ClinicalTrials.gg
TerminatedNCT03920657Updated Nov 21, 2022

Early and Low Dose Deferasirox (3.5 mg/kg FCT) to Suppress NTBI and LPI as Early Intervention to Prevent Tissue Iron Overload in Lower Risk MDS

A Phase 2 interventional study of Deferasirox in Myelodysplastic Syndromes, sponsored by Fondazione Italiana Sindromi Mielodisplastiche-ETS. Terminated at 10 sites in Italy. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-11-21.

Sponsored by Fondazione Italiana Sindromi Mielodisplastiche-ETS · Phase 2, Interventional, and Treatment

Why this study was terminated
enrollment failed
Phase
Phase 2
Study type
Interventional
Enrollment
11
Allocation
Not applicable
Ages
18 Years and older
Sex
All
01

Study summary

The scientific rationale for this study is the evolving understanding that iron-induced tissue damage is not only a process of progressive bulking of organs through high-volumes iron deposition, but also a reactive iron species related "toxic" damage.

Iron mediated damage can occur prior reaching high iron storage thresholds derived from thalassemia major setting, free toxic iron species being already present when transferrin saturation >60-70% (25); therefore a timely early adoption of iron chelation may be of benefit before overt iron overload is seen.

Our hypothesis is that early and low dose DFX-FCT is better tolerated and is able to prevent iron accumulation and consequently tissue iron related damage, by consistently suppressing iron reactive oxygen species (NTBI and LPI).

If this hypothesis is confirmed this approach could contribute to an improvement of clinical practice of patients managements. Additionally this approach might also be a contribute in preventing future iron overloaded related complication, in this already frail and co-treated patient population.

02

Conditions studied

  • Myelodysplastic Syndromes

Keywords

  • MDS
03

In context

Myelodysplastic Syndromes

1,997 studies on the registry are indexed under Myelodysplastic Syndromes; 324 are open to participants now.

This study's enrollment of 11 is below the median of 40 across 1,611 interventional studies indexed under Myelodysplastic Syndromes.

Browse Myelodysplastic Syndromes studies →

Lead sponsor

Fondazione Italiana Sindromi Mielodisplastiche-ETS is the lead sponsor of 10 studies on the registry; 1 is open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Diagnosis: Adult Myelodysplastic Syndrome (≥18 years).
  • Revised IPSS: very low. low - intermediate
  • Having received 5-20 packed red blood cell units
  • Serum ferritin ≥300 ng/ml
  • Transferrin saturation ≥ 60%
  • Chelation naïve
  • Capability to provide

Exclusion criteria

Exclusion Criteria:

  • Patients aged \<18 years old
  • Higher risk (revised IPSS) MDS (Intermediate 2, high)
  • Cumulative transfusion story of > 20 packed red cell units
  • (CrCL): \<60 ml/min. Patients with CrCl of 40-60ml/min will be included only individually if no other renal risk factors are present.
  • Serum creatinine >2 x at screening. If borderline serum creatinine will be measured within 7-10 days and the mean value will be used for eligibility criteria.
  • Significant proteinuria as indicated by a urinary protein/creatinine ratio > 0.5 mg/mg in a non-first void urine sample (or alternatively in two of three samples obtained for screening).
  • performance status >2.
  • \< 50% by echocardiography
  • A history of repeated hospitalization for congestive heart failure.
  • Systemic diseases that would prevent study treatment (e.g. uncontrolled hypertension, cardiovascular, renal, hepatic, metabolic, etc.)
  • Clinical or laboratory evidence of chronic or (definition of chronic hepatitis follows EASL 2017 criteria).
  • History of positive test result (ELISA or Western blot).
  • Treatment with systemic drug within 4 weeks or topical investigational drug within 7 days of study start.
  • or AST over 3 times superior to ULN at screening.
  • ANC \< 500/ microL
  • transfusion dependency
  • Total over 1.5 times superior to ULN at screening (patients with Gilbert syndrome are allowed to enter the study)
  • Diagnosis of Child score C liver cirrhosis.
  • Patients participating in another clinical trial other than an observational registry study.
  • Patients with a history of another within the past 3 years, with the exception of basal skin carcinoma or cervical carcinoma in situ or completely resected colonic polyps carcinoma in situ.
  • History of non-compliance to medical regimens, or patients who are considered potentially unreliable and/or not cooperative.
  • Presence of a surgical or medical condition which might significantly alter the absorption, distribution, metabolism or excretion of study drug.
  • Pregnant, intending-to-become pregnant, or breast-feeding patients.
  • Women of potential maternity age who do not agree to practice effective methods fo the entire study duration.
  • History of drug or alcohol abuse within the 12 months prior to enrollment.
  • to the active substance or to any of the .
  • Inability to provide a valid
Terms in these criteria, in plain language(16)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

LVEF (left ventricular ejection fraction)

The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

Excipients

The other ingredients in a medicine besides the active drug, such as fillers, colours or preservatives.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
11 participants (actual)

Study arms

  • Experimental
    Deferasirox

    patients will be assigned to a fixed dose of 3.5 mg/kg/day of DFX FCT.

