Study of Acalabrutinib (ACP-196) Versus Ibrutinib in Previously Treated Participants With High Risk Chronic Lymphocytic Leukemia (CLL)
A Randomized, Multicenter, Open-Label, Non-Inferiority, Phase III Study of Acalabrutinib (ACP-196) Versus Ibrutinib in Previously Treated Subjects With High Risk Chronic Lymphocytic Leukemia
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Locations
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Darlinghurst, Australia, 2010
- Research Site
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Frankston, Australia, 3199
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Melbourne, Australia, 3000
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St Leonards, Australia, 2065
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Waratah NSW, Australia, 2298
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Wollongong, Australia, 2500
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Bruges, Belgium, 8000
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Brussels, Belgium, 1200
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Ghent, Belgium, 9000
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Leuven, Belgium, 3000
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Yvoir, Belgium, 5530
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Aalborg, Denmark, 9100
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Indgang 27B, Denmark, DK-4000
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Bobigny, France, 93000
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Créteil, France, 94010
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Pierre-Bénite, France, 69310
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Rennes, France, 35000
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Rouen, France, 76038
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Toulouse, France, 31059
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München, Germany, 81241
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Ulm, Germany, 89081
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Budapest, Hungary, 1083
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Budapest, Hungary, 1122
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Debrecen, Hungary, 4032
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Kaposvár, Hungary, 7400
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Haifa, Israel, 34362
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Haifa, Israel, 31096
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Haifa, Israel, 31000
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Jerusalem, Israel, 9103102
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Nahariya, Israel, 22100
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Petah Tikvah, Israel, 49102
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Tel Litwinsky, Israel, 52621
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Tiberias, Israel, 15208
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Bologna, Italy, 40138
- Research Site
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Cagliari, Italy, 9121
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Cona, Italy, 44124
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Florence, Italy, 50134
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Meldola, Italy, 47014
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Milan, Italy, 20162
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Milan, Italy, 20132
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Modena, Italy, 41100
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Ravenna, Italy, 48121
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Rome, Italy, 168
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Almere Stad, Netherlands, 1315 RA
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Amsterdam, Netherlands, 1105 AZ
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Blaricum, Netherlands, 1261
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Breda, Netherlands, 4818 CK
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Delft, Netherlands, 2600 GA
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Dordrecht, Netherlands, 3317
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Geleen, Netherlands, 6162 BG
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Groningen, Netherlands, 9700
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Haarlem, Netherlands, 2035 RC
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Leiden, Netherlands, 2333
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Rotterdam, Netherlands, 3062 PA
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Rotterdam, Netherlands, 3083 AN
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Utrecht, Netherlands, 3584
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Zutphens, Netherlands, 7207 AE
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Addington, New Zealand, 8011
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Auckland, New Zealand, ?0620
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Tauranga, New Zealand, 3112
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Bydgoszcz, Poland, 85-168
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Gdansk, Poland, 80-129
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Gdynia, Poland, 81-519
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Krakow, Poland, 30-727
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Lodz, Poland, 93-510
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Olsztyn, Poland, 10-228
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Opole, Poland, 46-020
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Słupsk, Poland, 76-200
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Wroclaw, Poland, 50-001
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Barcelona, Spain, 8907
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Barcelona, Spain, ?08041
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Madrid, Spain, 28031
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Madrid, Spain, 28041
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Madrid, Spain, 28009
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Madrid, Spain, 28006
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Majadahonda, Spain, 28222
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Murcia, Spain, 30008
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Santander, Spain, 39008
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Ankara, Turkey (Türkiye), 6230
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Ankara, Turkey (Türkiye), 6560
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Instabul, Turkey (Türkiye), 34365
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Izmir, Turkey (Türkiye), 35340
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Izmir, Turkey (Türkiye), 35040
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Kayseri, Turkey (Türkiye), 38030
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Birmingham, United Kingdom, B9 5SS
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Bournemouth, United Kingdom, BH7 7DW
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Cambridge, United Kingdom, CB2 0QQ
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Cardiff, United Kingdom, CF14 4XW
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Greater London, United Kingdom, E1 2AD
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Hull, United Kingdom, HU32JZ
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Leeds, United Kingdom, LS9 7TF
