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A Study of the Safety and Effectiveness of Apixaban in Preventing Blood Clots in Children With Leukemia Who Have a Central Venous Catheter and Are Treated With Asparaginase

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02369653
Recruitment Status : Completed
First Posted : February 24, 2015
Results First Posted : March 8, 2022
Last Update Posted : March 8, 2022
Sponsor:
Collaborator:
Pfizer
Information provided by (Responsible Party):
Bristol-Myers Squibb

Brief Summary:
The purpose of this study is to compare the effect of a blood thinning drug called Apixaban versus no administration of a blood thinning drug, in preventing blood clots in children with leukemia or lymphoma. Patients must be receiving chemotherapy, including asparaginase, and have a central line (a catheter inserted for administration of medications and blood sampling)

Condition or disease Intervention/treatment Phase
Lymphoma Acute Lymphoblastic Leukemia Drug: Apixaban Other: No systemic anticoagulant prophylaxis Phase 3

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 512 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: A Phase III Randomized, Open Label, Multi-center Study of the Safety and Efficacy of Apixaban for Thromboembolism Prevention Versus No Systemic Anticoagulant Prophylaxis During Induction Chemotherapy in Children With Newly Diagnosed Acute Lymphoblastic Leukemia (ALL) or Lymphoma (T or B Cell) Treated With Asparaginase
Actual Study Start Date : October 22, 2015
Actual Primary Completion Date : July 7, 2021
Actual Study Completion Date : July 7, 2021


Arm Intervention/treatment
Experimental: Apixaban

Children aged 1 to <18 years weighing 6 to <35 kg randomized to apixaban will receive a fixed dose apixaban based on body weight tier twice a day for approximately 28 days.

Children aged 1 to <18 years weighing ≥ 35 kg will receive 2.5 mg of apixaban twice a day for approximately 28 days. Subjects ≥ 5 years may be administered either 2.5-mg, 0.5-mg tablets or oral solution apixaban. Subjects < 5years and < 35 kg may be administered 0.5-mg tablets only

Drug: Apixaban
Placebo Comparator: No systemic anticoagulant prophylaxis
No systemic anticoagulant prophylaxis
Other: No systemic anticoagulant prophylaxis



Primary Outcome Measures :
  1. The Number of Participants With Non-Fatal DVT, PE, and CVST, and VTE-Related-Death [ Time Frame: From first dose up to approximately 40 days after first dose ]

    The number of participants with non-fatal deep vein thromboses (DVT) (including asymptomatic and symptomatic), pulmonary embolism (PE), cerebral venous sinus thrombosis (CVST); and venous thromboembolism (VTE) related-death objectively confirmed by a blinded, independent adjudication committee.

    Symptomatic events are included during the intended treatment period. Asymptomatic events are included from scans up to Day 40.


  2. The Number of Participants With Adjudicated Major Bleeding [ Time Frame: From first dose up to approximately 34 days after first dose ]

    The number of participants with major bleeding adjudicated by a blinded, independent adjudication committee. Adjudicated major bleeding is defined as bleeding that satisfies one or more of the following criteria:

    1. fatal bleeding
    2. clinically overt bleeding associated with a decrease in hemoglobin of at least 20g/L (ie, 2g/dL) in a 24-hour period
    3. bleeding that is retroperitoneal, pulmonary, intracranial, or otherwise involves the CNS; and/or
    4. bleeding that requires surgical intervention in an operating suite, including interventional radiology.


Secondary Outcome Measures :
  1. The Number of Participants With Non-fatal Asymptomatic Deep Vein Thromboses (DVT) [ Time Frame: From first dose up to approximately 40 days after first dose ]
    The number of participants with non-fatal asymptomatic deep vein thromboses (DVT) adjudicated by a blinded, independent adjudication committee

  2. The Number of Participants With Non-fatal Symptomatic Deep Vein Thromboses (DVT) [ Time Frame: From first dose up to approximately 34 days after first dose ]
    The number of participants with non-fatal symptomatic deep vein thromboses (DVT) adjudicated by a blinded, independent adjudication committee

  3. The Number of Participants With Non-fatal Pulmonary Embolism (PE) [ Time Frame: From first dose up to approximately 34 days after first dose ]
    The number of participants with non-fatal pulmonary embolism (PE) adjudicated by a blinded, independent adjudication committee

