A Study of Eltrombopag or Placebo in Combination With Azacitidine in Subjects With International Prognostic Scoring System (IPSS) Intermediate-1, Intermediate-2 or High-risk Myelodysplastic Syndromes (MDS)
A Randomized, Double-blind, Placebo-controlled, Phase III, Multi-centre Study of Eltrombopag or Placebo in Combination With Azacitidine in Subjects With IPSS Intermediate-1, Intermediate 2 and High-risk Myelodysplastic Syndromes (MDS) SUPPORT: A StUdy of eltromboPag in myelodysPlastic SyndrOmes Receiving azaciTidine
研究概览
研究类型
注册 (实际的)
阶段
- 第三阶段
联系人和位置
学习地点
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Aarhus、丹麦、8000 C
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Koebenhavn Oe、丹麦、2100
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Haifa、以色列、31096
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Holon、以色列、58100
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Jerusalem、以色列、91120
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Jerusalem、以色列、91031
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Kfar Saba、以色列、44281
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Petach-Tikva、以色列、49100
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Tel Aviv、以色列、64239
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Kaluga、俄罗斯联邦、248007
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Moscow、俄罗斯联邦、115478
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Moscow、俄罗斯联邦、125167
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Moscow、俄罗斯联邦、129301
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Penza、俄罗斯联邦、440071
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St Petersburg、俄罗斯联邦、193024
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St'Petersburg、俄罗斯联邦、197341
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Quebec、加拿大、G1J 1Z4
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Québec、加拿大、G1J 1Z4
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Ontario
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Toronto、Ontario、加拿大、M5G 2M9
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Quebec
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Montreal、Quebec、加拿大、H2L 4M1
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Sherbrooke、Quebec、加拿大、J1H 5N4
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Debrecen、匈牙利、4012
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Szeged、匈牙利、6725
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Changhua、台湾、500
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Kaohsiung、台湾、807
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Kaohsiung、台湾、833
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Taipei、台湾、112
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Oaxaca、墨西哥、68000
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Nuevo León
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Monterrey、Nuevo León、墨西哥、64460
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Seoul、大韩民国、06351
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Seoul、大韩民国、138-736
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Seoul、大韩民国、135-710
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Seoul、大韩民国、137-701
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Seoul、大韩民国、06591
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Seoul、大韩民国、05505
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Graz、奥地利、8036
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Innsbruck、奥地利、A-6020
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Linz、奥地利、4020
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Rankweil、奥地利、A-6830
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Salzburg、奥地利、A-5020
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Steyr、奥地利、4400
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Vienna、奥地利、1140
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Rio de Janeiro、巴西、20211-030
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Sao Paulo - SP、巴西、01323-900
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Minas Gerais
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Belo Horizonte、Minas Gerais、巴西、30130-100
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Paraná
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Curitiba、Paraná、巴西、81520-060
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Rio Grande Do Sul
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Porto Alegre、Rio Grande Do Sul、巴西、90035-903
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Santa Catarina
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Florianopolis、Santa Catarina、巴西、88034-000
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São Paulo
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Sao Paulo、São Paulo、巴西、01236030
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Sao Paulo、São Paulo、巴西、08270-070
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Athens,、希腊、11 527
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Larisa、希腊、41 110
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Patra、希腊、26500
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Thessaloniki、希腊、54642
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Thessaloniki、希腊、54636
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Baden-Wuerttemberg
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Stuttgart、Baden-Wuerttemberg、德国、70199
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Bayern
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Muenchen、Bayern、德国、81675
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Niedersachsen
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Goettingen、Niedersachsen、德国、37075
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Nordrhein-Westfalen
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Duesseldorf、Nordrhein-Westfalen、德国、40225
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Duesseldorf、Nordrhein-Westfalen、德国、40479
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Duisburg、Nordrhein-Westfalen、德国、47166
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Sachsen
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Dresden、Sachsen、德国、01307
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Calabria
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Reggio Calabria、Calabria、意大利、89100
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Emilia-Romagna
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Modena、Emilia-Romagna、意大利、41124
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Liguria
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Genova、Liguria、意大利、10126
