Uno studio retrospettivo di revisione della tabella di pazienti con sindrome da disfunzione bronchiale obliterante da allotrapianto polmonare cronico (CLAD-BOS) dopo trapianto polmonare
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Descrizione dettagliata
Questo è uno studio retrospettivo, multinazionale e multicentrico di revisione delle cartelle cliniche di pazienti adulti con diagnosi clinica di CLAD-BOS dopo trapianto polmonare. Tutti i dati verranno raccolti retrospettivamente dalle cartelle cliniche dei pazienti a partire dalla data del trapianto polmonare fino all'ultima data di dati disponibili e, pertanto, nessun intervento verrà applicato come parte di questo studio.
Il periodo di osservazione per ciascun paziente andrà dalla data del trapianto polmonare fino all'ultima data di dati disponibili o alla morte, a seconda di quale evento si verifica prima e includerà i seguenti periodi di tempo:
Finestra di diagnosi: 01 gennaio 2013 attraverso i dati più recenti disponibili.
Tipo di studio
Tipo di studio
Iscrizione (Effettivo)
Iscrizione
Contatti e Sedi
Contatto studio
Contatto studio
- Nome: Ceravolo, MD
- Numero di telefono: +39 02665241
- Email: ferdinando.ceravolo@zambongroup.com
Backup dei contatti dello studio
- Nome: Gentile, MD
- Numero di telefono: +39 02665241
- Email: emanuela.gentile@zambongroup.com
Luoghi di studio
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Leuven
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Leuven, Leuven, Belgio, 3000
- Universitaire Ziekenhuizen Leuven (UZ Leuven)
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Andalusia
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Córdoba, Andalusia, Spagna, 14004
- Hospital Universitario Reina Sofia
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Cantabria
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Santander, Cantabria, Spagna, 39008
- Hospital Universitario Marques de Valdecilla (HUMV)
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Ohio
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Cleveland, Ohio, Stati Uniti, 44195
- Cleveland Clinic Transplantation Center
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Columbus, Ohio, Stati Uniti, 43210
- The Ohio State University
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Texas
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Dallas, Texas, Stati Uniti, 75246
- Baylor Scott and White Health Center for Advanced Heart and Lung Disease
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Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
- Adulto
- Adulto più anziano
Accetta volontari sani
Metodo di campionamento
Popolazione di studio
Descrizione
Criterio di inclusione:
- Pazienti adulti di età ≥ 18 anni alla data della diagnosi CLAD-BOS
- Pazienti con diagnosi clinica CLAD-BOS già dal 1° gennaio 2013
- Pazienti con diagnosi clinica CLAD-BOS effettuata almeno 12 mesi dopo il trapianto di polmone
- I pazienti hanno ricevuto almeno un regime di mantenimento di base di agenti immunosoppressori incluso tacrolimus, un secondo agente come, ma non limitato a, micofenolato mofetile o azatioprina (o altro agente antiproliferativo) e un corticosteroide sistemico come il prednisone come terzo agente per almeno 1 mese prima della data indice. Finché il regime di mantenimento di base verrà mantenuto per il periodo sopra indicato, i pazienti saranno comunque considerati idonei per lo studio anche se stanno ricevendo altri agenti immunosoppressori in aggiunta al regime di mantenimento di base.
Criteri di esclusione:
- Pazienti con grave malattia concomitante al momento della data indice che, secondo il giudizio del medico, può interferire con la progressione e la mortalità di CLAD-BOS (ad es. tumori maligni, malattie croniche gravi)
- Pazienti che sono stati esposti a qualsiasi prodotto medico sperimentale nelle 4 settimane precedenti la data indice o durante il periodo post-diagnosi
- Pazienti con altro fenotipo CLAD confermato (ad es. Sindrome da allotrapianto restrittivo) secondo il giudizio del medico.
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
Numero di gruppi/coorti
Coorti e interventi
Gruppo / CoorteGruppo / Coorte |
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CLAD-BOS Cohort
Adult patients with clinically diagnosed chronic lung allograft dysfunction-bronchiolitis obliterans syndrome (CLAD-BOS) following lung transplantation, included in a retrospective observational chart review study.
