Graft FailurePhase 2NCT04731298
Study to Investigate the Pharmacokinetics, Pharmacodynamics and Assess the Efficacy and Safety to Support Dose Selection of Emapalumab in Pre-empting Graft Failure in Patients at High Risk After HSCT.
A Phase 2 study testing Emapalumab in people with Graft Failure, run by Swedish Orphan Biovitrum at 5 sites in 3 countries.
Trial summary
This study is designed as an open-label, single arm, proof of concept study in order to determine the appropriate emapalumab dosing regimen neutralizing IFNγ in patients at risk of GF. Patients presenting CXCL9 levels above a defined threshold and other clinical criteria will be eligible to receive emapalumab. Read more about this study
- Who is it for?
- Ages 1 year and older
- Conditions the study is for
- Graft Failure
- What is being tested?
- Emapalumab
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 2 participants
- Where
- 5 sitesin 3 countries
- Study dates
- 25 May 2021to 21 Apr 2022
- Phase
- Phase 2
- 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 1 year and older
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- Informed consent form signed by the patient (as required by law) or by the patient's legally authorized representative(s) with the assent of patients who are legally capable of providing it, as applicable
- Recipients of allogeneic Hematopoietic Stem Cell Transplantation (HSCT) and at high risk of graft failure (GF) based on at least one of the following criteria:
- Receiving reduced intensity conditioning (RIC) or non-myeloablative conditioning (NMA) combined with a non-malignant disease or with a graft from Bone Marrow (BM)
- Ex vivo T cell depleted graft
- Graft from mismatched unrelated or haploidentical donor
- Graft from Umbilical Cord Blood (UCB)
Show all 12Show fewer
- Patients requiring allo-HSCT with the following underlying diseases:
- Malignant disease with high risk of GF, i.e. Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL) with primary induction failure, second partial remission or relapse; Chronic Myeloid Leukemia (CML) in blastic phase (circulating blast or blast above 5% in biopsy); Non Hodgkin and Hodgkin Lymphoma and multiple myeloma with primary induction failure, second partial remission or relapse, myelodysplastic syndromes (MDS) and myeloproliferative disorders (MPD) with splenomegaly, myelofibrosis with portal hypertension pre-transplant, MDS/MPD overlap syndromes
- Non-malignant hematological diseases (e.g. autoimmune and metabolic disorders, aplastic anemia, Sickle cell anemia, Fanconi anemia, Diamond-Blackfan anemia, thalassemia, osteopetrosis, Wiskott-Aldrich syndrome, severe combined immunodeficiency, Hemophagocytic lymphohistiocytosis and other immunoregulatory disorders)
- Male and female patients
- Children aged at least 1 year and adults. Once the appropriate dose has been determined in one of the three cohorts and safety has been assessed by the Independent Data Monitoring Committee (IDMC), children less than 1 year old may be included in the study.
- Females of child-bearing potential, defined as all women physiologically capable of becoming pregnant, require use of highly effective contraceptive measures from screening until 6 months after the last study drug administration
Who cannot join
- Pregnant (or planning to become pregnant) or lactating female patients
- Body weight < 3 kg
- Underlying malignant disease with Karnofsky/Lansky performance status equal or less than 40 or an Eastern Cooperative Oncology Group (ECOG) performance status equal or less than 3
- Patients presenting CXCL9 levels 10 times above the upper limit of the 95% interval (CI) of the normal range (reported in the CXCL9 assay laboratory manual) within 24 hours prior to HSCT
- Clinically manifested infections caused by typical and atypical Mycobacteria, Salmonella, Histoplasma capsulatum and Herpes Zoster on the day of HSCT
- Active or clinical suspicion of latent tuberculosis
Show all 16Show fewer
- Concomitant diseases that in the opinion of the Investigator may interfere with the assessment of emapalumab safety or efficacy
- Receipt of a Bacille Calmette-Guerin (BCG) vaccine within 3 months prior to HSCT
- Receipt of a live or attenuated live (other than BCG) vaccine within 6 weeks prior to HSCT
- Current or scheduled administration of therapies known to potentially trigger a cytokine release syndrome within 21 days from HSCT.
- Patients having received IFNγ during the last 2 weeks prior to HSCT and/or who require treatment with IFNγ.
- Patients having received emapalumab during the last 6 months prior to HSCT, unless it is known that emapalumab is no longer detectable.