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Piemonte
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Novara、Piemonte、意大利、28100
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Toscana
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Firenze、Toscana、意大利、50134
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Bergen、挪威、N-5021
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Oslo、挪威、0027
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Brno、捷克语、625 00
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Ostrava、捷克语、708 52
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Praha、捷克语、128 20
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Praha 10、捷克语、100 34
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Praha 2、捷克语、128 08
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Brasschaat、比利时、2930
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Brugge、比利时、8000
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Leuven、比利时、3000
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Lodelinsart、比利时、6042
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Turnhout、比利时、2300
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Angers Cedex 9、法国、49933
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Caen Cedex 9、法国、14033
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Le Mans、法国、72000
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Paris、法国、75010
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Paris Cedex 12、法国、75571
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Pringy Cedex、法国、74374
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Krakow、波兰、31-501
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Legnica、波兰、59-200
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Lublin、波兰、20-081
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Opole、波兰、45-061
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Slupsk、波兰、76-200
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Torun、波兰、87-100
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San Juan、波多黎各、00927
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Bangkok、泰国、10700
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Bangkok、泰国、10400
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ChiangMai、泰国、50000
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New South Wales
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Kogarah、New South Wales、澳大利亚、2217
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South Australia
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Adelaide、South Australia、澳大利亚、5000
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Victoria
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Clayton、Victoria、澳大利亚、3168
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East Melbourne、Victoria、澳大利亚、3002
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Melbourne、Victoria、澳大利亚、3000
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Ankara、火鸡、06590
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Izmir、火鸡、35340
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Izmir、火鸡、35100
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Samsun、火鸡、55139
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Dublin、爱尔兰、7
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Galway、爱尔兰
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James Street、爱尔兰、8
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Limerick、爱尔兰
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Tallaght, Dublin、爱尔兰、24
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Goteborg、瑞典、SE-413 45
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Göteborg、瑞典、SE-413 45
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Stockholm、瑞典、SE-141 86
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Uppsala、瑞典、SE-751 85
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Aarau、瑞士、5001
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Bellinzona、瑞士、6500
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Bern、瑞士、3010
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Zuerich、瑞士、8091
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Lima、秘鲁、Lima 11
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Lima、秘鲁、Lima 31
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Connecticut
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Hartford、Connecticut、美国、06105
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Georgia
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Atlanta、Georgia、美国、30322
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Illinois
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Chicago、Illinois、美国、60612
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Indiana
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Anderson、Indiana、美国、46016
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Missouri
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Kansas City、Missouri、美国、64128
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San Luis、Missouri、美国、63110
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New York
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Bronx、New York、美国、10461
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North Carolina
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Winston-Salem、North Carolina、美国、27157
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Washington
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Seattle、Washington、美国、98108
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Wisconsin
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Milwaukee、Wisconsin、美国、53226
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Barcelona、西班牙、08035
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Barcelona、西班牙、08036
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Gerona、西班牙、17007
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La Laguna (Santa Cruz De Tenerife)、西班牙、38320
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Leon、西班牙、24071
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León、西班牙、24071
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Madrid、西班牙、28034
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Madrid、西班牙、28046
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Madrid、西班牙、28007
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Majadahonda (Madrid)、西班牙、28222
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Malaga、西班牙、29010
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Málaga、西班牙、29010
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Oviedo、西班牙、33006
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Palma de Mallorca、西班牙、07198