No study-specific interventions were administered.
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
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Change Per Year in FEV1 Trajectory Starting From the Onset Date Through the End of the Post-diagnosis Period.
Lasso di tempo: From CLAD-BOS onset up to 3 years post-onset
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CLAD-BOS onset was defined as the first occurrence of a forced expiratory volume in 1 second (FEV1) value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement ≤80% at least 3 months later, as documented in the medical records.
The personal best FEV1 was defined as the mean of the two highest post-transplant FEV1 measurements obtained at least 3 weeks apart, derived from post-transplant spirometry data or identified in clinical records according to physician judgment.
The FEV1 value at CLAD-BOS onset served as the baseline for the analysis.
Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects.
Results are reported as model-based estimated mean changes from baseline in FEV1 per year.
The reported mean values represent estimates derived from the statistical model.
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From CLAD-BOS onset up to 3 years post-onset
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Change in FEV1 Trajectory Over Time Starting From the Onset Date Through the End of the Post-diagnosis Period.
Lasso di tempo: From CLAD-BOS onset up to 3 years post-onset
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CLAD-BOS onset was defined as the first occurrence of a forced expiratory volume in 1 second (FEV1) value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement ≤80% at least 3 months later, as documented in the medical records.
The personal best FEV1 was defined as the mean of the two highest post-transplant FEV1 measurements obtained at least 3 weeks apart, derived from post-transplant spirometry data or identified in clinical records according to physician judgment.
The FEV1 value at CLAD-BOS onset served as the baseline for the analysis.
Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects.
Results are reported as model-based estimated mean changes from baseline in FEV1 at prespecified time points after onset (1, 2, and 3 years).
The reported mean values represent estimates derived from the statistical model.
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From CLAD-BOS onset up to 3 years post-onset
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Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
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Age at Transplant
Lasso di tempo: At transplant date
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This secondary outcome summarizes descriptive characteristics collected at the time of lung transplantation.
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At transplant date
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Sex at Transplant
Lasso di tempo: At transplant date
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This secondary outcome summarizes descriptive characteristics collected at the time of lung transplantation.
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At transplant date
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Race
Lasso di tempo: At transplant date
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This secondary outcome summarizes descriptive characteristics collected at the time of lung transplantation.
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At transplant date
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Number of Participants With Pre-transplant Medical History and Lung Transplant History
Lasso di tempo: Up to transplant date
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This secondary outcome summarizes descriptive characteristics collected at the time of lung transplantation.
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Up to transplant date
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Time From Lung Transplantation to CLAD-BOS Onset
Lasso di tempo: From transplant date to onset date
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This secondary outcome summarizes descriptive characteristics collected at the time of lung transplantation.
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From transplant date to onset date
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Number of Participants With Clinical Characteristics Following Lung Transplantation (Acute Rejection Events, Presence of Lung Opacities, and Signs, Symptoms, or Other Clinical Records)
Lasso di tempo: From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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Descriptive clinical characteristics collected following lung transplantation in patients diagnosed with CLAD-BOS.
Variables included the occurrence of acute rejection events, presence of lung opacities as documented by computed tomography (CT) scans, and signs, symptoms, or other clinical records related to mobility, self-care, usual activities, pain or discomfort, anxiety, and depression.
These data were collected for descriptive purposes only.
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From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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Percentage of Participants by Donor-specific Antibodies Results
Lasso di tempo: From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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Descriptive clinical characteristics collected following lung transplantation in patients diagnosed with CLAD-BOS.
Presence of donor-specific antibodies.
These data were collected for descriptive purposes only.
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From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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Total Lung Capacity (Plethysmography)
Lasso di tempo: From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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Descriptive clinical characteristics collected following lung transplantation in patients diagnosed with CLAD-BOS. These data were collected for descriptive purposes only. All available plethysmography assessments after lung transplantation were considered; therefore, data from multiple time points were collected and presented as mean and standard deviation. |
From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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Change Per Year in FVC Trajectory
Lasso di tempo: From CLAD-BOS onset up to 3 years post-onset
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Change in Forced vital capacity (FVC) were evaluated from CLAD-BOS onset through the end of the post-diagnosis period.