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Leicester, United Kingdom, LE1 7RH
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Liverpool, United Kingdom, L7 8XP
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London, United Kingdom, SE5 9RS
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Manchester, United Kingdom, M20 4BX
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Nottingham, United Kingdom, NG5 1PB
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Plymouth, United Kingdom, PL6 8DH
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Southampton, United Kingdom, SO16 6YD
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Surrey, United Kingdom, SM2 5PT
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Arizona
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Phoenix, Arizona, United States, 85054
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California
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Anaheim, California, United States, 92801
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Berkeley, California, United States, 94704
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Duarte, California, United States, 91010
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La Jolla, California, United States, 92093
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Los Angeles, California, United States, 90095
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Palo Alto, California, United States, 94304
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Santa Rosa, California, United States, 95403
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Florida
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Jacksonville, Florida, United States, 32224
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Tampa, Florida, United States, 33612
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Georgia
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Athens, Georgia, United States, 30607
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Illinois
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Harvey, Illinois, United States, 60426
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Peoria, Illinois, United States, 61615
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Kansas
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Wichita, Kansas, United States, 67214
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Minnesota
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Minneapolis, Minnesota, United States, 55426
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Rochester, Minnesota, United States, 55905
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Montana
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Billings, Montana, United States, 59102
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New Jersey
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Hackensack, New Jersey, United States, ?07601
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New York
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Lake Success, New York, United States, 11042
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New Hyde Park, New York, United States, 11042
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New York, New York, United States, 10021
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New York, New York, United States, 10065
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New York, New York, United States, 10029
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North Carolina
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Durham, North Carolina, United States, 27710
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Ohio
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Columbus, Ohio, United States, 43210
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Pennsylvania
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Philadelphia, Pennsylvania, United States, 19104
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Texas
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Houston, Texas, United States, 77030
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Round Rock, Texas, United States, 78665
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Virginia
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Charlottesville, Virginia, United States, 22908
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Washington
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Tacoma, Washington, United States, 98405
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Wisconsin
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Northwest WA, Wisconsin, United States, 20007
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Men and women ≥ 18 years of age.
- ECOG performance status of 0 to 2.
- Diagnosis of CLL.
Must have ≥ 1 of the following high-risk prognostic factors:
- Presence of 17p del by central laboratory.
- Presence of 11q del by central laboratory.
- Active disease meeting ≥ 1 of the following IWCLL 2008 criteria for requiring treatment
- Must have received ≥ 1 prior therapies for CLL.
Meet the following laboratory parameters:
- Absolute neutrophil count (ANC) ≥ 750 cells/μL or ≥ 500 cells/μL in participants with documented bone marrow involvement, and independent of growth factor support 7 days before assessment.
- Platelet count ≥ 30,000 cells/μL without transfusion support 7 days before assessment. Participants with transfusion-dependent thrombocytopenia are excluded.
- Serum aspartate aminotransferase (AST)/serum glutamic oxaloacetic transaminase (SGOT) and alanine aminotransferase (ALT)/serum glutamic-pyruvic transaminase (SGPT) ≤ 3.0 x upper limit of normal (ULN).
- Total bilirubin ≤ 1.5 x ULN.
- Estimated creatinine clearance ≥ 30 mL/min.
Exclusion Criteria:
- Known CNS lymphoma or leukemia.
- Known prolymphocytic leukemia or history of, or currently suspected, Richter's syndrome.
- Uncontrolled autoimmune hemolytic anemia or idiopathic thrombocytopenia purpura.
- Prior exposure to ibrutinib or to a B-cell receptor (BCR) inhibitor or a B-cell lymphoma-2 (BCL-2) inhibitor.
- Received any chemotherapy, external beam radiation therapy, anticancer antibodies, or investigational drug within 30 days before first dose of study drug.
- Prior radio- or toxin-conjugated antibody therapy.
- Prior allogeneic stem cell or autologous transplant.
- Major surgery within 4 weeks before first dose of study drug.
- Prior malignancy, except for adequately treated lentigo maligna melanoma, non-melanomatous skin cancer, in situ cervical carcinoma or other malignancy treated with no evidence of active disease > 3 years before Screening and at low risk for recurrence.
- Significant cardiovascular disease within 6 months of screening.
- Known history of infection with human immunodeficiency virus (HIV).
- History of stroke or intracranial hemorrhage within 6 months before randomization.
- History of bleeding diathesis.
- Requires or receiving anticoagulation with warfarin or equivalent vitamin K antagonists within 7 days of first dose of study drug.
- Requires treatment with a strong cytochrome P450 3A (CYP3A) inhibitor/inducer.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
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Experimental: Acalabrutinib
Participants will receive oral acalabrutinib 100 mg twice daily (BID) until disease progression (PD), or unacceptable toxicity, or other reasons for discontinuation, whichever occurs first.
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Participants will receive oral acalabrutinib as stated in arm description.