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Palma de Mallorca、西班牙、07014
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Pozuelo De Alarcon/Madrid、西班牙、28223
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Pozuelo De Alarcón/Madrid、西班牙、28223
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Salamanca、西班牙、37007
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Valencia、西班牙、46026
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Valencia、西班牙、46010
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Asturias
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Oviedo、Asturias、西班牙、33011
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Ciudad Autonoma de Buenos Aires、阿根廷、1114
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Ciudad Autonoma de Buenos Aires、阿根廷、1425
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Ciudad Autonoma de Buenos Aires、阿根廷、C1181ACH
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Santa Fe、阿根廷、S3000ADL
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Chai Wan、香港
- Novartis Investigative Site
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Hong Kong、香港
- Novartis Investigative Site
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Shatin, New Territories、香港
- Novartis Investigative Site
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Tuen Mun、香港
- Novartis Investigative Site
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Age >=18 years (For subjects in Taiwan, Age >= 20 years)
- MDS by World Health Organization (WHO) or French-American-British (FAB) classification
- Intermediate 1, intermediate 2 or high risk MDS by IPSS
- At least one platelet count < 75 Gi/L
- Eastern Cooperative Oncology Group (ECOG) Status 0-2
- Adequate baseline organ function defined by the criteria below: total bilirubin =< 1.5x the upper limit of normal (ULN) except for Gilbert's syndrome or cases clearly not indicative of inadequate liver function (i.e. elevation of indirect [haemolytic] bilirubin in the absence of alanine aminotransferase [ALT] abnormality); ALT =< 2.5xULN; creatinine =< 2.5xULN
- Subjects with a corrected QT interval (QTc) <450 milliseconds (msec) or <480msec for subjects with bundle branch block. The QTc is the QT interval corrected for heart rate according to Fridericia's formula (QTcF), machine or manual overread. For subject eligibility and withdrawal, QTcF will be used. For purposes of data analysis, QTcF will be used. The QTc should be based on single or averaged QTc values of triplicate electrocardiograms (ECGs) obtained over a brief recording period
- Subject is able to understand and comply with protocol requirements and instructions
- Subject has signed and dated informed consent
- Women must be either of non-child bearing potential, or women with child-bearing potential and men with reproductive potential must be willing to practice acceptable methods of birth control during the study
- Women of childbearing potential must have a negative serum or urine pregnancy test within 7 days of first dose of study treatment and agree to use effective contraception during the study and for 3 months following the last dose of study treatment
- Men with a female partner of childbearing potential must have either had a prior vasectomy or agree to use effective contraception from time of randomization until 16 weeks after the last dose of study treatment
- French subjects: In France, a subject will be eligible for inclusion in this study only if either affiliated to or a beneficiary of a social security category
Exclusion Criteria:
- Previous treatment with hypomethylating agent or induction chemotherapy for MDS
- Proliferative type chronic myelomonocytic leukemia with white blood cell count >12 Gi/L at any time during the 28 days before Day 1
- History of treatment with eltrombopag, romiplostim or other thrombopoietin receptor (TPO-R) agonists
- Previous allogeneic stem-cell transplantation
- Known thrombophilic risk factors. Exception: Subjects for whom the potential benefits of participating in the study outweigh the potential risks of thromboembolic events, as determined by the investigator
- Treatment with an investigational drug within 30 days or 5 half-lives (whichever is longer) preceding the first dose of investigational product (eltrombopag/placebo)
- Active and uncontrolled infections, including hepatitis B or C
- Human Immunodeficiency Virus (HIV) infection
- Known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to eltrombopag or its excipient, or azacitidine, that contraindicates the subjects' participation
- Pregnant or lactating female
- Any serious and/or unstable pre-existing medical condition (including any advanced malignancy other than the disease under study), psychiatric disorder, or other conditions that could interfere with subject's safety, obtaining informed consent or compliance with the study procedures
- French subjects: the French subject has participated in any study using an investigational drug during the previous 30 days
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:双倍的
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
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实验性的:Eltrombopag
Eligible subject will receive a starting dose of eltrombopag of 200 milligrams (mg) (100 mg for subjects of East Asian heritage).
Dose modifications of eltrombopag will be permitted by 100 mg increments (50 mg increments for East Asians) to a lowest dose of 100 mg (50 mg for East Asian heritage) or a maximum dose of 300 mg (150 mg for East Asian heritage) in order to maintain platelet counts at a safe and effective level (i.e. a level sufficient to avoid platelet transfusions and bleeding events).
Subjects will receive azacitidine 75 mg/meter^2 subcutaneously once daily for 7 days (+/- 3 day treatment window permitted) every 28 days, for at least 6 cycles if tolerated and until they are no longer receiving benefit (defined as at least stable disease per the investigator's assessment) or until disease progression, death, or unacceptable toxicity/adverse event.
The subject may receive eltrombopag daily for the full 28 days each cycle for as long as the subject is receiving azacitidine
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Eltrombopag will be round film-coated tablets containing eltrombopag equivalent to 50 mg (white to off-white), 200 mg and 300 mg (green) of eltrombopag free acid
Subcutaneous Injection (IV if local standard)
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|
安慰剂比较:Placebo
Eligible subject will receive eltrombopag matching placebo.