  4. The Number of Participants With Cerebral Venous Sinus Thrombosis (CVST) [ Time Frame: From first dose up to approximately 34 days after first dose ]
    The number of participants with cerebral venous sinus thrombosis (CVST) adjudicated by a blinded, independent adjudication committee

  5. The Number of Participants With Venous Thromboembolism (VTE)-Related-death [ Time Frame: From first dose up to approximately 34 days after first dose ]
    The number of participants with venous thromboembolism (VTE)-related-death adjudicated by a blinded, independent adjudication committee

  6. The Number of Participants With Major and Clinically Relevant Non-Major Bleeding (CRNMB) [ Time Frame: From first dose up to approximately 34 days after first dose ]

    The number of participants with major and clinically relevant non-major bleeding (CRNMB) adjudicated by a blinded, independent adjudication committee

    CRNM bleeding is defined as bleeding that satisfies one or both of the following:

    1. overt bleeding for which blood product is administered and not directly attributable to the subject's underlying medical condition and
    2. bleeding that requires medical or surgical intervention to restore hemostasis, other than in an operating room

  7. The Number of Participant Deaths [ Time Frame: From first dose date until the end of the treatment period + 30 days (Up to approximately 59 days) ]
    The number of participant deaths adjudicated by a blinded, independent adjudication committee

  8. The Number of Participants With an Arterial Thromboembolic Event [ Time Frame: From first dose up to approximately 34 days after first dose ]
    The number of participants with an arterial thromboembolic event including paradoxical embolism and stroke adjudicated by a blinded, independent adjudication committee

  9. The Number of Participants With a CVAD-Related Infection [ Time Frame: From first dose up to approximately 34 days after first dose ]
    The number of participants with a central venous access device (CVAD)-related infection adjudicated by a blinded, independent adjudication committee

  10. The Number of Participants Needing Catheter Replacements During the Study [ Time Frame: From first dose up to approximately 34 days after first dose ]
    The number of participants needing catheter replacements during the study

  11. The Number of Participants With CVAD Patency Restoration Events After Thrombolytic Therapy Use [ Time Frame: From first dose up to approximately 34 days after first dose ]
    The number of participants with central venous access device (CVAD) patency restoration events after thrombolytic therapy use

  12. The Number Participants Experiencing Superficial Vein Thrombosis Events [ Time Frame: From first dose up to approximately 34 days after first dose ]

    The number participants experiencing superficial vein thrombosis events.

    Clots that occur in a superficial vein ie, cephalic vein, basilic vein (upper extremity) or saphenous vein (lower extremity) confirmed by radiographic imaging.


  13. The Number of Participants With Clinically Relevant Non-Major Bleeding Events (CRNMB) [ Time Frame: From first dose up to approximately 34 days after first dose ]

    The number of participants with clinically relevant non-major bleeding events (CRNMB) adjudicated by a blinded, independent adjudication committee.

    CRNM bleeding is defined as bleeding that satisfies one or both of the following:

    1. overt bleeding for which blood product is administered and not directly attributable to the subject's underlying medical condition and
    2. bleeding that requires medical or surgical intervention to restore hemostasis, other than in an operating room

  14. The Number of Participants With Minor Bleeding Events [ Time Frame: From first dose up to approximately 34 days after first dose ]

    The number of participants with minor bleeding events adjudicated by a blinded, independent adjudication committee.

    Minor bleeding defined as any overt or macroscopic evidence of bleeding that does not fulfill the criteria for either major bleeding or CRNMB


  15. The Number of Platelet Transfusions Needed During the Study [ Time Frame: From first dose up to approximately 34 days after first dose ]

    The number of platelet transfusions needed during the study.

    The events are not adjudicated. A subject could have more than one platelet transfusion.


  16. Maximum Observed Concentration (Cmax) [ Time Frame: pre-dose, 1-4 hours post dose ]
    The maximum observed concentration (Cmax) was measured to assess the pharmacokinetics of oral or enteric apixaban in pediatric subjects receiving induction chemotherapy.