Other Names:
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Active Comparator: Ibrutinib
Participants will receive oral ibrutinib 420 mg once daily (QD) until PD, or unacceptable toxicity, or other reasons for discontinuation, whichever occurrs first.
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Participants will receive oral ibrutinib as stated in arm description.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Progression-free Survival (PFS) Based on Independent Review Committee (IRC) Assessment
Time Frame: Baseline (Days -28 to -1) through 55.2 months (maximum observed duration)
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The PFS is defined as the time from date of randomization to the date of first IRC-assessed PD or death due to any cause, whichever occurred first.
PD (per International Workshop on Chronic Lymphocytic Leukemia [iwCLL] 2008 criteria): Lymphocytes >= 50% increase over baseline, or >= 50% increase in lymphadenopathy/hepatomegaly/splenomegaly, or >= 50% platelets or > 2 g/dL hemoglobin decreases from baseline secondary to chronic lymphocytic leukemia (CLL).
The PFS is assessed using the Kaplan-Meier method.
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Baseline (Days -28 to -1) through 55.2 months (maximum observed duration)
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Number of Participants With Treatment-emergent Infections Grade >= 3
Time Frame: Day 1 through 83.5 months (maximum observed duration)
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Number of participants with treatment-emergent infections Grade >=3 are reported.
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Day 1 through 83.5 months (maximum observed duration)
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Number of Participants With Treatment-emergent Richter's Transformation
Time Frame: Day 1 through 83.5 months (maximum observed duration)
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Richter's transformation is defined as the occurrence of an aggressive lymphoma in participants with a previous or concomitant diagnosis of CLL.
Richter's transformation was assessed by central pathology.
Number of participants with treatment-emergent Richter's transformation are reported.
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Day 1 through 83.5 months (maximum observed duration)
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Number of Participants With Treatment-emergent Atrial Fibrillation
Time Frame: Day 1 through 83.5 months (maximum observed duration)
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Number of participants with treatment-emergent atrial fibrillation (including atrial flutter) are reported.
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Day 1 through 83.5 months (maximum observed duration)
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Overall Survival (OS)
Time Frame: Baseline (Days -28 to -1) through 83.7 months (maximum observed duration)
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The OS is defined as the time from date of randomization to date of death due to any cause.
The OS is assessed using the Kaplan-Meier method.
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Baseline (Days -28 to -1) through 83.7 months (maximum observed duration)
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Number of Participants With Treatment-emergent Adverse Events (TEAEs) and Treatment-emergent Serious Adverse Events (TESAEs)
Time Frame: Day 1 through 83.5 months (maximum observed duration)
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An adverse event (AE) is any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship.
A serious adverse event (SAE) is an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly.
The TEAEs are defined as events present at baseline that worsened in intensity after administration of study drug or events absent at baseline that emerged after administration of study drug.
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Day 1 through 83.5 months (maximum observed duration)
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Number of Participants With Treatment-emergent Laboratory Abnormalities
Time Frame: Day 1 through 83.5 months (maximum observed duration)
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Number of participants with treatment-emergent laboratory abnormalities are reported.
Laboratory abnormality is defined as any abnormal finding during analysis of hematology and serum chemistry.
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Day 1 through 83.5 months (maximum observed duration)
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Number of Participants With Abnormal Vital Signs Reported as TEAEs
Time Frame: Day 1 through 83.5 months (maximum observed duration)
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Number of participants with abnormal vital signs reported as TEAEs are reported.
Abnormal vital signs are defined as any abnormal finding in the vital sign parameters (body temperature, blood pressure, heart rate, and respiratory rate).
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Day 1 through 83.5 months (maximum observed duration)
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Percentage of Participants With Lymphocytosis
Time Frame: Day 1 through 83.5 months (maximum observed duration)
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Percentage of participants with at least one occurrence of treatment-related lymphocytosis defined as an elevation in ALC of >= 50% compared with baseline and a postbaseline assessment of > 5000/μL in the peripheral blood are reported.
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Day 1 through 83.5 months (maximum observed duration)
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Number of Participants With Electrocardiogram (ECG) Abnormality at Baseline
Time Frame: Baseline (Days -28 to -1)
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Number of participants with ECG abnormality at baseline are reported.