Subjects will receive azacitidine 75 mg/meter^2 subcutaneously once daily for 7 days (+/- 3 day treatment window permitted) every 28 days, for at least 6 cycles if tolerated and until they are no longer receiving benefit (defined as at least stable disease per the investigator's assessment) or until disease progression, death, or unacceptable toxicity/adverse event.
The subject may receive eltrombopag daily for the full 28 days each cycle for as long as the subject is receiving azacitidine
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Subcutaneous Injection (IV if local standard)
Eltrombopag matching placebo tablets
Eltrombopag matching placebo tablets will be supplied
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Number of Participants Who Were Platelet Transfusion Independent During Cycles 1-4 of Azacitidine Therapy
大体时间:4 cycles (Cycle = 28 days)
|
A subject is defined as being platelet transfusion independent if they received no platelet transfusions within the first 4 cycles of treatment with azacitidine.
Subjects who died or withdrew from investigational product within the first four cycles were treated as failures (i.e.
not transfusion independent) in the analysis
|
4 cycles (Cycle = 28 days)
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
|
Overall Survival (OS)
大体时间:Randomization until death or end of study, approximately 2 years
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Overall survival is defined as the time from randomization until death due to any cause and deaths have been presented.
Subjects still alive at the time of the analysis and subjects who have withdrawn from the study will be censored at the time of last contact
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Randomization until death or end of study, approximately 2 years
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Summary of Progression Free Survival From Investigator Assessment (ITT)
大体时间:First day of each cycle (Cycles 3+), at the end of therapy visit and every 3 months in follow-up for approximately 2 years
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Progression-free survival, defined as the time from randomization until either disease progression or death.
The modified 2006 IWG criteria for MDS used for progression assessment For patients with: Less than 5% BM blasts: ≥ 50% increase in blasts to > 5% blasts; 5% - <10% BM blasts: ≥ 50% increase to > 10% blasts; 10% - <20% BM blasts: ≥ 50% increase to > 20% blasts; 20% - 30% BM blasts: ≥ 50% increase to > 30% blasts
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First day of each cycle (Cycles 3+), at the end of therapy visit and every 3 months in follow-up for approximately 2 years
|
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Summary of Progression Free Survival From Central Review (ITT)
大体时间:First day of each cycle (Cycles 3+), at the end of therapy visit and every 3 months in follow-up for approximately 2 years
|
Progression-free survival, defined as the time from randomization until either disease progression or death. The modified 2006 IWG criteria for MDS used for progression assessment For patients with: Less than 5% BM blasts: ≥ 50% increase in blasts to > 5% blasts; 5% - <10% BM blasts: ≥ 50% increase to > 10% blasts; 10% - <20% BM blasts: ≥ 50% increase to > 20% blasts; 20% - 30% BM blasts: ≥ 50% increase to > 30% blasts |
First day of each cycle (Cycles 3+), at the end of therapy visit and every 3 months in follow-up for approximately 2 years
|
|
Summary of AML Progression From Investigator Assessment and Central Review (ITT)
大体时间:First day of each cycle (Cycles 3+), at the end of therapy visit and every 3 months in follow-up for approximately 2 years
|
Progression to AML in MDS patients with baseline bone marrow blast < 20% was defined as meeting definition of disease progression according to the modified 2006 IWG response criteria for MDS with the additional requirement that bone marrow blast or peripheral blast increases from < 20% at baseline to ≥ 20% postbaseline. Progression assessment For patients with: Less than 5% BM blasts: ≥ 50% increase in blasts to > 5% blasts; 5% - <10% BM blasts: ≥ 50% increase to > 10% blasts; 10% - <20% BM blasts: ≥ 50% increase to > 20% blasts; 20% - 30% BM blasts: ≥ 50% increase to > 30% blasts |
First day of each cycle (Cycles 3+), at the end of therapy visit and every 3 months in follow-up for approximately 2 years
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Best Disease Response From Investigator Assessment (ITT)
大体时间:At end of Cycle 6 (cycle=28 days) or end of therapy, whichever came first
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Best disease response is categorized as complete remission (CR), partial remission (PR), or marrow CR, stable disease, disease progression, or as non-evaluable; according to modified 2006 International Working Group (IWG) criteria for MDS
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At end of Cycle 6 (cycle=28 days) or end of therapy, whichever came first
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Best Disease Response From Central Review (ITT)
大体时间:At end of Cycle 6 (cycle=28 days) or end of therapy, whichever came first
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Best disease response is categorized as complete remission (CR), partial remission (PR), or marrow CR, stable disease, disease progression, or as non-evaluable; according to modified 2006 International Working Group (IWG) criteria for MDS
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At end of Cycle 6 (cycle=28 days) or end of therapy, whichever came first
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Hematologic Improvement (HI) in Platelets, Neutrophils, and Hemoglobin Based on the Modified IWG Criteria for MDS (ITT)
大体时间:From Day 1 to 4-week follow-up (samples collected weekly in Cycle 1, Days 1 and 15 in Cycles 2-6 and Day 1 of Cycles >=7)
|
HI based on the modified IWG criteria for MDS.
