LCH-IV, międzynarodowy protokół współpracy w leczeniu dzieci i młodzieży z histiocytozą z komórek Langerhansa
The LCH-IV is an international, multicenter, prospective clinical study for pediatric Langerhans Cell Histiocytosis LCH (age < 18 years).
Przegląd badań
Status
Status
Warunki
Warunki
Interwencja / Leczenie
Interwencja / Leczenie
Szczegółowy opis
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)
Typ studiów
Typ studiów
Zapisy (Rzeczywisty)
Zapisy
Faza
Faza
- Faza 2
- Faza 3
Kontakty i lokalizacje
Lokalizacje studiów
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Alabama
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Birmingham, Alabama, Stany Zjednoczone, 35233
- Children's of Alabama
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Arizona
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Phoenix, Arizona, Stany Zjednoczone, 85006
- Phoenix Children's Hospital
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Arkansas
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Little Rock, Arkansas, Stany Zjednoczone, 72202
- Arkansas Children's Hospital
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California
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Los Angeles, California, Stany Zjednoczone, 90027
- Children's Hospital of Los Angeles
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Madera, California, Stany Zjednoczone, 93636
- Valley Children's Healthcare
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Oakland, California, Stany Zjednoczone, 94609
- UCSF Benioff Children's Hospital of Oakland
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Orange, California, Stany Zjednoczone, 92868
- Children's Hospital of Orange County
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San Francisco, California, Stany Zjednoczone, 94158-0106
- UCSF Helen Diller Family Cancer Center
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Connecticut
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Hartford, Connecticut, Stany Zjednoczone, 06106
- Connecticut Children's Medical Center
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District of Columbia
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Washington D.C., District of Columbia, Stany Zjednoczone, 20010
- Children's National Medical Center
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Florida
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St. Petersburg, Florida, Stany Zjednoczone, 33701
- Johns Hopkins All Children's Hospital
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Georgia
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Atlanta, Georgia, Stany Zjednoczone, 30342
- Children's Healthcare of Atlanta, Emory
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Illinois
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Chicago, Illinois, Stany Zjednoczone, 60611-2991
- Ann & Robert H. Lurie Children's Hospital of Chicago
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Indiana
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Indianapolis, Indiana, Stany Zjednoczone, 46202
- Riley Hospital for Children - Indiana University
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Kansas
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Kansas City, Kansas, Stany Zjednoczone, 64108
- Children's Mercy Hospitals
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Kentucky
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Lexington, Kentucky, Stany Zjednoczone, 40536
- University of Kentucky A.B.Chandler Medical Center
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Louisville, Kentucky, Stany Zjednoczone, 40202
- University of Louisville, Norton Children's Hospital
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Maryland
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Baltimore, Maryland, Stany Zjednoczone, 21287
- Johns Hopkins University
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Massachusetts
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Boston, Massachusetts, Stany Zjednoczone, 02114
- Massachusetts General Hospital
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Boston, Massachusetts, Stany Zjednoczone, 02115
- Dana Farber Cancer Institute
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Minnesota
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Minneapolis, Minnesota, Stany Zjednoczone, 55404
- Children's Minnesota
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New Jersey
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Hackensack, New Jersey, Stany Zjednoczone, 07601
- Hackensack University Medical Center
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New York
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New Hyde Park, New York, Stany Zjednoczone, 11040
- Cohen Children's Medical Center
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New York, New York, Stany Zjednoczone, 10029
- Mount Sinai Hospital
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New York, New York, Stany Zjednoczone, 10032
- Columbia University / Herbert Irving Cancer Center
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New York, New York, Stany Zjednoczone, 10170
- Memorial Sloan Kettering Cancer Center
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Syracuse, New York, Stany Zjednoczone, 13210
- SUNY Upstate Medical University
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The Bronx, New York, Stany Zjednoczone, 10467
- Children's Hospital at Montefiore
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North Carolina
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Charlotte, North Carolina, Stany Zjednoczone, 28203
- Carolinas Medical Center, Levine Children's Hospital
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Ohio
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Akron, Ohio, Stany Zjednoczone, 44308
- Akron Children's Hospital
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Cincinnati, Ohio, Stany Zjednoczone, 45229
- Cincinnati Children's Hospital Medical Center
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Cleveland, Ohio, Stany Zjednoczone, 44106
- Rainbow Babies & Children's Hospital, University Hospitals
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Toledo, Ohio, Stany Zjednoczone, 43606
- Russell J Ebeid Children's Hospital (Promedica)
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Pennsylvania
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Pittsburgh, Pennsylvania, Stany Zjednoczone, 15224
- UPMC Children's Hospital of Pittsburgh
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South Carolina
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Charleston, South Carolina, Stany Zjednoczone, 29425
- Medical University of South Carolina (MUSC)
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Greenville, South Carolina, Stany Zjednoczone, 29605
- Greenville Health System BI-LO Charities Children's Cancer Center
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Tennessee
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Memphis, Tennessee, Stany Zjednoczone, 38105
- St. Jude Children's Research Hospital
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Nashville, Tennessee, Stany Zjednoczone, 37232
- Vanderbilt-Ingram Cancer Center
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Texas
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Dallas, Texas, Stany Zjednoczone, 75235
- Children's Medical Center Dallas, UT Southwestern
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Washington
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Spokane, Washington, Stany Zjednoczone, 99204
- Providence Sacred Heart Children's Hospital
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Tacoma, Washington, Stany Zjednoczone, 98431
- Madigan Army Medical Center
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Wisconsin
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Madison, Wisconsin, Stany Zjednoczone, 53792
- American Family Children's Hospital University of Wisconsin
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Kryteria uczestnictwa
Kryteria kwalifikacji
Kryteria kwalifikacji
Wiek uprawniający do nauki
Akceptuje zdrowych ochotników
Płeć kwalifikująca się do nauki
Opis
Inclusion Criteria:
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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
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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
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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
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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)
Plan studiów
Jak projektuje się badanie?
