LCH-IV, protocollo internazionale di trattamento collaborativo per bambini e adolescenti con istiocitosi a cellule di Langerhans
The LCH-IV is an international, multicenter, prospective clinical study for pediatric Langerhans Cell Histiocytosis LCH (age < 18 years).
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Descrizione dettagliata
The international efforts of the past 20 years have shown that combination therapy with vinblastine and prednisone is an effective therapy for Multi-system (MS)-LCH. The previous prospective trial LCH-III confirmed this regimen as a standard regimen for MS-LCH in patients with and without risk organ involvement. It also showed that prolonged treatment in the latter group (treatment duration of 12 vs. 6 months) is superior in preventing disease reactivations. The results of this trial are encouraging and serve as a basis for the LCH-IV study design.Due to the complexity of the disease presentations and outcomes, the LCH-IV study seeks to tailor treatment based on features at presentation and on response to treatment, leading to seven strata:
- Stratum I: First-line treatment for MS-LCH patients (Group 1) and patients with Single system (SS)-LCH with multifocal bone or "Central Nervous System (CNS)-risk" lesions (Group 2)
- Stratum II: Second-line treatment for non-risk patients (patients without risk organ involvement who fail first-line therapy or have a reactivation after completion of first-line therapy)
- Stratum III: Salvage treatment for risk LCH (patients with dysfunction of risk organs who fail first-line therapy)
- Stratum IV: Stem cell transplantation for risk LCH (patients with dysfunction of risk organs who fail first-line therapy)
- Stratum V: Monitoring and treatment of isolated tumorous and neurodegenerative CNS-LCH
- Stratum VI: Natural history and management of "other" SS-LCH (patients who do not need systemic therapy at the time of diagnosis)
- Stratum VII: Long-term Follow up (all patients irrespective of previous therapy will be followed for reactivation or permanent consequences once complete disease resolution has been achieved and the respective protocol treatment completed)
Tipo di studio
Tipo di studio
Iscrizione (Effettivo)
Iscrizione
Fase
Fase
- Fase 2
- Fase 3
Contatti e Sedi
Luoghi di studio
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Alabama
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Birmingham, Alabama, Stati Uniti, 35233
- Children's of Alabama
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Arizona
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Phoenix, Arizona, Stati Uniti, 85006
- Phoenix Children's Hospital
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Arkansas
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Little Rock, Arkansas, Stati Uniti, 72202
- Arkansas Children's Hospital
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California
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Los Angeles, California, Stati Uniti, 90027
- Children's Hospital of Los Angeles
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Madera, California, Stati Uniti, 93636
- Valley Children's Healthcare
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Oakland, California, Stati Uniti, 94609
- UCSF Benioff Children's Hospital of Oakland
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Orange, California, Stati Uniti, 92868
- Children's Hospital of Orange County
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San Francisco, California, Stati Uniti, 94158-0106
- UCSF Helen Diller Family Cancer Center
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Connecticut
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Hartford, Connecticut, Stati Uniti, 06106
- Connecticut Children's Medical Center
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District of Columbia
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Washington D.C., District of Columbia, Stati Uniti, 20010
- Children's National Medical Center
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Florida
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St. Petersburg, Florida, Stati Uniti, 33701
- Johns Hopkins All Children's Hospital
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Georgia
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Atlanta, Georgia, Stati Uniti, 30342
- Children's Healthcare of Atlanta, Emory
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Illinois
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Chicago, Illinois, Stati Uniti, 60611-2991
- Ann & Robert H. Lurie Children's Hospital of Chicago
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Indiana
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Indianapolis, Indiana, Stati Uniti, 46202
- Riley Hospital for Children - Indiana University
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Kansas
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Kansas City, Kansas, Stati Uniti, 64108
- Children's Mercy Hospitals
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Kentucky
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Lexington, Kentucky, Stati Uniti, 40536
- University of Kentucky A.B.Chandler Medical Center
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Louisville, Kentucky, Stati Uniti, 40202
- University of Louisville, Norton Children's Hospital
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Maryland
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Baltimore, Maryland, Stati Uniti, 21287
- Johns Hopkins University
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Massachusetts
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Boston, Massachusetts, Stati Uniti, 02114
- Massachusetts General Hospital
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Boston, Massachusetts, Stati Uniti, 02115
- Dana Farber Cancer Institute
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Minnesota
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Minneapolis, Minnesota, Stati Uniti, 55404