HI - Platelets (BL <100Gi/L), response criteria= BL <20: increase to>20 and 100% at least for 56 days or BL >=20: absolute increase of >=30.
HI - Neutrophils (BL <1.0 Gi/L), response criteria=100% increase and an absolute increase >0.5 Gi/L over BL for at least 56 days.
HI-Hemoglobin (BL <g/dL), response criteria=Hgb increase by >=1.5 g/dL over BL, RBC transfusions(given for Hgb<=9.0)
reduced by >=4 per 8w from BL
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From Day 1 to 4-week follow-up (samples collected weekly in Cycle 1, Days 1 and 15 in Cycles 2-6 and Day 1 of Cycles >=7)
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Number of Participants Who Were Platelet Transfusion Independent (ITT Set)
大体时间:From Day 1 to end of study treatment up to approximately 2 years
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Platelet transfusion independence is defined for each cycle as the number of participants who continue to the end of a cycle without requiring a platelet transfusion
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From Day 1 to end of study treatment up to approximately 2 years
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Bleeding Adverse Events (AEs) >= Grade 3
大体时间:From Day 1 to 4-week follow-up up to approximately 2 years
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Bleeding will be assessed by recording AEs or serious adverse events (SAEs) as graded according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.0
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From Day 1 to 4-week follow-up up to approximately 2 years
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Number of of Subjects With Azacitidine Dose Delays, Dose Reductions, Interruptions
大体时间:From Day 1 to 4-week follow-up up to approximately 2 years
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The proportion of subjects with any delay, reduction or interruption in dosage of Azacitidine excluding those for non-medical reasons will be analyzed
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From Day 1 to 4-week follow-up up to approximately 2 years
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Response Levels in All Domains of Euroquol-5 Dimensions of Health, 3 Response Levels (EQ-5D-3L™)
大体时间:From Day 1 to 4-week follow-up up to approximately 2 years
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The EQ-5D is a general health status and health utility measure which captures 5 dimensions of health state: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.
(EQ-5D is a trademark of the Stichting EuroQol Group) .
C=cycle, D=Day
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From Day 1 to 4-week follow-up up to approximately 2 years
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Functional Assessment of Chronic Disease Therapy-fatigue Subscale (FACIT-Fatigue) (ITT)
大体时间:From Day 1 to 4-week follow-up (Approximate median 9 Cycles+4 weeks follow-up) up to approximately 2 years
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The FACIT-Fatigue subscale measures severity and impact of fatigue on functioning and Health Related QoL experienced in the past 7 days.
Scale is a 13 item measure of fatigure.
Items are scored on a 0-4 response scale ranging from "not at all" to "very much so".
All items are summed to create a single fatigure score with a range from 0 to 52.
Items are reverse scored when appropriate to provide a scale in which higher scores represent better functioning or less fatiigue (The FACIT Fatigue Scale is owned by David Cella, Ph.D.)
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From Day 1 to 4-week follow-up (Approximate median 9 Cycles+4 weeks follow-up) up to approximately 2 years
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Medical Resource Utilization (MRU): Event -Hospitalizations Inpatient and Outpatient
大体时间:From Day 1 to 4-week follow-up (Approximate median 9 Cycles+4 weeks follow-up) up to approximately 2 years
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MRU data will be collected for each subject.
