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Graft-versus-Host DiseasePhase 3NCT01002742

Acute Graft-versus-Host Disease Treatment (BMT CTN 0802)

A Phase 3 study testing Mycophenolate Mofetil in people with Graft-versus-Host Disease and Immune System Disorders, run by Medical College of Wisconsin at 36 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The study is a Phase III, randomized double blind, placebo controlled, and trial evaluating the addition of Mycophenolate mofetil (MMF) vs. placebo to systemic corticosteroids as initial therapy for acute Graft Vs Host Disease (GVHD). The primary endpoint will be GVHD free survival at Day 56 post randomization. Read more about this study

Who is it for?
Any age
What is being tested?
Mycophenolate Mofetil
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
236 participants
Where
36 sitesUnited States
Study dates
Jan 2010to Jun 2013
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Acute GVHD developing after allogeneic hematopoietic stem cell transplant using either bone marrow, peripheral blood stem cells or cord blood. Recipients of non-myeloablative and myeloablative transplants are eligible.
  • Acute GVHD after planned donor lymphocyte infusion or planned T cell add back are eligible.
  • De novo acute GVHD requiring systemic therapy. GVHD is defined as the presence of skin rash and/or persistent nausea, vomiting, and/or diarrhea and/or cholestasis presenting in a context in which acute GVHD is likely to occur and where other etiologies such as drug rash, enteric infection, or hepatotoxic syndromes are unlikely or have been ruled out. Note that patients with stage I and II skin only (overall grade I) or isolated upper gastrointestinal (GI) involvement are eligible if the treating physician deems that systemic high-dose corticosteroid treatment is indicated.
  • The patient must have had no previous systemic immune suppressive therapy for treatment of acute GVHD except for a maximum 72 hours of prior corticosteroid therapy at >0.5mg/kg methylprednisolone or equivalent after the onset of acute GVHD.
  • Clinical status at enrollment to allow tapering of steroids to not less than 0.25 mg/kg/day prednisone (0.2 mg/kg/day methylprednisolone) at Day 28 of therapy.
  • Absolute neutrophil count (ANC) greater than 500/µL.
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  • Written informed consent and/or assent from patient, parent or guardian.
  • Documentation that the assent document and education materials have been provided to, and reviewed with, patients between the ages of 7 and 17.
  • Patients of all ages are eligible.
  • Biopsy confirmation of GVHD is recommended, but not required. Enrollment should not be delayed for biopsy or pathology results unless these are to be used to decide about whether to treat for GVHD.

Who cannot join

  • Patients receiving mycophenolate mofetil or mycophenolic acid (Myfortic) within seven days of screening for enrollment.
  • Patients with uncontrolled infections will be excluded. If a bacterial or viral infection is present, patients must be receiving definitive therapy and have no signs of progressing infection for 72 hours prior to enrollment. If a fungal infection is present, patients must be receiving definitive systemic anti-fungal therapy and have no signs of progressing infection for 1 week prior to enrollment. Progressing infection is defined as hemodynamic instability attributable to sepsis or new symptoms, worsening physical signs or radiographic findings attributable to infection. Persisting fever without other signs or symptoms will not be interpreted as progressing infection.
  • Relapsed/persistent malignancy requiring rapid immune suppression withdrawal.
  • Patients with GVHD after an unplanned Donor Lymphocyte Infusion (DLI), i.e., DLI that was not part of their original transplant therapy plan, or DLI given for treatment of persistent or recurrent malignancy after transplantation.
  • Patients unlikely to be available at the transplantation center on Day 28 and 56 of therapy.
  • A clinical syndrome resembling de novo chronic GVHD developing at any time after allotransplantation.
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  • Patients receiving other drugs for the treatment of GVHD.
  • Patients receiving methylprednisolone > 0.5 mg/kg/day (or 0.6 mg/kg/day prednisone) within 7 days before the onset of acute GVHD. If steroid therapy has been administered for treatment of a non-GVHD related condition and tapered to ≤ 0.5 mg/kg/day methylprednisolone (0.6 mg/kg/day prednisone) for seven or more days before the onset of acute GVHD, the patient is eligible.
  • Patients who are pregnant, breast feeding, or, if sexually active, unwilling to use effective birth control for the duration of the study. Available evidence and/or expert consensus is inconclusive or is inadequate for determining infant risk when used during breastfeeding, therefore breast feeding patients are not eligible.
  • Adults unable to provide informed consent.
  • Patients on dialysis.
  • Patients with severe hepatic Veno-Occlusive Disease (VOD) or sinusoidal obstruction syndrome who in the judgement of the treating physician are not expected to have normalized bilirubin by Day 56 after enrollment.
  • Patients with a history of intolerance/allergy to MMF.

Trial locations and contacts

36 sites in 1 country.