- Children's Minnesota
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New Jersey
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Hackensack, New Jersey, Stati Uniti, 07601
- Hackensack University Medical Center
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New York
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New Hyde Park, New York, Stati Uniti, 11040
- Cohen Children's Medical Center
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New York, New York, Stati Uniti, 10029
- Mount Sinai Hospital
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New York, New York, Stati Uniti, 10032
- Columbia University / Herbert Irving Cancer Center
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New York, New York, Stati Uniti, 10170
- Memorial Sloan Kettering Cancer Center
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Syracuse, New York, Stati Uniti, 13210
- SUNY Upstate Medical University
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The Bronx, New York, Stati Uniti, 10467
- Children's Hospital at Montefiore
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North Carolina
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Charlotte, North Carolina, Stati Uniti, 28203
- Carolinas Medical Center, Levine Children's Hospital
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Ohio
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Akron, Ohio, Stati Uniti, 44308
- Akron Children's Hospital
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Cincinnati, Ohio, Stati Uniti, 45229
- Cincinnati Children's Hospital Medical Center
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Cleveland, Ohio, Stati Uniti, 44106
- Rainbow Babies & Children's Hospital, University Hospitals
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Toledo, Ohio, Stati Uniti, 43606
- Russell J Ebeid Children's Hospital (Promedica)
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Pennsylvania
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Pittsburgh, Pennsylvania, Stati Uniti, 15224
- UPMC Children's Hospital of Pittsburgh
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South Carolina
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Charleston, South Carolina, Stati Uniti, 29425
- Medical University of South Carolina (MUSC)
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Greenville, South Carolina, Stati Uniti, 29605
- Greenville Health System BI-LO Charities Children's Cancer Center
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Tennessee
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Memphis, Tennessee, Stati Uniti, 38105
- St. Jude Children's Research Hospital
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Nashville, Tennessee, Stati Uniti, 37232
- Vanderbilt-Ingram Cancer Center
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Texas
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Dallas, Texas, Stati Uniti, 75235
- Children's Medical Center Dallas, UT Southwestern
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Washington
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Spokane, Washington, Stati Uniti, 99204
- Providence Sacred Heart Children's Hospital
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Tacoma, Washington, Stati Uniti, 98431
- Madigan Army Medical Center
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Wisconsin
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Madison, Wisconsin, Stati Uniti, 53792
- American Family Children's Hospital University of Wisconsin
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Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
-
Stratum I
- Patients must be less than 18 years of age at the time of diagnosis.
- Patients must have histological verification of the diagnosis of Langerhans cell histiocytosis according to the criteria described in Section 6.1
- Signed informed consent form
-
Stratum II
- Patients of Stratum I who have:
- Progressive disease (AD worse) in non-risk organs after 6 weeks (Initial Course
- AD intermediate or worse in non-risk organs or AD better in risk organs after 12 weeks (Initial Course 2)
- Disease progression (AD worse) in non-risk organs at any time during continuation treatment
- Active disease at the end of Stratum I treatment
- Disease reactivation in non-risk organs at any time after completion of Stratum I treatment
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Stratum III
-
Patients from Stratum I who fulfill the following criteria:
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AD worse in risk organs after week 6 (after Initial Course 1), or AD worse or AD intermediate in risk organs after week 12 (after Initial Course 2).
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Presence of unequivocally severe organ dysfunction at the above mentioned evaluation points (hematological dysfunction, liver dysfunction, or both of them) as
- Hb <70 g/L (<7.0 g/dl) and/or transfusion dependency
- PLT <20 x109/L (20,000/μL) and/or transfusion dependency (both criteria have to be fulfilled) AND/OR
- Liver dysfunction (or digestive involvement with protein loss)
- Total protein <55 g/L or substitution dependency
- Albumin <25 g/L or substitution dependency (at least one of the two criteria to be fulfilled)
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-
Stratum IV
- Patients from Stratum I or Stratum III who fulfill the following criteria:
- AD worse in risk organs after week 6 (after Initial Course 1), or AD worse or AD intermediate in risk organs after week 12 (after Initial Course 2) of Stratum I OR
- AD worse after the 2nd and 3rd 2-CdA/Ara-C course, and those AD worse or AD intermediate after the 4th 2-CdA/Ara-C course of Stratum III AND
- Presence of unequivocally severe organ dysfunction at the above mentioned evaluation points (hematological dysfunction, liver dysfunction, or both of them) as defined in Table XI (see Section 10.3.1).