Events corresponding to unscheduled (not scheduled per protocol) hospitalizations
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From Day 1 to 4-week follow-up (Approximate median 9 Cycles+4 weeks follow-up) up to approximately 2 years
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Medical Resource Utilization (MRU): Event and Use of Site Specific Medical Resources - Non-study Laboratory Tests
大体时间:From Day 1 to 4-week follow-up (Approximate median 9 Cycles+4 weeks follow-up) up to approximately 2 years
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MRU data will be collected for each subject.
Events corresponding to unscheduled (not scheduled per protocol) hospitalizations, office visits including consultations, laboratory and diagnostic tests (lab results, imaging etc.), and procedures prior to therapy initiation and during therapy will be collected
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From Day 1 to 4-week follow-up (Approximate median 9 Cycles+4 weeks follow-up) up to approximately 2 years
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Medical Resource Utilization (MRU): Use of Site Specific Medical Resources
大体时间:From Day 1 to 4-week follow-up (Approximate median 9 Cycles+4 weeks follow-up) up to approximately 2 years
|
MRU data will be collected for each subject.
Events corresponding to unscheduled (not scheduled per protocol) hospitalizations, office visits including consultations, laboratory and diagnostic tests (lab results, imaging etc.), and procedures prior to therapy initiation and during therapy will be collected
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From Day 1 to 4-week follow-up (Approximate median 9 Cycles+4 weeks follow-up) up to approximately 2 years
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Summary of Post-Hoc Estimates of Steady-state Eltrombopag Cmax and Cmin Pharmacokinetic Parameters for a 50 mg Dose
大体时间:Cycle 1, Week 2: Pre-dose, 1.5 and 3 hour post dose; Cycle 1, Week 3: 4, 5.5, and 7 hours post dose
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Eltrombopag concentrations were analyzed using a population PK model along with data from other studies in healthy volunteers and in patients with MDS and/or AML.
Post-hoc PK parameters were derived.
Only patients from this study were included (163)
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Cycle 1, Week 2: Pre-dose, 1.5 and 3 hour post dose; Cycle 1, Week 3: 4, 5.5, and 7 hours post dose
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Summary of Post-Hoc Estimates of Steady-state Eltrombopag AUC0 Infinity Pharmacokinetic Parameters for a 50 mg Dose
大体时间:Cycle 1, Week 2: Pre-dose, 1.5 and 3 hour post dose; Cycle 1, Week 3: 4, 5.5, and 7 hours post dose
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Eltrombopag concentrations were analyzed using a population PK model along with data from other studies in healthy volunteers and in patients with MDS and/or AML.
Post-hoc PK parameters were derived.
Only patients from this study were included (163)
|
Cycle 1, Week 2: Pre-dose, 1.5 and 3 hour post dose; Cycle 1, Week 3: 4, 5.5, and 7 hours post dose
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AUC0-infinity -Pharmacokinetic(s) Parameter of Azacitidine
大体时间:Cycle 2 Day 1: Pre-dose, 15 min, 0.5, 1, 2 and 4 hr post dose
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An analysis of variance (ANOVA) on AUC0-infinity.
The PK parameters were log transformed prior to analysis.
The model included treatment as a fixed effect.
Point estimates and their associated 90% CI were constructed for the differences in PK parameter values.
The point estimates and their associated 90% CI were then back transformed to provide point estimates and 90% CI for the azacitidine + eltrombopag:azacitidine + placebo PK parameter ratios.
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Cycle 2 Day 1: Pre-dose, 15 min, 0.5, 1, 2 and 4 hr post dose
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Cmax -Pharmacokinetic Parameter of Azacitidine
大体时间:Cycle 2 Day 1: Pre-dose, 15 min, 0.5, 1, 2 and 4 hr post dose
|
An analysis of variance (ANOVA) on Cmax .
The PK parameters were log transformed prior to analysis.
The model included treatment as a fixed effect.
Point estimates and their associated 90% CI were constructed for the differences in PK parameter values.
The point estimates and their associated 90% CI were then back transformed to provide point estimates and 90% CI for the azacitidine + ltrombopag:azacitidine + placebo PK parameter ratios.
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Cycle 2 Day 1: Pre-dose, 15 min, 0.5, 1, 2 and 4 hr post dose
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合作者和调查者
出版物和有用的链接
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学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
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首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
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上次提交的符合 QC 标准的更新
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