A Phase 2 interventional study of Midostaurin and Standard of Care in Acute Myeloid Leukemia, sponsored by Novartis Pharmaceuticals. Completed at 19 sites in 2 countries. Open to participants aged 18 Years to 70 Years. Per ClinicalTrials.gov, last updated 2021-03-17.
Sponsored by Novartis Pharmaceuticals · Phase 2, Interventional, and Prevention
To determine if the addition of midostaurin (PKC412) to Standard of Care (SOC) therapy reduces relapse in FLT3-ITD mutated AML patients receiving an allogenetic hematopoietic stem cell transplant,
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Busulfan/Fludarabine (Bu/Flu) Busulfan (16 mg/kg PO or 12.8 mg/kg IV) Fludarabine (120-180 mg/m2) Fludarabine / Melphalan (Flu/Mel) Fludarabine (120-180 mg/m2) Melphalan (≤ 150 mg/m2) Busulfan/Cyclophosphamide (Bu/Cy) Busulfan (16 mg/kg PO or 12.8 mg/kg IV) Cyclophosphamide (120 mg/kg) Cyclophosphamide/Total Body Irradiation (Cy/TBI) Cyclophosphamide (120 mg/kg) TBI (1200-1420 cGy)
Exclusion Criteria:
Patients eligible for this study must not have met any of the following criteria:
Impaired cardiac function including any of the following:
Pregnant or nursing (lactating) women, or women of child-bearing potential, must have used highly effective methods of contraception during dosing and for 30 days after treatment completion
Patients received standard of care in the post stem cell transplant (SCT) setting in addition to Midostaurin 50mg twice a day for 12 months (cycles).
Drug: Midostaurin
Patients received standard of care alone in the post SCT setting
Other: Standard of Care
Midostaurin was supplied in 25mg soft gelatin capsule taken orally twice a day for 28 days of each cycle. Patients will be treated for 12 cycles.
Also known as: PKC412
Standard of Care was not defined per protocol. The investigator prescribed based on the commonly used medications given in the post SCT setting.
Proportion of Participants With Relapse Free Survival (RFS) up to 18 Months Post Transplant (Full Analysis Set) by Kaplan-Meier Analysis
Relapse-free survival assesses the clinical benefit of remaining in remission free from relapse or death due to the disease. It was defined as the time from transplant to relapse or death due to the disease. Relapse following complete response was defined as reappearance of leukemic blasts in the peripheral blood or finding more than 5% blasts in the bone marrow.
Time frame: date of transplant up to 18 months
Proportion of Participants With Relapse Free Survival (RFS) - Time From Randomization up to 18 Months (Full Analysis Set) by Kaplan-Meier Analysis
Relapse-free survival assesses the clinical benefit of remaining in remission free from relapse or death due to the disease. It was defined as the time from transplant to relapse or death due to the disease. Relapse following complete response was defined as reappearance of leukemic blasts in the peripheral blood or finding more than 5% blasts in the bone marrow.
Time frame: Randomization to 18 months
Proportion of Participants With Relapse Free Survival (RFS) - Time From Randomization up to 24 Months(Full Analysis Set) by Kaplan-Meier Analysis
DFS was defined as the time from transplant to relapse or death due to any cause. If a patient had more than 1 event (e.g., relapse then death) then the earliest date was taken into account.
Time frame: date of transplant up to 24 months
Proportion of Participants With Relapse Free Survival (RFS) - Time From Transplant (Full Analysis Set) by Kaplan-Meier Analysis
Relapse-free survival was defined as the time from transplant to relapse or death due to the disease 24 months post-transplant. If a patient had more than one event (e.g., relapse then death) then the earliest date was taken into account.
Time frame: date of transplant up to 24 months
Probability of Overall Survival - Date of Transplant up to 24 Months (Full Analysis Set) by Kaplan-Meier Analysis
Overall survival was defined as the time from transplant to death due to any cause.
Time frame: date of transplant up to 24 months
Probability of Non-relapse Mortality (NRM) - Date of Transplant up to 24 Months (Full Analysis Set) by Kaplan-Meier Analysis
Non-relapse mortality (NRM) was defined as the time from transplant to death due to reasons other than relapse/progressive disease
Time frame: date of transplant up to 24 months
FLT3-ITD Mutation Status Centrally in Archived Material From Diagnosis (if Available) Including Mutant:Wild Type Ratio.