CLAD-BOS onset was defined as the first occurrence of a forced expiratory volume in 1 second (FEV1) value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement at least 3 months later.
The FVC value at CLAD-BOS onset served as the baseline for the analysis.
Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects to account for within-subject correlation over time.
Results are reported as model-based estimated mean changes from baseline in FVC per year.
The reported mean values represent estimates derived from the statistical model.
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From CLAD-BOS onset up to 3 years post-onset
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Change in FVC Trajectory Over Time
Lasso di tempo: From CLAD-BOS onset up to 3 years post-onset
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Change in Forced vital capacity (FVC) were evaluated from CLAD-BOS onset through the end of the post-diagnosis period.
CLAD-BOS onset was defined as the first occurrence of a forced expiratory volume in 1 second (FEV1) value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement at least 3 months later.
The FVC value at CLAD-BOS onset served as the baseline for the analysis.
Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects to account for within-subject correlation over time.
Model-based estimates of mean change from baseline in FVC (absolute values) are reported at prespecified time points after onset (1, 2, and 3 years).
The reported mean values represent estimates derived from the statistical model and are accompanied by standard errors.
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From CLAD-BOS onset up to 3 years post-onset
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Change Per Year in FEV1/FVC Trajectory
Lasso di tempo: From CLAD-BOS onset up to 3 years post-onset
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Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured by spirometry, and the FEV1/FVC ratio was derived accordingly. CLAD-BOS onset was defined as the first occurrence of an FEV1 value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement at least 3 months later, as documented in the medical records. The FEV1/FVC value at CLAD-BOS onset served as the baseline for the analysis. Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects to account for within-subject correlation over time. Results are reported as model-based estimated mean changes from baseline in FEV1/FVC per year. The reported mean values represent estimates derived from the statistical model. |
From CLAD-BOS onset up to 3 years post-onset
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Change in FEV1/FVC Trajectory Over Time
Lasso di tempo: From CLAD-BOS onset up to 3 years post-onset
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Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured by spirometry, and the FEV1/FVC ratio was derived accordingly. CLAD-BOS onset was defined as the first occurrence of an FEV1 value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement at least 3 months later, as documented in the medical records. The FEV1/FVC value at CLAD-BOS onset served as the baseline for the analysis. Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects to account for within-subject correlation over time. Results are reported as model-based estimated mean changes from baseline in FEV1/FVC at prespecified time points after onset (1, 2, and 3 years). The reported mean values represent estimates derived from the statistical model, rather than arithmetic means of observed measurements. |
From CLAD-BOS onset up to 3 years post-onset
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Change in FEF25-75% Trajectory Over Time
Lasso di tempo: From CLAD-BOS onset up to 3 years post-onset
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Change from baseline in Forced mid-expiratory flow (FEF25-75%), expressed as liters per second (L/s), was evaluated to characterize changes in mid-expiratory airflow following CLAD-BOS onset. CLAD-BOS onset was defined as the first occurrence of an FEV1 value ≤80% of the patient's post-transplant best FEV1, confirmed by a subsequent measurement. Repeated post-onset spirometry measurements collected during routine clinical practice were analyzed using a linear mixed-effects model with random subject-specific effects to account for within-subject correlation over time. Due to non-normal distribution, FEF25-75% values were log-transformed for model fitting. Model-based estimates of mean change from baseline on the original scale are reported at prespecified follow-up time points (at 1, 2 and 3 years). The reported values represent estimates derived from the statistical model rather than arithmetic means of observed measurements. |
From CLAD-BOS onset up to 3 years post-onset
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Overall Survival (OS) From CLAD-BOS Onset
Lasso di tempo: From CLAD-BOS onset through death, up to 120 months
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Overall survival (OS) was defined as the time from CLAD-BOS onset to death from any cause.
OS was calculated as the time from the CLAD-BOS onset date to the earliest of the date of death or the last date the patient was known to be alive, expressed in months using a conversion factor of 30.4375 days per month.