- Patients having received kinase inhibitors (Janus kinase inhibitors [JAKi] or bruton tyrosine kinase inhibitors [BTKi]) one week (or 5 half-lives whichever is greater) prior to HSCT.
- Intolerance to antimicrobial and virus infection prophylaxis.
- Hypersensitivity to emapalumab or any of the excipients.
- Ongoing participation in an interventional trial or administration of any investigational drug (within 3 half-lives of the investigational drug) with the exception of interventional trials involving supportive care such as probiotics or antiemetics, graft manipulation, or use of new combinations or new dosing of conventional therapies for conditioning and prophylaxis pre-HSCT.
Trial locations and contacts
5 sites in 3 countries.
5 sites in 3 countries
Australia2 sites
Peter MacCallum Cancer Centre
Melbourne, 3000
Kids Cancer Centre Sydney Children's Hospital
Randwick, 2031
Israel2 sites
The Rambam Academic Hospital
Haifa, 31096
Hadassah Hebrew University
Jerusalem, 91120
About this study
Official title: An Open Label, Single Arm, Multicentre, Proof of Concept, Phase 2 Study to Investigate the Pharmacokinetics, Pharmacodynamics and Assess the Efficacy and Safety to Support Dose Selection of Emapalumab in Pre-empting Graft Failure in Patients at High Risk After Allogeneic Hematopoietic Stem Cell Transplantation
This study is designed as an open-label, single arm, proof of concept study in order to determine the appropriate emapalumab dosing regimen neutralizing IFNγ in patients at risk of GF. Patients presenting CXCL9 levels above a defined threshold and other clinical criteria will be eligible to receive emapalumab.
Both children and adults, with malignant and non-malignant underlying diseases, receiving allo-HSCT who are at high risk of GF as defined in the inclusion criteria will be included in the study. The main objective of the study is to determine the appropriate emapalumab dose regimen neutralizing interferon gamma (IFNγ) activity to pre-empt graft failure post allo-HSCT in a population with various underlying diseases and at high risk of graft failure (GF).
Read more
Maximum 3 cohorts are foreseen to determine the appropriate dose regimen to pre-emptively treat patients at risk of primary GF.
Emapalumab will be administered by IV infusion and treatment will last up to 56 days (15 infusions) or until evidence of engraftment.
The study is expected to last approximately 3 years from screening to the last follow-up phone call for each patient.
Read the detailed description
This study is designed as an open-label, single arm, proof of concept study in order to determine the appropriate emapalumab dosing regimen neutralizing IFNγ in patients at risk of GF. Patients presenting CXCL9 levels above a defined threshold and other clinical criteria will be eligible to receive emapalumab.
Both children and adults, with malignant and non-malignant underlying diseases, receiving allo-HSCT who are at high risk of GF as defined in the inclusion criteria will be included in the study. The main objective of the study will be to determine the appropriate emapalumab dose regimen neutralizing interferon gamma (IFNγ) activity to pre-empt graft failure post allo-HSCT in a population with various underlying diseases and at high risk of graft failure (GF).
Maximum 3 cohorts are foreseen to determine the appropriate dose regimen to pre-emptively treat patients at risk of primary GF.
Emapalumab will be administered by IV infusion over 1 to 2 hours depending on the volume of the infusion. Treatment will last up to 56 days (15 infusions) or until evidence of engraftment.
The study is comprised of the following study periods: screening (Day -21 to Day -8), allogeneic HSCT Day 0, monitoring period for primary GF (Day 1 up to Day 42), extended monitoring for secondary GF (up to Day 98), treatment period (up to 56 days) and follow-up period of 3 years after HSCT.
The main objective of this proof of concept study is:
- To determine the appropriate emapalumab dose regimen neutralizing interferon gamma (IFNγ) activity to pre-empt graft failure post allogeneic hematopoietic stem cell transplantation (HSCT) in a population with various underlying diseases and at high risk of graft failure (GF)
The following objectives will support the dose selection:
- To describe the Pharmacokinetic (PK) and Pharmacodynamic (PD) profiles of emapalumab post allogeneic HSCT (allo-HSCT)
- To assess the efficacy of emapalumab to pre-empt GF post allo-HSCT
- To assess the safety of emapalumab to pre-empt GF post allo-HSCT
- To assess the immunogenicity of emapalumab post allo-HSCT
Exploratory objectives will be:
- To evaluate further data on the correlation between relevant biomarkers including C-X-C motif chemokine ligand 9 (CXCL9) levels and the risk of GF post allo-HSCT in a population with various underlying diseases and at high risk of GF also in the context of development of a diagnostic test.
