Treosulfan Therapeutic Drug Monitoring in Pediatric Hematopoietic Stem Cell Transplant Recipients

Обзор

One of the major challenges to improve the outcome of hematopoietic stem cell transplantation (HSCT) is the reduction of toxicity and non-relapse mortality caused by the pre-transplant conditioning regimen, while maintaining efficacy. Treosulfan (TREO) (L-treitol-1,4-bis-methanesulfonate) is a busulfan analogue with a distinct site of alkylation that results in a more favourable toxicity profile in comparison with busulfan and total body irradiation. TREO is the prodrug of L-epoxybutane, a water-soluble bifunctional alkylating agent with remarkable myeloablative and immunosuppressive properties. The use of TREO, in combination with other chemotherapy agents, as part of the conditioning regimen for hematopoietic stem cell transplantation (HSCT) in children has progressively increased during the last decade for both malignant and non-malignant disorders. Data on TREO pharmacokinetics in the pediatric population are still scarce. To date, only a few studies, including small numbers of pediatric patients, have investigated the PK profile of TREO. These studies reported high variability of TREO pharmacokinetics, and the relationship between TREO exposure, toxicity and clinical outcome is still unresolved. Therefore, therapeutic drug monitoring with a personalized approach may be an important tool to optimize outcomes in the pediatric population. The aim of the investigators' study is to characterize TREO PK/PD profiles in children undergoing HSCT and to evaluate the relationship between TREO exposure and early toxicity and clinical outcome.

Первичные конечные точки

• percentage of patients in therapeutic range after the first dose of TREO during the pre-transplant conditioning regimen [Срок оценки: within 24 hours from the first dose]

Вторичные конечные точки (4)

• correlation between TREO exposure and early toxicity using the NCI Common Toxicity Criteria (Toxicity score 1- 5 for each organ/system) at 100 days post HSCT [Срок оценки: 100 days post HSCT]
• To evaluate the inter-individual and intra-individual variability of PK profile [Срок оценки: day 0-3]
• To study the cumulative incidence of non-relapse mortality at 100 days post HSCT [Срок оценки: 100 days post HSCT]
• correlation between TREO exposure (measured by AUC) and efficacy [Срок оценки: 1 year post HSCT]

Критерии участия

Критерии включения

• Age range 0 - 18 years.
• Life expectancy > 12 weeks.
• Diagnosis of malignant or non-malignant disorder.
• Pre-HSCT Lansky / Karnofsky score ≥ 40%.
• Indication to allogeneic or autologous HSCT with TREO as part of the pre-transplant conditioning regimen.
• Negativity of pregnancy test for female patients.
• Written informed consent signed by the parents or guardians.

Критерии исключения

• Absence of written informed consent signed by the parents or guardians.
• Current clinically active infectious disease (including positive HIV serology or viral RNA).
• Severe cardiovascular disease (arrhythmias requiring chronic treatment, congestive heart failure or left ventricular ejection fraction <40%).
• Liver dysfunction (AST/ALT ≥ 3 times institutional upper limit normal value -ULN- or bilirubin > 3 times ULN).
• Renal dysfunction: serum creatinine > 1.5 times ULN or calculated creatinine clearance < 60 ml/min/1.73 m2
• End stage irreversible multi-system organ failure.
• Pregnant or breast feeding female patient.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Когортное

Центры проведения

Италия · 10 центров

• Policlinico Sant'Orsola Malpighi, Clinica Pediatrica Oncologia Ed Ematologia Pediatrica "L — Bologna
• Ospedali Civili, Presidio Ospedale Dei Bambini, Oncoematologia Pediatrica e TMO — Brescia
• IRCCS Istituto Giannina Gaslini, U.O.S.D. Centro Trapianto di Midollo Osseo — Genova
• Ospedale San Raffaele, U.O. Immunoematologia Pediatrica — Milan
• Fondazione IRCCS San Gerardo dei Tintori - Clinica Pediatrica — Monza
• Azienda Ospedaliera di Padova, Oncoematologia Pediatrica — Padova
• Fondazione IRCCS Policlinico San Matteo, S.C. Ematologia 2 - Oncoematologia Pediatrica — Pavia
• AOU Città della Salute e della Scienza Di Torino, SC Oncoematologia Pediatrica e Centro Tr — Torino
• … и ещё 2 центра

Идентификаторы

NCT: NCT06861257 · TREO

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

Открыть это исследование на ClinicalTrials.gov ↗