Szczegóły projektu
- Główny cel: Leczenie
- Przydział: Randomizowane
- Model interwencyjny: Przydział równoległy
- Maskowanie: Brak (otwarta etykieta)
Liczba ramion
Broń i interwencje
Grupa uczestników / ArmGrupa uczestników / Arm |
Interwencja / LeczenieInterwencja / Leczenie |
|---|---|
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Eksperymentalny: 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
Inne nazwy:
Stratum I
Inne nazwy:
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Eksperymentalny: 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). |
Inne nazwy:
Stratum I Stratum I
Inne nazwy:
Stratum I
Inne nazwy:
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. |
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Eksperymentalny: 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. |
Inne nazwy:
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Eksperymentalny: 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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Eksperymentalny: 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. |
Inne nazwy:
Inne nazwy:
Inne nazwy:
|
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Eksperymentalny: Stratum VI
Natural history and management of "other" SS-LCH not eligible for stratum I group 2.
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Inne nazwy:
Inne nazwy:
Inne nazwy:
Stratum I Stratum I
Inne nazwy:
Stratum I
Inne nazwy:
|
Co mierzy badanie?
Podstawowe miary wyniku
Podstawowe miary wyniku
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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Percentage of Patients with Reactivation Free Survival
Ramy czasowe: 12 Months
|
Stratum I, II, VI |
12 Months
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Response Rate of Second Cycle
Ramy czasowe: 9 weeks
|
Stratum III |
9 weeks
|
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Overall and disease free survival at 1 and 3 years after reduced intensity conditioning hematopoietic stem cell transplantation (RIC-HSCT)
Ramy czasowe: 3 Years
|
Stratum IV |
3 Years
|
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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
Ramy czasowe: 2 Years
|
Stratum V |
2 Years
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The time interval and cumulative incidence of progression of radiological neurodegeneration to clinically manifested ND-CNS-LCH
Ramy czasowe: 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.
Ramy czasowe: 2 Years
|
From all treatment stratum via long-term follow up in Stratum VII |
2 Years
|
Miary wyników drugorzędnych
Miary wyników drugorzędnych
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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Liczba uczestników z poważnymi i niepoważnymi zdarzeniami niepożądanymi
Ramy czasowe: 2 lata
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2 lata
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Skumulowana częstość występowania reaktywacji w narządach ryzyka
Ramy czasowe: 2 lata
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2 lata
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Częstość występowania regeneracji hematopoetycznej i chimeryzmu dawcy w d + 100 i 1 rok po RIC-HSCT
Ramy czasowe: 2 lata
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2 lata
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Zidentyfikuj możliwe czynniki ryzyka trwałych konsekwencji (PC)
Ramy czasowe: 2 lata
|
2 lata
|
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Overall Survival
Ramy czasowe: 2 Years
|
Stratum I |
2 Years
|
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Incidence of Permanent Consequences
Ramy czasowe: 2 Years
|
All Stratum |
2 Years
|
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Time to complete disease resolution
Ramy czasowe: 2 Years
|
Stratum III |
2 Years
|
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Response rate to the combination of prednisone, vincristine and cytarabine
Ramy czasowe: 2 years
|
Stratum II |
2 years
|
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The proportion of patients alive and free of disease without permanent consequences (e.g. diabetes insipidus, anterior pituitary dysfunction, radiological or clinical neurodegeneration)
Ramy czasowe: 2 Years
|
Stratum II |
2 Years
|
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Percentage of treatment-related toxicities
Ramy czasowe: 2 Years
|
Stratum II |
2 Years
|
|
Reactivation rates after continuation treatment with Indomethacin vs. 6-MP/MTX.