The study is expected to last approximately 3 years from screening to the last follow-up phone call for each patient.
- Conditions
- Graft Failure
- Being tested
- Emapalumab
- Keywords
- HSCT, allo-HSCT, Graft failure, emapalumab, interferon gamma, CXCL9
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
EmapalumabDrug
Also called Gamifant®, NI-0501
Emapalumab is a fully human immunoglobulin G1 (IgG1) anti-IFNγ monoclonal antibody that binds to and neutralizes IFNγ. Emapalumab binds to both soluble and receptor (IFNγR1)-bound forms of IFNγ.
Emapalumab is in development for treatment of primary and secondary HLH. The benefit expected from the targeted neutralization of IFNγ by emapalumab has been validated by the recent FDA approval of emapalumab for treatment of patients with pHLH who have refractory, recurrent or progressive disease or intolerance with conventional HLH therapy. The safety profile has been assessed as acceptable.
Emapalumab will be administered by intravenous infusion over 1 to 2 hours, depending on the volume of the infusion. The first infusion must be performed within 12 hours after CXCL9 levels have been measured above defined threshold. Treatment will last until maximum dose 15 (up to 56 days) or until evidence of engraftment, whichever comes first.
| Study group | Role | What they receive |
|---|---|---|
| Emapalumab | Experimental | The first cohort of patients will receive a first infusion of 6 mg/kg at TD0, followed by a second infusion at 3 mg/kg after 3 days (treatment day 3 - TD3). Subsequent infusions of 3 mg/kg will be every 3 or 4 days from previous dose until dose 15 or until engraftment.
A maximum of 2 additional cohorts may be added to allow dosing regimen adaptation based on the PK/PD data observed from the previous cohort(s). Efficacy and safety data will also be considered before adding additional cohorts. Receives: Drug: Emapalumab |
What is being measured
The primary outcome is the main question the study is designed to answer.
CXCL9 in Serum
Serum concentration of C-X-C Motif Chemokine Ligand 9 (CXCL9)
Measured: From start of treatment to EoS Visit, up to 34 weeks
Primary Graft Failure (GF)
Number of participants with primary graft failure (GF)
Measured: From Hematopoietic stem-cell transplantation (HSCT) [Day 0] up to study termination, approximately 46 weeks
Secondary GF
Number of participants with secondary GF
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Secondary outcomes (60)
Free & Total Interferon Gamma (IFNγ) in Serum
Serum concentration of free and total Interferon gamma (IFNγ)
Measured: From start of treatment to EoS Visit, up to 34 weeks
Emapalumab in Serum - Peak
Peak emapalumab serum concentration
Measured: From start of treatment to EoS, up to 34 weeks
Ctrough (Emapalumab)
Concentration just before administration
Measured: From start of treatment to EoS, up to 34 weeks
Exploratory Biomarkers: Ferritin
Ferritin - serum concentration
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
ADA and nAbs
Number of participants developing antibodies against emapalumab (antidrug antibodies [ADA]) and Neutralizing antibodies (nAb)
Measured: From Start of treatment until EoS, up to 34 weeks
Number of Participants With Mixed Donor Chimerism <10% and <20%
Based on unselected leukocytes and based on sorted T cells
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants Receiving Thrombopoietic Agents, Stem Cell Boost, Donor Lymphocyte Infusion (DLI)
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants Receiving a Second Allogeneic HSCT
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants With Poor Graft Function
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants With Event Free Engraftment
defined as absence of GF or graft support
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants With Acute and/or Chronic Mild to Severe Graft Versus Host Disease (GvHD)
(grade I to IV)
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Biomarker Levels, in Particular IFNy and CXCL9, as Predictors of Primary and/or Secondary Graft Failure or Acute and/or Chronic GvHD
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Engraftment Syndrome
Number of participants with engraftment syndrome
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants With Endothelial Complications
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants With Relapse, Defined as Cumulative Incidence of Reoccurring Underlying Disease
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Survival Rate
Number of patients alive at the end of study.