Unable to retrieve a sufficient amount of archived samples to perform an analysis therefore the study was not able to verify the FLT3-ITD mutation status
Time frame: up to 24 months from date of transplannt or at study completion
Plasma Pharmacokinetics (PK) of Midostaurin and the Metabolites: CGP62221 and CGP52421: Pre-dose Levels
Pre-dose levels (Cmin) will be directly determined from raw plasma concentration-time data. Values below the lower limit of quantification (LLOQ) will be treated as zero in any calculations of summary statistics.
Time frame: Pre-dose on days 1 and 15 of Cycle 1, on day 1 of Cycles 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12
| Milestone | Standard of Care With Midostaurin | Standard of Care |
|---|---|---|
| Started | 30 | 30 |
| Completed | 14 | 16 |
| Not completed | 16 | 14 |
| Withdrew: Adverse event | 1 | 8 |
| Withdrew: Withdrawal by subject | 6 | 2 |
| Withdrew: Administrative problems | 4 | 1 |
| Withdrew: Relapse | 4 | 2 |
| Withdrew: Randomized, not treated | 1 | 1 |
| Milestone | Standard of Care With Midostaurin | Standard of Care |
|---|---|---|
| Started | 26 | 27 |
| Completed | 10 | 13 |
| Not completed | 16 | 14 |
| Withdrew: Protocol violation | 0 | 1 |
| Withdrew: Withdrawal by subject | 4 | 3 |
| Withdrew: Lost to follow-up | 1 | 4 |
| Withdrew: Administrative problems | 2 | 0 |
| Withdrew: Death | 8 | 4 |
| Withdrew: Relapse | 1 | 2 |
Relapse-free survival assesses the clinical benefit of remaining in remission free from relapse or death due to the disease. It was defined as the time from transplant to relapse or death due to the disease. Relapse following complete response was defined as reappearance of leukemic blasts in the peripheral blood or finding more than 5% blasts in the bone marrow.
| proportion of participants | Standard of Care With Midostaurin | Standard of Care |
|---|---|---|
| 6 months | 0.93 (0.75 to 0.98) | 0.93 (0.74 to 0.98) |
| 12 months | 0.80 (0.59 to 0.91) | 0.93 (0.74 to 0.98) |
| 18 months | 0.76 (0.54 to 0.88) | 0.89 (0.69 to 0.96) |
Relapse-free survival assesses the clinical benefit of remaining in remission free from relapse or death due to the disease. It was defined as the time from transplant to relapse or death due to the disease. Relapse following complete response was defined as reappearance of leukemic blasts in the peripheral blood or finding more than 5% blasts in the bone marrow.
| Proportion of participants | Standard of Care With Midostaurin | Standard of Care |
|---|---|---|
| 6 months | 0.93 (0.75 to 0.98) | 0.93 (0.74 to 0.98) |
| 12 months | 0.80 (0.59 to 0.91) | 0.93 (0.74 to 0.98) |
| 18 months | 0.76 (0.54 to 0.88) | 0.85 (0.64 to 0.94) |
DFS was defined as the time from transplant to relapse or death due to any cause. If a patient had more than 1 event (e.g., relapse then death) then the earliest date was taken into account.
| Proportion of participants | Standard of Care With Midostaurin | Standard of Care |
|---|---|---|
| 6 months | 0.90 (0.71 to 0.96) | 0.93 (0.74 to 0.98) |
| 12 months | 0.77 (0.56 to 0.89) | 0.89 (0.70 to 0.96) |
| 18 months | 0.69 (0.48 to 0.83) | 0.85 (0.65 to 0.94) |
| 24 months | 0.69 (0.48 to 0.83) | 0.81 (0.61 to 0.92) |
Relapse-free survival was defined as the time from transplant to relapse or death due to the disease 24 months post-transplant. If a patient had more than one event (e.g., relapse then death) then the earliest date was taken into account.