Ramy czasowe: 2 years
|
Stratum II |
2 years
|
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The type of subsequent intensive and/or maintenance therapy utilized
Ramy czasowe: 2 Years
|
Stratum III |
2 Years
|
|
Early and late mortality
Ramy czasowe: 2 Years
|
Stratum II |
2 Years
|
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Early and late toxicity
Ramy czasowe: 2 Years
|
Stratum III |
2 Years
|
|
d+100 transplant related mortality
Ramy czasowe: 2 Years
|
Stratum IV |
2 Years
|
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Record all occurrence of skin, GI or liver abnormalities fulfilling criteria of Grades II-IV acute GVHD
Ramy czasowe: 2 Years
|
Stratum IV: Hematopoetic Stem Cell Transplantation for Risk LCH |
2 Years
|
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Percentage of Participants with incidence of chronic GVHD
Ramy czasowe: 2 Years
|
Stratum IV |
2 Years
|
|
Response Rate to ND-CNS-targeted therapy at 12 and 24 months after start of therapy
Ramy czasowe: 2 years
|
Stratum V |
2 years
|
|
Response of isolated tumorous CNS-LCH to 2-CDA
Ramy czasowe: 2 Years
|
Stratum V |
2 Years
|
|
Frequency of ND-CNS-LCH in patients with isolated tumorous CNS-LCH
Ramy czasowe: 2 Years
|
Stratum V |
2 Years
|
|
Methods of early identification of ND-CNS-LCH
Ramy czasowe: 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
Ramy czasowe: 2 Years
|
Stratum VI |
2 Years
|
Współpracownicy i badacze
Sponsor
Sponsor
Współpracownicy
Współpracownicy
Śledczy
Śledczy
- Krzesło do nauki: Milen Minkov, MD, Ph.D, Children's Cancer Research Institute / St. Anna Children's Hospital
- Krzesło do nauki: Carlos Rodriguez-Galindo, MD, North American Consortium for Histiocytosis
Daty zapisu na studia
Główne daty studiów
Rozpoczęcie studiów
Rozpoczęcie studiów
Zakończenie podstawowe (Szacowany)
Zakończenie podstawowe
Ukończenie studiów (Szacowany)
Ukończenie studiów
Daty rejestracji na studia
Pierwszy przesłany
Pierwszy przesłany
Pierwszy przesłany, który spełnia kryteria kontroli jakości
Pierwszy przesłany, który spełnia kryteria kontroli jakości
Pierwszy wysłany (Szacowany)
Pierwszy wysłany
Aktualizacje rekordów badań
Ostatnia wysłana aktualizacja (Rzeczywisty)
Ostatnia wysłana aktualizacja
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
Ostatnia weryfikacja
Ostatnia weryfikacja
Więcej informacji
Terminy związane z tym badaniem
Słowa kluczowe
Dodatkowe istotne warunki MeSH
- Choroby Układu Oddechowego
- Choroby płuc
- Choroby limfatyczne
- Choroby płuc, śródmiąższowe
- Histiocytoza
- Choroby hemowe i limfatyczne
- Histiocytoza, komórki Langerhansa
- Aminokwasy, peptydy i białka
- Białka
- Związki siarki
- Organiczne chemikalia
- Związki heterocykliczne, 1-ring
- Związki heterocykliczne
- Związki heterocykliczne, 2-ring
- Związki heterocykliczne, sterowanie stopieniem
- Lecznictwo
- Procedury chirurgiczne, operacyjny
- Kwasy nukleinowe, nukleotydy i nukleozydy
- Alkaloidy
- Związki policykliczne
- Przeszczep
- Indole
- Przeciwciała
- Immunoglobuliny
- Immunoproteiny
- Białka krwi
- Globuliny w surowicy
- Globuliny
- Puryny
- Cytydyna
- Nukleozydy pirymidynowe
- Pirymidyn
- Ciąży
- Ciężarne
- Steroidy
- Związki sterownika
- Nukleozydy
- Rybonukleozydy
- Pterins
- Perydyny
- Ciąży
- Vinca alkaloidy
- Sesologanina alkaloidy tryptaminy
- Alkaloidy indole
- Indolizicyny
- Indolizyny
- Arabinonukleozydy
- Aminopterina
- Izotypy immunoglobuliny
- Immunoglobulina g
- Przeszczep komórki
- Terapia oparta na komórkach i tkankach
- Terapia biologiczna
- Deoksyrybonukleozydy
- Przeszczep komórek macierzystych
- 2-chloroadenozyna
- Adenozyna
- Nukleozydy purynowe
- Deoksyadenozyny
- Związki sulfhydrylowe
- Metotreksat
- Prednizon
- Cytarabina
- Merkaptopuryna
- Winblastyna
- Immunoglobuliny, dożylnie
- Kladrybina
- Indometacyna
- Hematopoetyczne przeszczep komórek macierzystych
Inne numery identyfikacyjne badania
Inne numery identyfikacyjne badania
- 13-428
- 2011-001699-20 (Numer EudraCT)
- 042011 (Inny identyfikator: Children's Cancer Research Institute)
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