  17. Trough Observed Concentration (Cmin) [ Time Frame: pre-dose, 1-4 hours post dose ]
    The trough observed concentration (Cmin) was measured to assess the pharmacokinetics of oral or enteric apixaban in pediatric subjects receiving induction chemotherapy.

  18. Area Under the Concentration-Time Curve [AUC(TAU)] [ Time Frame: pre-dose, 1-4 hours post dose ]
    The area under the concentration-time curve [AUC(TAU)] was measured to assess the pharmacokinetics of oral or enteric apixaban in pediatric subjects receiving induction chemotherapy.

  19. Anti-FXa Activity [ Time Frame: pre-dose and 2.5 hours after dosing on day 7. Day 8 and day 15. ]
    Anti-FXa Activity was measured to characterize the relationship between apixaban plasma concentration and anti-FXa activity in pediatric subjects receiving induction chemotherapy



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   1 Year to 17 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

For more information regarding BMS clinical trial participation, please visit www.BMSStudyConnect.com

Inclusion Criteria:

  • New diagnosis of de novo ALL, lymphomas (T or B cell), or mixed-phenotype acute leukemia
  • Planned 3-4 drug systemic induction chemotherapy with a corticosteroid, vincristine and a single dose or multiple doses of asparaginase, with or without daunorubicin
  • Functioning Central Venous Access Device
  • Must be able to tolerate oral medication or have it administered via an Nasogastric tube (NGT) or GT tube
  • Males and females,age 1 year(365 days) to < 18 (17 years and 364 days) years.

Exclusion Criteria:

  • Subjects scheduled to have > 3 Lumbar Punctures over the course of the study treatment period
  • Prior history of documented DVT or PE in the past 3 months
  • Known inherited bleeding disorder or coagulopathy
  • Major surgery [excluding Central Venous Access Device (CVAD) replacement and bone marrow aspiration and non-open biopsy] within the last 7 days prior to enrollment that may be associated with a risk of bleeding. Open biopsy is considered a major surgery.
  • Uncontrolled severe hypertension at enrollment. Severe hypertension is defined as a systolic or diastolic blood pressure (BP) > 5 mm Hg above the 95th percentile as defined by the National High Blood Pressure Education Program Working Group (NHBPEP) established guidelines for the definition of normal and elevated blood pressure in children
  • Extreme hyperleukocytosis, white blood cell (WBC) counts over 200 x 109/L (200,000/microL) at the time of enrollment
  • Liver dysfunction manifested by SGTP (ALT) > 5X Upper limit of normal (ULN) and/or Aspartate aminotransferase (AST) >5 X ULN and/or direct (conjugated) bilirubin > 2X ULN
  • Renal function < 30% of normal for age and size as determined by the Schwartz formula
  • International normalized ratio (INR) > 1.4 and activated partial thromboplastin time (aPTT) > 3 seconds above the upper limit of normal for age, within 1 week prior to enrollment.
  • History of allergy to apixaban or Factor Xa inhibitors
  • History of significant adverse reaction or major bleeding related adverse reaction to other anticoagulant or antiplatelet agents
  • History of any significant drug allergy (such as anaphylaxis or hepatotoxicity
  • Any investigational drug being administered during the study

Other protocol inclusion/exclusion criteria may apply


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02369653


Locations
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Sponsors and Collaborators
Bristol-Myers Squibb
Pfizer
Investigators
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Study Director: Bristol-Myers Squibb Bristol-Myers Squibb
  Study Documents (Full-Text)

Documents provided by Bristol-Myers Squibb:
Study Protocol  [PDF] September 3, 2020
Statistical Analysis Plan  [PDF] March 2, 2021

Additional Information:
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Responsible Party: Bristol-Myers Squibb
ClinicalTrials.gov Identifier: NCT02369653    
Other Study ID Numbers: CV185-155
2014-000328-47 ( EudraCT Number )
First Posted: February 24, 2015    Key Record Dates
Results First Posted: March 8, 2022
Last Update Posted: March 8, 2022
Last Verified: February 2022

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Bristol-Myers Squibb:
Anticoagulation
Additional relevant MeSH terms:
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Lymphoma
Leukemia
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukemia, Lymphoid
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Apixaban
Anticoagulants
Factor Xa Inhibitors
Antithrombins
Serine Proteinase Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action