- Informed consent: All patients or their legal guardians (if the patient is <18 years of age) must sign an Ethics or institutional Review Board approved consent form indicating their awareness of the investigational nature and the risks of this study. When appropriate, younger patients will be included in all discussions in order to obtain assent.
- Adequate organ function: Patients should have adequate hepatic, renal, cardiac and pulmonary function to undergo reduced intensity HCT based upon local institutional guidelines, or at a minimum meet requirements noted in eligibility checklist Appendix A-VIII_1. However, significant hepatic and pulmonary dysfunction, if secondary to underlying LCH disease activity, will not exclude patients from protocol enrollment and should be discussed with the National PI Coordinator and the Coordinating Principal Investigator.
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Stratum V
- All patients with verified diagnosis of LCH and MRI findings consistent with ND-CNSLCH irrespective of previous treatments (also those not registered to other Strata ofLCH-IV).
- Patients with isolated tumorous CNS-LCH (including isolated DI with mass lesion in the hypothalamus-pituitary axis). In patients with already established diagnosis of LCH and radiologic finding of CNS lesions compatible with LCH, a biopsy of the lesion is not obligatory. In all other cases a biopsy of the lesion is needed for inclusion into the study
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Stratum VI
-- Patients with newly diagnosed SS-LCH and localization other than "multifocal bone",isolated tumorous CNS lesion, or isolated "CNS-risk" lesion.
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Stratum VII -- All patients registered in LCH IV (regardless of treatment) as long as consent for longterm follow-up has not been withheld.
Exclusion Criteria:
-
Stratum I
- Pregnancy (patients of child-bearing age must be appropriately tested before chemotherapy)
- LCH-related permanent consequences (e.g. vertebra plana, sclerosing cholangitis, lung fibrosis, etc.) in the absence of active disease
- Prior systemic therapy
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Stratum II
- Patients with progressive disease in risk organs
- Permanent consequences (e.g. sclerosing cholangitis, lung fibrosis, etc.) without evidence of active LCH in the same organ or in any other locations
- No written consent of the patient or his/her parents or legal guardian
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Stratum III
- The presence of any of the following criteria will exclude the patient from the study:
- Isolated sclerosing cholangitis without evidence of active hepatic LCH as the only evidence of risk organ involvement.
- Inadequate renal function as defined by serum creatinine > 3x normal for age
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Stratum IV
- Pulmonary failure (requiring mechanical ventilation) not due to active LCH.
- Isolated liver sclerosis or pulmonary fibrosis, without active LCH.
- Uncontrolled active life-threatening infection.
- Decreased renal function with a GFR of less than 50ml/1.73m2/min.
- Pregnancy or active breast feeding
- Failure to provide signed informed consent
-
Stratum VI
- Patients with SS-LCH who have an isolated tumorous CNS lesion (they are eligible for Stratum V),
- Patients with isolated "CNS-risk" or multifocal bone lesions (they are eligible for Stratum I, Group 2)
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Nessuno (etichetta aperta)
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
|
Sperimentale: Stratum I
Stratum I The combination of Prednisone and vinblastine is the standard first-line combination for patients needing systemic therapy (Stratum I). Patients with MS-LCH and involvement of risk organs, who do not respond to 6-12 weeks of standard therapy, will be immediately switched to alternative treatment approaches (Stratum III or Stratum IV). Further therapy prolongation (12 vs. 24 months) and intensification (± mercaptopurine) will further reduce the reactivation rate and the permanent consequences. |
Stratum I Stratum I
Altri nomi:
Stratum I
Altri nomi:
|
|
Sperimentale: Stratum II
A uniform "intensive" 24-week course consisting of prednisolone, vincristine and cytosine-arabinoside will be introduced in Stratum II for eligible patients. It will be followed by a continuation therapy to total treatment duration of 24 months. Participants who after SL-IT (week 24) have a response (NAD or AD better) are eligible for randomization between the continuation arms "INDOMETHACIN" and "6-MP/MTX" (mercaptopurine and Methotrexate). |