36 sites in 1 country

United States36 sites
  • University of Michigan Medical Center

    Ann Arbor, Michigan, 48109

  • BMT Program at Northside Hospital

    Atlanta, Georgia, 30342

  • University of Maryland Medical Systems

    Baltimore, Maryland, 21201

  • Johns Hopkins University

    Baltimore, Maryland, 21231

  • Indiana BMT at Beech Grove

    Beech Grove, Indiana, 46107

  • Tufts Medical Center

    Boston, Massachusetts, 02111

  • DFCI, Massachusetts General Hospital

    Boston, Massachusetts, 02114

  • Dana Farber Cancer Institute, Brigham & Women's Hospital

    Boston, Massachusetts, 02115

  • University of North Carolina Hospital at Chapel Hill

    Chapel Hill, North Carolina, 27599-7305

  • Medical University of South Carolina

    Charleston, South Carolina, 29425

  • Levine Children's Hospital, Carolinas Medical Center

    Charlotte, North Carolina, 28232

  • Ann & Robert Lurie Children's Hospital of Chicago

    Chicago, Illinois, 60611

  • Rush University Medical Center

    Chicago, Illinois, 60612

  • Ohio State University

    Columbus, Ohio, 43210

  • Baylor University Medical Center

    Dallas, Texas, 75246

  • Colorado Blood Cancer Institute

    Denver, Colorado, 80218

  • City of Hope National Medical Center

    Duarte, California, 91010

  • Duke University Medical Center

    Durham, North Carolina, 27705

  • University of Florida College of Medicine

    Gainesville, Florida, 32610

  • Hackensack Univ. Medical Center

    Hackensack, New Jersey, 07601

  • University of Texas, MD Anderson Cancer Research Center

    Houston, Texas, 77030

  • University of Iowa Hospitals and Clinics

    Iowa City, Iowa, 52242

  • University of California San Diego Medical Center

    La Jolla, California, 92093

  • Medical College of Wisconsin

    Milwaukee, Wisconsin, 53211

  • University of Minnesota

    Minneapolis, Minnesota, 55455

  • Memorial Sloan-Kettering Cancer Center

    New York, New York, 10021

  • Weill Cornell Medical College, NY Presbyterian Hospital

    New York, New York, 10065

  • University of Pennsylvania Cancer Center

    Philadelphia, Pennsylvania, 19104

  • Oregon Health and Science University

    Portland, Oregon, 97239

  • Virginia Commonwealth University

    Richmond, Virginia, 23298

  • Mayo Clinic

    Rochester, Minnesota, 55905

  • Texas Transplant Institute

    San Antonio, Texas, 78229

  • Fred Hutchinson Cancer Research Center

    Seattle, Washington, 98109

  • Avera Hematology & Transplant Center

    Sioux Falls, South Dakota, 57105

  • Washington University, Barnes Jewish Hospital

    St Louis, Missouri, 63110

  • Stanford Hospital and Clinics

    Stanford, California, 94305

Other trials in United States

About this study

Official title: A Multi-Center, Randomized, Double Blind, Phase III Trial Evaluating Corticosteroids With Mycophenolate Mofetil vs. Corticosteroids With Placebo as Initial Systemic Treatment of Acute Graft-Vs-Host-Disease (BMT CTN #0802)

The study is a Phase III, randomized double blind, placebo controlled, and trial evaluating the addition of Mycophenolate mofetil (MMF) vs. placebo to systemic corticosteroids as initial therapy for acute Graft Vs Host Disease (GVHD). The primary endpoint will be GVHD free survival at Day 56 post randomization.

Read the detailed description

Corticosteroids have been used as primary therapy for acute GVHD for many years. Historical published and unpublished data from Johns Hopkins, M. D. Anderson, University of Michigan and others defined an expected 35%-53% complete response (CR) at Day +28 of corticosteroid therapy for previously untreated patients with acute GVHD.

BMT CTN study 0302 (NCT00224874)was a randomized Phase II study evaluating etanercept, mycophenolate mofetil, denileukin diftitox or pentostatin in addition to corticosteroids. The results of that study suggested that mycophenolate mofetil produced the highest rates of CR at Day 28 and overall survival, supporting its evaluation in a Phase III study. Day 56 GVHD-free survival for the four treatment arms (all combining corticosteroids with one of the four study drugs) ranged from 39-71% across the four study arms.

Being tested
Mycophenolate Mofetil, Placebo
Keywords
GVHD
Medical subject headings
Graft vs Host Disease, Immune System Diseases

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Mycophenolate MofetilDrug

    Also called Cellcept®, MMF

    Oral dosing should be delivered in 250 mg units. For those < 40 kg, IV dosing should be within ± 10% of the exact dose. Intravenous doses are infused over a two-hour period.

    • Patients who weight > 60 kg should receive MMF 1 gm PO/IV every 8 hours.
    • Patients who weight between 40-60 kg should receive 750 mg PO/IV every 8 hours.
    • Patients who weight <40 kg should receive 20 mg/kg IV or PO every 8 hours.
  • PlaceboDrug

    Also called Inactive drug

    Oral dosing should be delivered in 250 mg units blinded placebo. For those < 40 kg, IV dosing should be within ± 10% of the exact dose. Intravenous doses are infused over a two-hour period.

