marçola M, Schuetz R, Loggetto SR, Maiolino A. Jornal Brasileiro de Economia da Saúde 14(1): 41-50. 10.21115/JBES.v14.n1.p41-50 Locatelli F, Zugmaier G, Rizzari C, Morris JD, Gruhn B, Klingebiel T, Parasole R, Linderkamp C, Flotho C, Petit A, Micalizzi C, Mergen N, Mohammad A, Kormany WN, Eckert C, Moricke A, Sartor M, Hrusak O, Peters C, Saha V, Vinti L, von Stackelberg A. Effect of Blinatumomab vs Chemotherapy on Event-Free Survival Among Children With High-risk First-Relapse B-Cell Acute Lymphoblastic Leukemia: A Randomized Clinical Trial. JAMA. 2021 Mar 2;325(9):843-854. doi: 10.1001/jama.2021.0987. Caillon M, Brethon B, van Beurden-Tan C, Supiot R, Le Mezo A, Chauny JV, Majer I, Petit A. Cost-Effectiveness of Blinatumomab in Pediatric Patients with High-Risk First-Relapse B-Cell Precursor Acute Lymphoblastic Leukemia in France. Pharmacoecon Open. 2023 Jul;7(4):639-653. doi: 10.1007/s41669-023-00411-4. Epub 2023 Apr 18.
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Public notes
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Contacts
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Amgen
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
De-identified individual patient data for variables necessary to address the specific research question in an approved data sharing request
Supporting document/s available: Study protocol, Statistical analysis plan (SAP), Informed consent form (ICF), Clinical study report (CSR)
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When will data be available (start and end dates)?
Data sharing requests relating to this study will be considered beginning 18 months after the study has ended and either 1) the product and indication (or other new use) have been granted marketing authorization in both the US and Europe or 2) clinical development for the product and/or indication discontinues and the data will not be submitted to regulatory authorities. There is no end date for eligibility to submit a data sharing request for this study.
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Available to whom?
Qualified researchers may submit a request containing the research objectives, the Amgen product(s) and Amgen study/studies in scope, endpoints/outcomes of interest, statistical analysis plan, data requirements, publication plan, and qualifications of the researcher(s). In general, Amgen does not grant external requests for individual patient data for the purpose of re-evaluating safety and efficacy issues already addressed in the product labelling. Requests are reviewed by a committee of internal advisors, and if not approved, may be further arbitrated by a Data Sharing Independent Review Panel. Upon approval, information necessary to address the research question will be provided under the terms of a data sharing agreement. This may include anonymized individual patient data and/or available supporting documents, containing fragments of analysis code where provided in analysis specifications. Further details are available at the link below.
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Available for what types of analyses?
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How or where can data be obtained?
IPD available at link: https://www.amgen.com/datasharing
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What supporting documents are/will be available?
No Supporting Document Provided
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Other Details
Attachment
Study protocol
https://cdn.clinicaltrials.gov/large-docs/59/NCT02393859/Prot_002.pdf
Statistical analysis plan
https://cdn.clinicaltrials.gov/large-docs/59/NCT02393859/SAP_001.pdf
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results are available at
https://clinicaltrials.gov/study/NCT02393859