Patients who were alive or had unknown vital status at the time of data abstraction were censored at the last date they were known to be alive.
Median OS and corresponding 95% confidence intervals were estimated using the Kaplan-Meier method, with confidence intervals calculated using the log-log transformation.
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From CLAD-BOS onset through death, up to 120 months
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Time to First CLAD-BOS Progression
Lasso di tempo: From CLAD-BOS onset through death (median follow up time 38.6 months)
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Time to first CLAD-BOS progression was defined as the time from CLAD-BOS onset to the first documented disease progression. Progression was defined as the earliest occurrence of any of the following events:
Median time to progression and 95% confidence intervals were estimated using the Kaplan-Meier method. |
From CLAD-BOS onset through death (median follow up time 38.6 months)
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Cumulative Number of CLAD-BOS Progression Events Per Patient
Lasso di tempo: From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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Cumulative CLAD-BOS progression events were assessed from CLAD-BOS onset through the end of the post-diagnosis follow-up period.
CLAD-BOS progression was defined as the earliest occurrence of an absolute decrease in FEV1 of ≥10% or ≥200 mL combined with an absolute decrease in FEV1/FVC of >5% confirmed by a subsequent assessment, change in CLAD grade severity, re-transplantation, death from respiratory failure, or clinical judgment reporting CLAD-BOS progression in patient records.
Event counts and rates were analyzed using a negative binomial regression model with an offset for follow-up time.
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From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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Hospitalization Rate Due to Respiratory Failure
Lasso di tempo: From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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The rate of hospitalizations due to respiratory failure was assessed from the CLAD-BOS onset date through the end of the post-diagnosis period.
Hospitalization events attributed to respiratory failure were identified from patient medical records.
Event rates were estimated using a negative binomial regression model with an offset for patient observation time to account for variable observation duration.
Results are reported as rates per year with 95% confidence intervals.
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From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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Number of Participants With Newly Diagnosed Cases of Concomitant Respiratory Diseases
Lasso di tempo: From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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The number of participants with concomitant respiratory diseases was assessed in the Full Analysis Set. Concomitant respiratory diseases were identified from patient records and coded using MedDRA (version 27.0) terminology. Results are summarized as the number and percentage of patients with at least one concomitant respiratory disease. Only concomitant respiratory disease categories reported in ≥ 5% of patients are presented. |
From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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Concomitant Treatments and Procedures for CLAD-BOS Starting From the Post-transplant Date Through the End of the Post-diagnosis Period
Lasso di tempo: From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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The use of concomitant treatments and procedures for CLAD-BOS following lung transplantation was assessed in the Full Analysis Set based on medical record review. Concomitant treatments and procedures were defined as those administered or performed after CLAD-BOS onset. Results are reported as the number and percentage of patients receiving at least one concomitant treatment or procedure. Concomitant treatments were coded using WHO Drug Dictionary terminology (version March 2024), and procedures were summarized descriptively. Only treatments and procedures reported in ≥ 5% of patients are presented. |
From lung transplantation until last date of data available or death. Specifically, from transplantation to CLAD-BOS onset, a median of 40.5 (max 227) months; from CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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Number of Participants With Newly Diagnosed Cases of Concomitant Non-respiratory Diseases
Lasso di tempo: From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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The number of participants with concomitant non-respiratory diseases was assessed in the Full Analysis Set based on medical record review.
Concomitant non-respiratory diseases were coded using MedDRA (version 27.0) preferred terms and summarized descriptively.
Results are reported as the number and percentage of patients with at least one concomitant non-respiratory disease.
Only non-respiratory disease categories reported in ≥ 5% of patients are presented.
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From CLAD-BOS onset to last data available or death a median of 38.6 (max 173) months
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Collaboratori e investigatori
Sponsor
Sponsor
Investigatori
Investigatori
- Direttore dello studio: Paola Castellani, MD, Zambon SpA
Studiare le date dei record
Studia le date principali
Inizio studio (Effettivo)
Inizio studio
Completamento primario (Effettivo)
Completamento primario
Completamento dello studio (Effettivo)
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 (Effettivo)
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
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- Z8000N01
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