Myelodysplastic syndromes (MDS) prevail in older age and are characterized by ineffective erythropoiesis and peripheral cytopenias. Supportive therapy is the main therapeutic option for most patients. Quality of Life (QoL) is mainly deteriorated by anemia and by the limitations associated with thrombocytopenia, neutropenia and transfusion dependence. The only available treatment for severe thrombocytopenia, in the presence of bleeding, is platelet transfusion. Eltrombopag is an orally bioavailable agonist of the thrombopoietin receptor. In adult patients with chronic immune thrombocytopenia (ITP), Eltrombopag rapidly increases platelet counts and significantly reduces bleeding episodes during treatment. Eltrombopag is well tolerated. In 2007, Eltrombopag has received the Orphan Drug Designation for the treatment of ITP (EMEA/OD/031/07), and in 2008 the Food and Drug Association approved Eltrombopag for the treatment of ITP refractory or resistant. It has been shown that in patients affected by MDS and by acute myeloid leukemia, Eltrombopag neither increases the proliferation, nor the clonogenic growth capacity of bone marrow blasts. Furthermore, Eltrombopag induces an increase in the megakaryocytic differentiation and in the formation of normal megakaryocytic colonies. These results provide the rationale for pursuing further research on Eltrombopag for the treatment of thrombocytopenia in case of MDS. The study is open to adult patients with myelodysplastic syndrome (MDS) with thrombocytopenia and low- or intermediate-1 IPSS risk (Index Prognostic Score System). Severe thrombocytopenia associated with MDS may lead to death from hemorrhage, even in low prognostic risk patients. The benefit of platelet transfusion is short-termed. Patients become refractory in the long term. The availability of a treatment that induces the increase of platelet count is extremely important, either in terms of quality of life, and in overall survival.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
174
Eltrombopag 50 mg once daily has been selected as the starting dose for this study. Thereafter, dependent on platelet response the dose of study medication can be increased by 50 mg every 2 weeks, up to a maximum dose of 300 mg once daily (150 mg in subjects of East Asian ethnicity).
The administration is the same of eltrombopag
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Amiens, France
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Bayonne, France
Centre d'Avicenne, Hôpital d'Avicenne
Bobigny, France
CHU de Haut-Lévèque
Bordeaux, France
Centre Hospitalier de Boulogne Sur Mer
Response rate
Proportion of patients achieving a complete response (CR) or response (R) during the treatment period
Time frame: Six months
Safety and Tolerability (number of adverse events)
Safety and tolerability in terms of frequency of adverse events (AE) and serious adverse events (SAE)
Time frame: Six month
Duration of platelet response
Time frame: five years
long-term safety and tolerability (number adverse events in the long term)
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0 and number of adverse events reporting in accordance with CTCAE v4.0
Time frame: five years
Quality of life (QoL) score
to evaluate the changes of the quality of life in the two arms
Time frame: six months
number of monthly platelet transfusions
Time frame: six months
duration of transfusion independence
Time frame: six months
time to response
time to response (time from starting treatment to time of achievement of CR or PR)
Time frame: six months
incidence and severity of bleeding
incidence and severity of bleeding using the WHO (World Health Organization)Bleeding Scale
Time frame: six months
overall survival
overall survival (OS) at 2 and at 5 years
Time frame: 2 and 5 years
leukemia-free survival (LFS)
leukemia-free survival (LFS) at 2 and at 5 years (events for LFS are defined as death and progression to AML);
Time frame: 2 and 5 years
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Boulogne-sur-Mer, France
CHU Clémenceau
Caen, France
Centre Henri Mondor
Créteil, France
CHU de Grenoble
Grenoble, France
Centre Le Mans
Le Mans, France
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