    • Patients who weight > 60 kg should receive placebo 1 gm PO/IV every 8 hours.
    • Patients who weight between 40-60 kg should receive 750 mg PO/IV every 8 hours.
    • Patients who weight <40 kg should receive 20 mg/kg IV or PO every 8 hours.
Study groups in NCT01002742
Study groupRoleWhat they receive
PlaceboExperimentalCorticosteroids with placebo
Receives: Drug: Placebo
Mycophenolate MofetilExperimentalCorticosteroids with Mycophenolate Mofetil
Receives: Drug: Mycophenolate Mofetil

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. GVHD-free Survival

    Success is defined as alive and free of GVHD at day 56 after randomization, all others are considered to be a study failure.

    Measured: Day 56

Secondary outcomes (14)
  1. Percentage of Surviving Participants With Complete Response (CR)

    CR is defined as a score of 0 for the GVHD grading in all evaluable organs.

    Measured: Days 14, 28, and 56

  2. Incidence of GVHD Flares Requiring Increased Therapy

    Flares are defined as any progression of acute GVHD after an initial response (i.e., earlier CR or PR) that requires re-escalation of steroid dosing, or initiation of additional topical or systemic therapy.

    Measured: Day 90

  3. Incidence of Discontinuation of Immune Suppression Without Flare

    Measured: Day 56, Day 180 and Day 360 post-treatment

  4. Cumulative Steroid Dose

    The cumulative steroid dose for each patient will be calculated by adding the doses (end of each week's dose) for each of the first four weeks of treatment, divided by the number of days of survival during this interval. The cumulative steroid dose was calculated for all patients per treatment arm and compared.

    Measured: Days 28 and 56

  5. Incidence of Topical/Non-absorbable Therapy

    Measured: Day 56

  6. Overall GVHD-free Survival Post-randomization

    Measured: Months 6 and 12

  7. Incidence of Chronic GVHD

    Measured: 12 months post-randomization

  8. Incidence of Systemic Infections

    Number of participants that experienced at least one infection.

    Measured: 6 Months

  9. Incidence of Epstein-Barr Virus (EBV)-Associated Lymphoma

    Measured: 12 months

  10. Incidence of Cytomegalovirus (CMV) Reactivation

    Measured: Year 1

  11. Cumulative Incidence of a Severe/Life-threatening/Fatal Infections

    Measured: Year 1

  12. Disease-Free Survival (DFS) Post-Randomization

    DFS includes death or progression/relapse of malignancy

    Measured: Year 1

  13. Treatment Related Mortality (TRM)

    Measured: Year 1

  14. Change in Patient Reported Outcomes From Enrollment to Day 56

    Measured: Day 56

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Oct 2009 (estimated)
  2. Study startJan 2010
  3. Primary completionJan 2012
  4. Study completionJun 2013

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
236 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01002742
Sponsor's protocol ID
BMTCTN0802
Other IDs
U01HL069294, BMT CTN 0802, U01HL069294-06, 5U24CA076518
Status last verified
Dec 2022
First submitted
23 Oct 2009
Last updated
4 Jan 2023
Data monitoring committee
Yes
Individual data sharing
Yes: Findings will be published in a manuscript.

Publications

  • Bolanos-Meade J, Logan BR, Alousi AM, Antin JH, Barowski K, Carter SL, Goldstein SC, Hexner EO, Horowitz MM, Lee SJ, Levine JE, MacMillan ML, Martin PJ, Mendizabal AM, Nakamura R, Pasquini MC, Weisdorf DJ, Westervelt P, Ho VT. Phase 3 clinical trial of steroids/mycophenolate mofetil vs steroids/placebo as therapy for acute GVHD: BMT CTN 0802. Blood. 2014 Nov 20;124(22):3221-7; quiz 3335. doi: 10.1182/blood-2014-06-577023. Epub 2014 Aug 28.

    PubMed 25170121
  • Shah O, Tamaresis JS, Kenyon LJ, Xu L, Zheng P, Gupta P, Rangarajan K, Lee S, Spellman S, Nikiforow S, Zehnder J, Meyer EH. Analysis of the Whole CDR3 T Cell Receptor Repertoire after Hematopoietic Stem Cell Transplantation in 2 Clinical Cohorts. Biol Blood Marrow Transplant. 2020 Jun;26(6):1050-1070. doi: 10.1016/j.bbmt.2020.01.020. Epub 2020 Feb 18.

    PubMed 32081787

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Mycophenolate Mofetil in people with Graft-versus-Host Disease and Immune System Disorders, run by Medical College of Wisconsin at 36 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 4 Jan 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 36 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 27 May 2016). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

GVHD-free Survival (time frame: Day 56). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01002742, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Jan 2023.

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