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Baseline (Days -28 to -1)
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Number of Participants With Shift From Baseline to Worst (Grade 3 and 4) Postbaseline in Eastern Cooperative Oncology Group (ECOG) Performance Status
Time Frame: Baseline (Days -28 to -1) through 83.5 months (maximum observed duration)
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The ECOG performance status assessed participant's performance status on 5 point scale: 0=Fully active/able to carry on all pre-disease activities without restriction; 1=restricted in physically strenuous activity, ambulatory/able to carry out light or sedentary work; 2=ambulatory (>50% of waking hours), capable of all self-care, unable to carry out any work activities; 3=capable of only limited self care, confined to bed/chair >50% of waking hrs; 4=completely disabled, cannot carry on any self care, totally confined to bed/chair; 5=death.
Number of participants with shift from baseline (Days -28 to -1) to worst Grade 3 and 4 in ECOG performance status are reported.
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Baseline (Days -28 to -1) through 83.5 months (maximum observed duration)
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Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Study Director: Acerta Clinical Trials, 1-888-292-9613
Publications and helpful links
General Publications
- Kipps TJ. Mining the Microenvironment for Therapeutic Targets in Chronic Lymphocytic Leukemia. Cancer J. 2021 Jul-Aug 01;27(4):306-313. doi: 10.1097/PPO.0000000000000536.
- Byrd JC, Hillmen P, Ghia P, Kater AP, Chanan-Khan A, Furman RR, O'Brien S, Yenerel MN, Illes A, Kay N, Garcia-Marco JA, Mato A, Pinilla-Ibarz J, Seymour JF, Lepretre S, Stilgenbauer S, Robak T, Rothbaum W, Izumi R, Hamdy A, Patel P, Higgins K, Sohoni S, Jurczak W. Acalabrutinib Versus Ibrutinib in Previously Treated Chronic Lymphocytic Leukemia: Results of the First Randomized Phase III Trial. J Clin Oncol. 2021 Nov 1;39(31):3441-3452. doi: 10.1200/JCO.21.01210. Epub 2021 Jul 26.
- Alfaifi A, Bahashwan S, Alsaadi M, Ageel AH, Ahmed HH, Fatima K, Malhan H, Qadri I, Almehdar H. Advancements in B-Cell Non-Hodgkin's Lymphoma: From Signaling Pathways to Targeted Therapies. Adv Hematol. 2024 Nov 12;2024:5948170. doi: 10.1155/2024/5948170. eCollection 2024.
- Woyach JA, Jones D, Jurczak W, Robak T, Illes A, Kater AP, Ghia P, Byrd JC, Seymour JF, Long S, Mohamed N, Benrashid S, Lai TH, De Jesus G, Lai R, de Bruin G, Rule S, Munugalavadla V. Mutational profile in previously treated patients with chronic lymphocytic leukemia progression on acalabrutinib or ibrutinib. Blood. 2024 Sep 5;144(10):1061-1068. doi: 10.1182/blood.2023023659.
- Seymour JF, Byrd JC, Ghia P, Kater AP, Chanan-Khan A, Furman RR, O'Brien S, Brown JR, Munir T, Mato A, Stilgenbauer S, Bajwa N, Miranda P, Higgins K, John E, de Borja M, Jurczak W, Woyach JA. Detailed safety profile of acalabrutinib vs ibrutinib in previously treated chronic lymphocytic leukemia in the ELEVATE-RR trial. Blood. 2023 Aug 24;142(8):687-699. doi: 10.1182/blood.2022018818.
- Byrd JC, Hakre S, Ghia P. How well does acalabrutinib work and how safe is it to treat patients with chronic lymphocytic leukemia/small lymphocytic lymphoma who have had previous treatments? a plain language summary of 2 key studies. Future Oncol. 2025 Nov;21(26):3343-3357. doi: 10.1080/14796694.2025.2494976. Epub 2025 Jun 8.
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimated)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Neoplasms
- Chronic Disease
- Disease Attributes
- Immune System Diseases
- Neoplasms by Histologic Type
- Hematologic Diseases
- Lymphatic Diseases
- Lymphoproliferative Disorders
- Immunoproliferative Disorders
- Leukemia, B-Cell
- Leukemia, Lymphoid
- Leukemia
- Pathological Conditions, Signs and Symptoms
- Hemic and Lymphatic Diseases
- Leukemia, Lymphocytic, Chronic, B-Cell
- Tyrosine Kinase Inhibitors
- Antineoplastic Agents
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Protein Kinase Inhibitors
- acalabrutinib
- ibrutinib
Other Study ID Numbers
Other Study ID Numbers
- ACE-CL-006
- 2014-005530-64 (EudraCT Number)
- 2023-509347-27-00 (Registry Identifier: CTIS (EU))
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal.
All request will be evaluated as per the AZ disclosure commitment:
https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure. Yes, indicates that AZ are accepting requests for IPD, but this does not mean all requests will be shared.
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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