| Proportion of participants | Standard of Care With Midostaurin | Standard of Care |
|---|---|---|
| 6 months | 0.93 (0.75 to 0.98) | 0.93 (0.74 to 0.98) |
| 12 months | 0.80 (0.59 to 0.91) | 0.93 (0.74 to 0.98) |
| 18 months | 0.76 (0.54 to 0.88) | 0.89 (0.69 to 0.96) |
| 24 months | 0.76 (0.54 to 0.88) | 0.85 (0.64 to 0.94) |
Overall survival was defined as the time from transplant to death due to any cause.
| proportion of participants | Standard of Care With Midostaurin | Standard of Care |
|---|---|---|
| 6 months | 0.96 (0.71 to 0.96) | 1.00 (1.00 to 1.00) |
| 12 months | 0.89 (0.56 to 0.89) | 0.89 (0.69 to 0.96) |
| 18 months | 0.76 (0.54 to 0.89) | 0.85 (0.65 to 0.94) |
| 24 months | 0.76 (0.54 to 0.89) | 0.85 (0.65 to 0.94) |
Non-relapse mortality (NRM) was defined as the time from transplant to death due to reasons other than relapse/progressive disease
| proportion of participants | Standard of Care With Midostaurin | Standard of Care |
|---|---|---|
| 6 months | 0.96 (0.77 to 0.99) | 1.00 (1.00 to 1.00) |
| 12 months | 0.96 (0.77 to 0.99) | 0.96 (0.76 to 0.99) |
| 18 months | 0.92 (0.71 to 0.98) | 0.96 (0.76 to 0.99) |
| 24 months | 0.92 (0.71 to 0.98) | 0.96 (0.76 to 0.99) |
Unable to retrieve a sufficient amount of archived samples to perform an analysis therefore the study was not able to verify the FLT3-ITD mutation status
No measurements were reported for this outcome.
Pre-dose levels (Cmin) will be directly determined from raw plasma concentration-time data. Values below the lower limit of quantification (LLOQ) will be treated as zero in any calculations of summary statistics.
| ng/ml | PKC412 | Metabolite CGP52421 | Metabolite CGP62221 |
|---|---|---|---|
| Visit 2,Cycle1,Day 1 | 17.46 ± 76.806 | 0.00 ± 0.000 | 16.89 ± 61.212 |
| Visit 4,Cycle1, Day 15 | 932.46 ± 770.597 | 1572.69 ± 684.955 | 906.57 ± 747.836 |
| Visit 5,Cycle2,Day 1 | 769.92 ± 485.353 | 1768.77 ± 849.580 | 779.90 ± 400.244 |
| Visit 6,Cycle3,Day 1 | 907.20 ± 528.017 | 2051.55 ± 765.758 | 929.45 ± 311.841 |
| Visit 7,Cycle4,Day 1 | 548.45 ± 459.294 | 1707.15 ± 810.143 | 714.00 ± 610.925 |
| Visit 8,Cycle5,Day 1 | 525.73 ± 255.032 | 1742.85 ± 658.905 | 722.00 ± 320.977 |
| Visit 9,Cycle6,Day 1 | 519.10 ± 328.032 | 1757.86 ± 685.740 | 763.86 ± 408.290 |
| Visit 10,Cycle 7 Day 1 | 754.95 ± 497.976 | 1717.35 ± 720.259 | 780.65 ± 424.200 |
| Visit 11,Cycle 8 Day 1 | 537.95 ± 229.529 | 1787.21 ± 733.162 | 774.84 ± 326.583 |
| Visit 12,Cycle 9 Day 1 | 571.76 ± 311.764 | 1889.76 ± 678.435 | 850.47 ± 328.411 |
| Visit 13,Cycle 10 Day 1 | 643.07 ± 452.268 | 1836.50 ± 632.894 | 851.38 ± 347.311 |
| Visit 14,Cycle 11 Day 1 | 718.22 ± 538.208 | 1857.33 ± 868.406 | 983.94 ± 801.361 |
| Visit 15,Cycle 12 Day 1 | 564.69 ± 410.156 | 1706.29 ± 643.326 | 763.60 ± 387.685 |
On treatment deaths were collected from FPFT up to 30 days after study drug discontinuation, for a maximum duration of 12.5 months (treatment duration ranged from 0.2 to 11.5 months). Deaths post treatment survival follow up were collected after the on treatment period, up to approximately 51 months.