    Drug: Deferasirox

Interventions

  • Fixed dose of 3.5 mg/kg/day of DFX FCT

    Also known as: Exjade

06

What researchers measure

Primary outcomes

  1. Change of hepatic iron

    Change of hepatic iron from the baseline according to baseline hepatic iron level: For patients with baseline LIC ≤5 mg/g dry weight (dw) ± 1.5 mg/g dw. For patients with baseline LIC \>5 mg/g dw ±20%

    Time frame: 1 year

Secondary outcomes

  1. Definition of iron overload

    The baseline iron status of MDS patients at the beginning of their transfusion story is today unknown. This study is the first unbiased and direct measurement of iron stress and oxidative stress in MDS patients at the beginning of the transfusion story. Baseline iron status will be described by classical iron markers: serum ferritin (ng/ml), transferritin saturation (%), liver and pancreas iron concentration by MRI (mg/g dry weight). Total body iron stores will be calculated (mg/kg) with the published formula (N Engl J Med 2000; 343:327-331). Tissue reactive oxygen species will be measured in the patient's plasma as follows: non-transferrin bound iron= micromoles/L, Labile Plasma Iron= micromoles/L. Oxidative stress will be measured by Malonildialdehyde (MDA). Levels in plasmas= micromoles/L.

    Time frame: 1 year

  2. Efficacy of treatment

    Absolute change in hepatic iron concentration EOS versus baseline.

    Time frame: 1 year

  3. Evolution of iron overload serologic markers

    Absolute and relative changes in serum ferritin and transferrin saturation from baseline to every visit during the whole treatment period

    Time frame: 1 year

  4. Evolution of toxic serum iron forms

    Presence and quantitative evolution of toxic serum iron forms (iron tissue reactive species) under low dose DFX therapy

    Time frame: 1 year

  5. Relationship between NTBI and LPI with serum ferritin and liver and pancreas iron overload

    Prevention of iron overload will be studied by the difference iron parameters end of therapy - baseline by liver iron concentration (mg/g dry weight), pancreas iron concentration (mg/g dry weight), total body iron stores (mg/kg) calculated the N Engl J med 2000 343:327-331 formula = liver iron concentration x 10.6. Serum ferritin = ng/ml. Relationship between suppression of tissue iron species and prevention of iron accumulation (observational study) will be measured by the: NTBI/LPI values (micromoles/L), Differences end of study - baseline quantitative parameters of iron loading (liver and pancreas iron concentration and total body iron stores).

    Time frame: 1 year

  6. Overall safety of deferasirox

    Evaluate the overall safety of deferasirox FCT formulation in patients with lower risk MDS at the beginning of their transfusional history

    Time frame: 1 year

  7. Leukemic transformation

    Leukemic transformation (progression to leukemia or higher rIPSS scores)

    Time frame: 1 year

  8. Hemopoietic response

    Percentage of patients with hematologic improvements in term of erythroid response following IWG 2006 criteria.

    Time frame: 1 year

  9. Costs analysis

    Treatment cost will be compared with standard approach cost (14 mg/kg/day. DFX-FCT after 20 units of packed red cells units and serum ferritin\> 1000 ng/ml over one year of treatment). For comparison literature and matched FISM registry data will be used. Unit of measurement will be 2019 USD and Euros.

    Time frame: 1 year

  10. Study of biological cellular damage

    Biological cellular damage will be measured by presence and level of oxidative stress determined at baseline, during and at end of study and compared with ongoing treatment by: Malonildialdehyde (MDA) plasma levels (micromoles/L).

    Time frame: 1 year

07

Study locations

10 sites
  • S.O.D. Ematologia Policlino Careggi
    Firenze, FI 50134, Italy
  • Medicina Interna II Divisione di Ematologia, Ospedale S. Luigi Gonzaga
    Orbassano, TO 10043, Italy
  • Ematologia - Spedali Civili
    Brescia, 25100, Italy
  • Ospedale Businco
    Cagliari, Italy
  • Ospedale San Martino
    Genova, Italy
  • Ospedale Niguarda
    Milano, Italy
  • Azienda Ospedaliera di Padova
    Padova, 35128, Italy
  • AO Bianchi Melacrino Morelli
    Reggio Calabria, 89125, Italy
  • Ospedale S. Eugenio
    Roma, Italy
  • Istituto clinico Humanitas
    Rozzano (MI), Italy
08

References and documents

Study documents

PDFs hosted by the registry, ClinicalTrials.gov.

Individual participant data

Plan to share: No

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Ran from Oct 2019 to primary completion in Oct 2020, 12 months.

How these figures are worked out, and which studies are left out of them.

Registered
Dec 14, 2018
First posted
Apr 19, 2019
StartActual
Oct 4, 2019
Primary completionActual
Oct 6, 2020
CompletionActual
Apr 22, 2022
Last update
Nov 21, 2022
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Nov 21, 2022, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT03920657
Lead sponsor
Fondazione Italiana Sindromi Mielodisplastiche-ETS
Responsible party
Sponsor
First posted
Apr 19, 2019
Start date
Oct 4, 2019
Primary completion
Oct 6, 2020
Completion
Apr 22, 2022
Last update
Nov 21, 2022

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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This study is terminated, as verified in Mar 2021. You cannot join it, but the record below documents what was studied.

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Studies of the drug tested here: Deferasirox

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