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Body Temperature
Change from baseline in body temperature
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Heart Rate
Change from baseline in heart rate
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Blood Pressure
Change from baseline systolic and diastolic blood pressure
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Body Weight
Change from baseline in body weight
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology: Red Blood Cells (RBC)
Change from baseline in Hematology: red blood cells (RBC)
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology: Hematocrit
Change from baseline in Hematology: hematocrit
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology: Hemoglobin
Change from baseline in Hematology: hemoglobin
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology: Platelets
Change from baseline in Hematology: platelets
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology: White Blood Cells (WBC)
Change from baseline in Hematology: white blood cells (WBC)
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology Differential: Lymphocytes
Change from baseline in Hematology differential: lymphocytes
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology Differential: Monocytes
Change from baseline in Hematology differential: monocytes
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology Differential: Neutrophils
Change from baseline in Hematology differential: neutrophils
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Ferritin
Change from baseline in Biochemistry: Ferritin
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Glucose
Change from baseline in Biochemistry: Glucose
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: C-reactive Protein
Change from baseline in Biochemistry: C-reactive protein
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Sodium
Change from baseline in Biochemistry: Sodium
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Potassium
Change from baseline in Biochemistry: Potassium
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Chloride
Change from baseline in Biochemistry: Chloride
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Calcium
Change from baseline in Biochemistry: Calcium
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Magnesium
Change from baseline in Biochemistry: Magnesium
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Phosphate
Change from baseline in Biochemistry: Phosphate
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Aspartate Aminotransferase (AST)
Change from baseline in Biochemistry: Aspartate aminotransferase (AST)
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Alanine Aminotransferase (ALT)
Change from baseline in Biochemistry: alanine aminotransferase (ALT)
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Gamma-glutamyl Transpeptidase (γGT)
Change from baseline in Biochemistry: gamma-glutamyl transpeptidase (γGT)
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Alkaline Phosphatase (ALP)
Change from baseline in Biochemistry: alkaline phosphatase (ALP)
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Lactate Dehydrogenase (LDH)
Change from baseline in Biochemistry: lactate dehydrogenase (LDH)
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Bilirubin
Change from baseline in Biochemistry: bilirubin (total, direct and indirect)
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Triglycerides
Change from baseline in Biochemistry: triglycerides
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Cholesterol
Change from baseline in Biochemistry: cholesterol (total and high-density lipoprotein [HDL])
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Albumin
Change from baseline in Biochemistry: Albumin
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Creatinine
Change from baseline in Biochemistry: Creatinine
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Urea
Change from baseline in Biochemistry: Urea
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Activated Partial Thromboplastin (aPTT)
Change from baseline in Coagulation: activated partial thromboplastin (aPTT)
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Prothrombin Time (PT)
Change from baseline in Coagulation: prothrombin time (PT)
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Urinalysis: Glucose
Change from baseline in Urinalysis: Glucose
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Urinalysis: Blood
Change from baseline in Urinalysis: Blood
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Urinalysis: Protein
Change from baseline in Urinalysis: Protein
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Urinalysis: Leucocytes
Change from baseline in Urinalysis: Leucocytes
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Urinalysis: Ketones
Change from baseline in Urinalysis: Ketones
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Urinalysis: pH
Change from baseline in Urinalysis: pH
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Urinalysis: Specific Gravity
Change from baseline in Urinalysis: specific gravity
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Subjects With Change in Donor Chimerism
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in HLA Antibodies
Change from baseline in HLA antibodies against donor cells
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change From Baseline in Minimal Residual Disease (MRD)
Only in patients presenting malignant disease
Measured: From HSCT (Day 0) up to study termination, approximately 46 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Jan 2021
- Study start25 May 2021
- Primary completion21 Apr 2022
- Study completion21 Apr 2022
Why it stopped: Sponsor Decision related to Business Priorities, Assessment of Development Options
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Other trials for Graft FailureStudies of the same condition, open and under way.
- More trials run by Swedish Orphan BiovitrumThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 2
- Primary purpose
- Prevention
- Allocation
- Not applicable
- Intervention model
- Sequential
- Model description
- Sequential dose cohorts. The first cohort of patients will receive a first emapalumab infusion of 6 mg/kg at TD0, followed by a second infusion at 3 mg/kg after 3 days. Subsequent infusions of 3 mg/kg will be every 3 or 4 days from previous dose until dose 15 or until engraftment. A maximum of 2 additional cohorts may be added to allow dosing regimen adaptation based on the PK/PD data observed from the previous cohort(s).