| Participants | Standard of Care With Midostaurin | Standard of Care |
|---|---|---|
| Total Deaths | 8 | 4 |
| Deaths on-treatment | 1 | 0 |
Collected over Adverse events were collected from FPFT up to 30 days after study drug discontinuation, for a maximum duration of 12.5 months (treatment duration ranged from 0.2 to 11.5 months).. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Standard of Care With Midostaurin | 1/30 (3.3%) | 9/30 (30%) | 28/30 (93.3%) |
| Standard of Care | 0/30 (0%) | 15/30 (50%) | 26/30 (86.7%) |
| ALL Patients | 1/60 (1.7%) | 24/60 (40%) | 54/60 (90%) |
| Event | Standard of Care With Midostaurin | Standard of Care | ALL Patients |
|---|---|---|---|
| DiarrhoeaGastrointestinal disorders | 4/30 | 2/30 | 6/60 |
| NauseaGastrointestinal disorders | 1/30 | 3/30 | 4/60 |
| AnaemiaBlood and lymphatic system disorders | 2/30 | 1/30 | 3/60 |
| Febrile neutropeniaBlood and lymphatic system disorders | 1/30 | 2/30 | 3/60 |
| VomitingGastrointestinal disorders | 1/30 | 2/30 | 3/60 |
| PyrexiaGeneral disorders | 2/30 | 2/30 | 4/60 |
| Acute kidney injuryRenal and urinary disorders | 0/30 | 2/30 | 2/60 |
| NeutropeniaBlood and lymphatic system disorders | 1/30 | 0/30 | 1/60 |
| PancytopeniaBlood and lymphatic system disorders | 1/30 | 0/30 | 1/60 |
| Arteriosclerosis coronary arteryCardiac disorders | 0/30 | 1/30 | 1/60 |
| Event | Standard of Care With Midostaurin | Standard of Care | ALL Patients |
|---|---|---|---|
| VomitingGastrointestinal disorders | 20/30 | 5/30 | 25/60 |
| NauseaGastrointestinal disorders | 19/30 | 5/30 | 24/60 |
| Oedema peripheralGeneral disorders | 6/30 | 10/30 | 16/60 |
| DiarrhoeaGastrointestinal disorders | 9/30 | 4/30 | 13/60 |
| HeadacheNervous system disorders | 8/30 | 5/30 | 13/60 |
| CoughRespiratory, thoracic and mediastinal disorders | 8/30 | 6/30 | 14/60 |
| FatigueGeneral disorders | 7/30 | 7/30 | 14/60 |
| Aspartate aminotransferase increasedInvestigations | 5/30 | 7/30 | 12/60 |
| Neutrophil count decreasedInvestigations | 7/30 | 3/30 | 10/60 |
| Upper respiratory tract infectionInfections and infestations | 3/30 | 6/30 | 9/60 |
| Age, Continuous(years) | Standard of Care With Midostaurin | Standard of Care | Total |
|---|---|---|---|
| Mean | 50.8 ± 13.68 | 46.0 ± 11.08 | 48.4 ± 12.58 |
| Sex: Female, Male(Participants) | Standard of Care With Midostaurin | Standard of Care | Total |
|---|---|---|---|
| Female | 14 | 12 | 26 |
| Male | 16 | 18 | 34 |
| Race/Ethnicity, Customized(participants) | Standard of Care With Midostaurin | Standard of Care | Total |
|---|---|---|---|
| Caucasian | 27 | 27 | 54 |
| Black | 1 | 0 | 1 |
| Asian | 1 | 1 | 2 |
| Other | 1 | 2 | 3 |
| Body Mass Index(kg/m^2) | Standard of Care With Midostaurin | Standard of Care | Total |
|---|---|---|---|
| Mean | 26.9934 ± 7.11368 | 26.6400 ± 5.27475 | 26.8101 ± 6.17055 |
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Novartis Pharmaceuticals