Altri nomi:
Stratum I Stratum I
Altri nomi:
Stratum I
Altri nomi:
Indomethacin fixed dose given daily orally in two divided doses with gastric protection for total treatment duration of 24 months. fixed dose weekly orally for total treatment duration of 24 months. |
|
Sperimentale: Stratum III
Salvage treatment for risk LCH To assess the efficacy of the combination 2-CdA/Ara-C (Cytosine Arabinoside and 2-chlorodeoxyadenosine) in MS-LCH (patients with risk organ involvement, who fail to respond to front-line (Stratum I) therapy. The initial therapy consists of 2 courses of 2-CdA/Ara-C. Continuation of outlined treatment to be assessed at assigned intervals in each stratum. |
Altri nomi:
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|
Sperimentale: Stratum IV
To determine the overall and disease free survival at 1 and 3 years after reduced intensity conditioning hematopoietic stem cell transplantation (RIC-HSCT). Salvage treatment option for MS-LCH patients with risk organ involvement, who fail to respond to front-line therapy (Stratum I) OR to the salvage 2- CdA/Ara-C regimen (Stratum III). |
|
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Sperimentale: Stratum V
Stratum V Monitoring and Treatment of isolated tumorous and neurodegenerative CNS-LCH - Special regimens will be offered to patients with isolated tumorous CNS-LCH (repeated 2-CdA courses) and to patients with clinically manifested ND-CNS-LCH (+/- extracranial LCH manifestations). For the last group monotherapy with Ara-C courses or (Intravenous immunoglobulin)IVIG will be offered depending on physician's choice. |
Altri nomi:
Altri nomi:
Altri nomi:
|
|
Sperimentale: Stratum VI
Natural history and management of "other" SS-LCH not eligible for stratum I group 2.
|
Altri nomi:
Altri nomi:
Altri nomi:
Stratum I Stratum I
Altri nomi:
Stratum I
Altri nomi:
|
Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Percentage of Patients with Reactivation Free Survival
Lasso di tempo: 12 Months
|
Stratum I, II, VI |
12 Months
|
|
Response Rate of Second Cycle
Lasso di tempo: 9 weeks
|
Stratum III |
9 weeks
|
|
Overall and disease free survival at 1 and 3 years after reduced intensity conditioning hematopoietic stem cell transplantation (RIC-HSCT)
Lasso di tempo: 3 Years
|
Stratum IV |
3 Years
|
|
The cumulative incidence of radiological and clinical neurodegeneration in patients with isolated tumorous CNS-LCH, DI, anterior pituitary dysfunction, and those with CNS-risk lesions
Lasso di tempo: 2 Years
|
Stratum V |
2 Years
|
|
The time interval and cumulative incidence of progression of radiological neurodegeneration to clinically manifested ND-CNS-LCH
Lasso di tempo: 2 Years
|
Stratum V |
2 Years
|
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Cumulative incidence of specific Permanent Consequences e.g. diabetes insipidus (DI), growth hormone deficiency (GHD), neuropsychological impairment, etc.
Lasso di tempo: 2 Years
|
From all treatment stratum via long-term follow up in Stratum VII |
2 Years
|
Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Numero di partecipanti con eventi avversi gravi e non gravi
Lasso di tempo: 2 anni
|
2 anni
|
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Incidenza cumulativa delle riattivazioni negli organi a rischio
Lasso di tempo: 2 anni
|
2 anni
|
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Incidenza del recupero ematopoietico e chimerismo del donatore a d+100 e 1 anno dopo RIC-HSCT
Lasso di tempo: 2 anni
|
2 anni
|
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Identificare possibili fattori di rischio per conseguenze permanenti (PC)
Lasso di tempo: 2 anni
|
2 anni
|
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Overall Survival
Lasso di tempo: 2 Years
|
Stratum I |
2 Years
|
|
Incidence of Permanent Consequences
Lasso di tempo: 2 Years
|
All Stratum |
2 Years
|
|
Time to complete disease resolution
Lasso di tempo: 2 Years
|
Stratum III |
2 Years
|
|
Response rate to the combination of prednisone, vincristine and cytarabine
Lasso di tempo: 2 years
|
Stratum II |
2 years
|
|
The proportion of patients alive and free of disease without permanent consequences (e.g. diabetes insipidus, anterior pituitary dysfunction, radiological or clinical neurodegeneration)
Lasso di tempo: 2 Years
|
Stratum II |
2 Years
|
|
Percentage of treatment-related toxicities
Lasso di tempo: 2 Years
|
Stratum II |
2 Years
|
|
Reactivation rates after continuation treatment with Indomethacin vs. 6-MP/MTX.