- Masking
- None (open label)
- Enrolment
- 2 participants (actual)
Sponsor and investigators
- Lead sponsor
- Swedish Orphan Biovitrum
- Sponsor type
- Industry (pharma, biotech, devices)
- Collaborators
- PRA Health Sciences, Cytel Inc., Q2 Solutions, ABF Pharmaceutical Services GmbH, Cromsource, BioMérieux
- Responsible party
- Sponsor
- Investigators
- Tsila Zuckerman, Dr, Principal investigator, The Rambam Academic HospitalHenrique Bittencourt, Dr, Principal investigator, St. Justine's HospitalPolina Stepensky, Dr, Principal investigator, Hadassah Hebrew UniversityAshvind Prabahran, Dr, Principal investigator, Peter MacCallum Cancer Centre, AustraliaRichard Mitchell, Dr, Principal investigator, Kids Cancer Centre Sydney Children's Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04731298
- Sponsor's protocol ID
- NI-0501-12
- Status last verified
- Dec 2023
- First submitted
- 13 Nov 2020
- Last updated
- 28 Dec 2023
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 28 Dec 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- An Open Label, Single Arm, Multicentre, Proof of Concept, Phase 2 Study to Investigate the Pharmacokinetics, Pharmacodynamics and Assess the Efficacy and Safety to Support Dose Selection of Emapalumab in Pre-empting Graft Failure in Patients at High Risk After Allogeneic Hematopoietic Stem Cell Transplantation
- ClinicalTrials.gov ID
- NCT04731298
- Acronym / sponsor ID
- NI-0501-12
- Conditions
- Graft Failure
- Keywords
- HSCT, allo-HSCT, Graft failure, emapalumab, interferon gamma, CXCL9
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- TerminatedReason stopped: Sponsor Decision related to Business Priorities, Assessment of Development Options
- Enrolment
- 2 participants (actual)
- Lead sponsor
- Swedish Orphan BiovitrumIndustry (pharma, biotech, devices)
- Collaborators
- PRA Health Sciences, Cytel Inc., Q2 Solutions, ABF Pharmaceutical Services GmbH, Cromsource, BioMérieux
- Study start
- 25 May 2021 (actual)
- Primary completion
- 21 Apr 2022 (actual)
- Study completion
- 21 Apr 2022 (actual)
- First posted
- 29 Jan 2021 (actual)
- Results
- Posted 28 Dec 2023
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study is designed as an open-label, single arm, proof of concept study in order to determine the appropriate emapalumab dosing regimen neutralizing IFNγ in patients at risk of GF. Patients presenting CXCL9 levels above a defined threshold and other clinical criteria will be eligible to receive emapalumab.
Both children and adults, with malignant and non-malignant underlying diseases, receiving allo-HSCT who are at high risk of GF as defined in the inclusion criteria will be included in the study. The main objective of the study is to determine the appropriate emapalumab dose regimen neutralizing interferon gamma (IFNγ) activity to pre-empt graft failure post allo-HSCT in a population with various underlying diseases and at high risk of graft failure (GF).
Maximum 3 cohorts are foreseen to determine the appropriate dose regimen to pre-emptively treat patients at risk of primary GF.
Emapalumab will be administered by IV infusion and treatment will last up to 56 days (15 infusions) or until evidence of engraftment.
The study is expected to last approximately 3 years from screening to the last follow-up phone call for each patient.
Detailed description
This study is designed as an open-label, single arm, proof of concept study in order to determine the appropriate emapalumab dosing regimen neutralizing IFNγ in patients at risk of GF. Patients presenting CXCL9 levels above a defined threshold and other clinical criteria will be eligible to receive emapalumab.
Both children and adults, with malignant and non-malignant underlying diseases, receiving allo-HSCT who are at high risk of GF as defined in the inclusion criteria will be included in the study. The main objective of the study will be to determine the appropriate emapalumab dose regimen neutralizing interferon gamma (IFNγ) activity to pre-empt graft failure post allo-HSCT in a population with various underlying diseases and at high risk of graft failure (GF).
Maximum 3 cohorts are foreseen to determine the appropriate dose regimen to pre-emptively treat patients at risk of primary GF.
Emapalumab will be administered by IV infusion over 1 to 2 hours depending on the volume of the infusion. Treatment will last up to 56 days (15 infusions) or until evidence of engraftment.
The study is comprised of the following study periods: screening (Day -21 to Day -8), allogeneic HSCT Day 0, monitoring period for primary GF (Day 1 up to Day 42), extended monitoring for secondary GF (up to Day 98), treatment period (up to 56 days) and follow-up period of 3 years after HSCT.
The main objective of this proof of concept study is:
- To determine the appropriate emapalumab dose regimen neutralizing interferon gamma (IFNγ) activity to pre-empt graft failure post allogeneic hematopoietic stem cell transplantation (HSCT) in a population with various underlying diseases and at high risk of graft failure (GF)
The following objectives will support the dose selection:
- To describe the Pharmacokinetic (PK) and Pharmacodynamic (PD) profiles of emapalumab post allogeneic HSCT (allo-HSCT)
- To assess the efficacy of emapalumab to pre-empt GF post allo-HSCT
- To assess the safety of emapalumab to pre-empt GF post allo-HSCT
- To assess the immunogenicity of emapalumab post allo-HSCT
Exploratory objectives will be:
- To evaluate further data on the correlation between relevant biomarkers including C-X-C motif chemokine ligand 9 (CXCL9) levels and the risk of GF post allo-HSCT in a population with various underlying diseases and at high risk of GF also in the context of development of a diagnostic test.
The study is expected to last approximately 3 years from screening to the last follow-up phone call for each patient.
Study design
- Primary purpose
- Prevention
- Allocation
- Not applicable
- Intervention model
- Sequential
- Masking
- None (open label)
- Number of arms
- 1
- Model description
- Sequential dose cohorts. The first cohort of patients will receive a first emapalumab infusion of 6 mg/kg at TD0, followed by a second infusion at 3 mg/kg after 3 days. Subsequent infusions of 3 mg/kg will be every 3 or 4 days from previous dose until dose 15 or until engraftment. A maximum of 2 additional cohorts may be added to allow dosing regimen adaptation based on the PK/PD data observed from the previous cohort(s).
| Arm | Type | Receives |
|---|---|---|
| Emapalumab | Experimental | Drug: EmapalumabThe first cohort of patients will receive a first infusion of 6 mg/kg at TD0, followed by a second infusion at 3 mg/kg after 3 days (treatment day 3 - TD3). Subsequent infusions of 3 mg/kg will be every 3 or 4 days from previous dose until dose 15 or until engraftment. A maximum of 2 additional cohorts may be added to allow dosing regimen adaptation based on the PK/PD data observed from the previous cohort(s). Efficacy and safety data will also be considered before adding additional cohorts. |
Who may qualify
- Ages
- 1 year and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (12 listed)
- Informed consent form signed by the patient (as required by law) or by the patient's legally authorized representative(s) with the assent of patients who are legally capable of providing it, as applicable
- Recipients of allogeneic Hematopoietic Stem Cell Transplantation (HSCT) and at high risk of graft failure (GF) based on at least one of the following criteria:
- Patients requiring allo-HSCT with the following underlying diseases:
- Male and female patients
- Children aged at least 1 year and adults. Once the appropriate dose has been determined in one of the three cohorts and safety has been assessed by the Independent Data Monitoring Committee (IDMC), children less than 1 year old may be included in the study.
Key exclusion criteria (16 listed)
- Pregnant (or planning to become pregnant) or lactating female patients
- Body weight < 3 kg
- Underlying malignant disease with Karnofsky/Lansky performance status equal or less than 40 or an Eastern Cooperative Oncology Group (ECOG) performance status equal or less than 3
- Patients presenting CXCL9 levels 10 times above the upper limit of the 95% interval (CI) of the normal range (reported in the CXCL9 assay laboratory manual) within 24 hours prior to HSCT
- Clinically manifested infections caused by typical and atypical Mycobacteria, Salmonella, Histoplasma capsulatum and Herpes Zoster on the day of HSCT
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| EmapalumabAlso: Gamifant®, NI-0501Emapalumab is a fully human immunoglobulin G1 (IgG1) anti-IFNγ monoclonal antibody that binds to and neutralizes IFNγ. Emapalumab binds to both soluble and receptor (IFNγR1)-bound forms of IFNγ. Emapalumab is in development for treatment of primary and secondary HLH. The benefit expected from the targeted neutralization of IFNγ by emapalumab has been validated by the recent FDA approval of emapalumab for treatment of patients with pHLH who have refractory, recurrent or progressive disease or intolerance with conventional HLH therapy. The safety profile has been assessed as acceptable. Emapalumab will be administered by intravenous infusion over 1 to 2 hours, depending on the volume of the infusion. The first infusion must be performed within 12 hours after CXCL9 levels have been measured above defined threshold. Treatment will last until maximum dose 15 (up to 56 days) or until evidence of engraftment, whichever comes first. | Drug | Emapalumab |
Primary outcome
CXCL9 in Serum
Time frame: From start of treatment to EoS Visit, up to 34 weeks
Serum concentration of C-X-C Motif Chemokine Ligand 9 (CXCL9)
Primary Graft Failure (GF)
Time frame: From Hematopoietic stem-cell transplantation (HSCT) [Day 0] up to study termination, approximately 46 weeks
Number of participants with primary graft failure (GF)
Secondary GF
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of participants with secondary GF
60 secondary outcomes
Free & Total Interferon Gamma (IFNγ) in Serum
Time frame: From start of treatment to EoS Visit, up to 34 weeks
Emapalumab in Serum - Peak
Time frame: From start of treatment to EoS, up to 34 weeks
Ctrough (Emapalumab)
Time frame: From start of treatment to EoS, up to 34 weeks
Exploratory Biomarkers: Ferritin
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
ADA and nAbs
Time frame: From Start of treatment until EoS, up to 34 weeks
Number of Participants With Mixed Donor Chimerism <10% and <20%
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants Receiving Thrombopoietic Agents, Stem Cell Boost, Donor Lymphocyte Infusion (DLI)
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants Receiving a Second Allogeneic HSCT
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants With Poor Graft Function
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants With Event Free Engraftment
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants With Acute and/or Chronic Mild to Severe Graft Versus Host Disease (GvHD)
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Biomarker Levels, in Particular IFNy and CXCL9, as Predictors of Primary and/or Secondary Graft Failure or Acute and/or Chronic GvHD
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Engraftment Syndrome
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants With Endothelial Complications
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Number of Participants With Relapse, Defined as Cumulative Incidence of Reoccurring Underlying Disease
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Survival Rate
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Body Temperature
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Heart Rate
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Blood Pressure
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Body Weight
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology: Red Blood Cells (RBC)
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology: Hematocrit
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology: Hemoglobin
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology: Platelets
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology: White Blood Cells (WBC)
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology Differential: Lymphocytes
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology Differential: Monocytes
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Hematology Differential: Neutrophils
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Ferritin
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Glucose
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: C-reactive Protein
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Sodium
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Potassium
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Chloride
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Calcium
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Magnesium
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Phosphate
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Aspartate Aminotransferase (AST)
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Alanine Aminotransferase (ALT)
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Change in Biochemistry: Gamma-glutamyl Transpeptidase (γGT)
Time frame: From HSCT (Day 0) up to study termination, approximately 46 weeks
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Dec 2023.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
Related trials for Graft Failure
Recruiting
Non-Invasive Monitoring of Pediatric Kidney Transplant Recipients and Immunosuppression Personalization: an Open-labeled Multicenter Randomized Controlled Study
Pediatric Kidney Disease, Transplant;Failure,Kidney
Not yet recruitingPhase 2
(TNX-1500) in Kidney Transplant Recipients
Kidney Transplant, Kidney Transplant Failure and Rejection
RecruitingPhase 2
A Study Comparing Siplizumab With Rabbit Anti-Thymocyte Globulin to Help the Body Accept a Kidney Transplant
Renal Transplant Failure and Rejection
RecruitingPhase 1
A Study of LBP-MARCO and Ruxolitinib in People With Graft-Versus-Host Disease (GVHD)
Transplant Failure or Rejection of Bone Marrow (Graft vs Host Disease, GVHD)
Not yet recruitingPhase 1
ECP-DL Cell Infusion for Induction in Living Donor Kidney (LDK) Transplants
Kidney Transplant Failure and Rejection, Kidney Transplant; Complications
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Tsila Zuckerman, Dr principal investigator
The Rambam Academic Hospital
Henrique Bittencourt, Dr principal investigator
St. Justine's Hospital
Polina Stepensky, Dr principal investigator
Hadassah Hebrew University
5 sites in 3 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Emapalumab in people with Graft Failure, run by Swedish Orphan Biovitrum at 5 sites in 3 countries.
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 12 inclusion and 16 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: stopped early, as of the sponsor's last update on 28 Dec 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 5 sites in Australia, Israel, Canada. 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 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
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 28 Dec 2023). 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?
CXCL9 in Serum (time frame: From start of treatment to EoS Visit, up to 34 weeks). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 28 Dec 2023.