Lasso di tempo: 2 years
|
Stratum II |
2 years
|
|
The type of subsequent intensive and/or maintenance therapy utilized
Lasso di tempo: 2 Years
|
Stratum III |
2 Years
|
|
Early and late mortality
Lasso di tempo: 2 Years
|
Stratum II |
2 Years
|
|
Early and late toxicity
Lasso di tempo: 2 Years
|
Stratum III |
2 Years
|
|
d+100 transplant related mortality
Lasso di tempo: 2 Years
|
Stratum IV |
2 Years
|
|
Record all occurrence of skin, GI or liver abnormalities fulfilling criteria of Grades II-IV acute GVHD
Lasso di tempo: 2 Years
|
Stratum IV: Hematopoetic Stem Cell Transplantation for Risk LCH |
2 Years
|
|
Percentage of Participants with incidence of chronic GVHD
Lasso di tempo: 2 Years
|
Stratum IV |
2 Years
|
|
Response Rate to ND-CNS-targeted therapy at 12 and 24 months after start of therapy
Lasso di tempo: 2 years
|
Stratum V |
2 years
|
|
Response of isolated tumorous CNS-LCH to 2-CDA
Lasso di tempo: 2 Years
|
Stratum V |
2 Years
|
|
Frequency of ND-CNS-LCH in patients with isolated tumorous CNS-LCH
Lasso di tempo: 2 Years
|
Stratum V |
2 Years
|
|
Methods of early identification of ND-CNS-LCH
Lasso di tempo: 2 Years
|
Stratum V - Exploration of the value of neurochemistry, neurophysiology, and neuropsychology methods in early identification of ND-CNS-LCH and in assessing its severity, and comparison to MRI findings. |
2 Years
|
|
Need for systemic therapy later during disease course
Lasso di tempo: 2 Years
|
Stratum VI |
2 Years
|
Collaboratori e investigatori
Sponsor
Sponsor
Collaboratori
Collaboratori
Investigatori
Investigatori
- Cattedra di studio: Milen Minkov, MD, Ph.D, Children's Cancer Research Institute / St. Anna Children's Hospital
- Cattedra di studio: Carlos Rodriguez-Galindo, MD, North American Consortium for Histiocytosis
Studiare le date dei record
Studia le date principali
Inizio studio
Inizio studio
Completamento primario (Stimato)
Completamento primario
Completamento dello studio (Stimato)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Stimato)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
- Malattie delle vie respiratorie
- Malattie polmonari
- Malattie linfatiche
- Malattie polmonari, interstiziale
- Istiocitosi
- Malattie emiche e linfatiche
- Istiocitosi, cellule di Langerhans
- Aminoacidi, peptidi e proteine
- Proteine
- Composti di zolfo
- Prodotti chimici organici
- Composti eterociclici, 1-anello
- Composti eterociclici
- Composti eterociclici, 2 anelli
- Composti eterociclici, anello fuso
- Terapie
- Procedure chirurgiche, operative
- Acidi nucleici, nucleotidi e nucleosidi
- Alcaloidi
- Composti policiclici
- Trapianto
- Indoli
- Anticorpi
- Immunoglobuline
- Immunoproteine
- Proteine del sangue
- Globuline sieriche
- Globuline
- Purine
- Citidina
- Nucleosidi di pirimidina
- Pirimidine
- Incinta
- In gravidanza
- Steroidi
- Composti anelli fusi
- Nucleosidi
- Ribonucleosidi
- Pterins
- Pteridine
- Incintadienediols
- Vinca Alkaloids
- Alcaloidi di triptamina di secologia
- Alcaloidi indolo
- Indolizidine
- Indolizine
- Arabinonucleosidi
- Aminopterino
- Isotipi di immunoglobulina
- Immunoglobulina g
- Trapianto di cellule
- Terapia a base di cellule e tessuti
- Terapia biologica
- Deossiribonucleosidi
- Trapianto di cellule staminali
- 2-cloroadenosina
- Adenosina
- Nucleosidi purine
- Deossyadenosines
- Composti solfidrilici
- Metotrexato
- Prednisone
- Citarabina
- Mercaptopurina
- Vinblastina
- Immunoglobuline, per via endovenosa
- Cladribina
- Indometacina
- Trapianto di cellule staminali ematopoietiche
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- 13-428
- 2011-001699-20 (Numero EudraCT)
- 042011 (Altro identificatore: Children's Cancer Research Institute)
Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .