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      Protocol description of the HOVON 141/VISION trial: a prospective, multicentre, randomised phase II trial of ibrutinib plus venetoclax in patients with creatinine clearance ≥30 mL/min who have relapsed or refractory chronic lymphocytic leukaemia (RR-CLL) with or without TP53 aberrations

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          Abstract

          Introduction

          Literature is scarce on the combination treatment of ibrutinib and venetoclax (IV) is scarce in relapsed or refractory chronic lymphocytic leukaemia (RR-CLL). Especially, the possibility of stopping ibrutinib in RR-CLL patients in deep remission is unclear.

          Methods and analysis

          In the HOVON 141/VISION trial, patients with RR-CLL are treated with 12 cycles of IV after a short induction with ibrutinib. Patients reaching undetectable minimal residual disease (uMRD) after 12 cycles of IV are randomised 1:2 to continue ibrutinib or stop treatment. The persistence of uMRD after stopping IV is studied. In addition, in patients who become positive for MRD again after stopping, IV treatment is reinitiated. The efficacy of this approach with regard to progression-free survival 12 months after randomisation is the primary endpoint of the study.

          Ethics and dissemination

          This protocol respects the Helsinki declaration and has been approved by the ethical committee of the Amsterdam Medical Center. Study findings will be disseminated through peer-reviewed papers. All patients who fulfil the inclusion criteria and no-exclusion criteria, and have signed the informed consent form are included in the study.

          Trial registration number

          ClinicalTrials.gov Registry (NCT03226301).

          Related collections

          Most cited references15

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          Prediction of Creatinine Clearance from Serum Creatinine

          A formula has been developed to predict creatinine clearance (C cr ) from serum creatinine (S cr ) in adult males: Ccr = (140 – age) (wt kg)/72 × S cr (mg/100ml) (15% less in females). Derivation included the relationship found between age and 24-hour creatinine excretion/kg in 249 patients aged 18–92. Values for C cr were predicted by this formula and four other methods and the results compared with the means of two 24-hour C cr’s measured in 236 patients. The above formula gave a correlation coefficient between predicted and mean measured Ccr·s of 0.83; on average, the difference between predicted and mean measured values was no greater than that between paired clearances. Factors for age and body weight must be included for reasonable prediction.
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            Ibrutinib versus ofatumumab in previously treated chronic lymphoid leukemia.

            In patients with chronic lymphoid leukemia (CLL) or small lymphocytic lymphoma (SLL), a short duration of response to therapy or adverse cytogenetic abnormalities are associated with a poor outcome. We evaluated the efficacy of ibrutinib, a covalent inhibitor of Bruton's tyrosine kinase, in patients at risk for a poor outcome. In this multicenter, open-label, phase 3 study, we randomly assigned 391 patients with relapsed or refractory CLL or SLL to receive daily ibrutinib or the anti-CD20 antibody ofatumumab. The primary end point was the duration of progression-free survival, with the duration of overall survival and the overall response rate as secondary end points. At a median follow-up of 9.4 months, ibrutinib significantly improved progression-free survival; the median duration was not reached in the ibrutinib group (with a rate of progression-free survival of 88% at 6 months), as compared with a median of 8.1 months in the ofatumumab group (hazard ratio for progression or death in the ibrutinib group, 0.22; P<0.001). Ibrutinib also significantly improved overall survival (hazard ratio for death, 0.43; P=0.005). At 12 months, the overall survival rate was 90% in the ibrutinib group and 81% in the ofatumumab group. The overall response rate was significantly higher in the ibrutinib group than in the ofatumumab group (42.6% vs. 4.1%, P<0.001). An additional 20% of ibrutinib-treated patients had a partial response with lymphocytosis. Similar effects were observed regardless of whether patients had a chromosome 17p13.1 deletion or resistance to purine analogues. The most frequent nonhematologic adverse events were diarrhea, fatigue, pyrexia, and nausea in the ibrutinib group and fatigue, infusion-related reactions, and cough in the ofatumumab group. Ibrutinib, as compared with ofatumumab, significantly improved progression-free survival, overall survival, and response rate among patients with previously treated CLL or SLL. (Funded by Pharmacyclics and Janssen; RESONATE ClinicalTrials.gov number, NCT01578707.).
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              Venetoclax–Rituximab in Relapsed or Refractory Chronic Lymphocytic Leukemia

              Venetoclax inhibits BCL2, an antiapoptotic protein that is pathologically overexpressed and that is central to the survival of chronic lymphocytic leukemia cells. We evaluated the efficacy of venetoclax in combination with rituximab in patients with relapsed or refractory chronic lymphocytic leukemia.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2020
                15 October 2020
                : 10
                : 10
                : e039168
                Affiliations
                [1 ]departmentDepartment of Internal Medicine , Albert Schweitzer Hospital Location Dordwijk , Dordrecht, Zuid-Holland, The Netherlands
                [2 ]departmentDepartment of Hematology , Amsterdam UMC - Locatie AMC , Amsterdam, North Holland, The Netherlands
                [3 ]departmentDepartment of Hematology , Uppsala Universitet , Uppsala, Sweden
                [4 ]departmentDepartment of Hematology , Haga Hospital , Den Haag, Zuid-Holland, The Netherlands
                [5 ]departmentDepartment of Hematology , University of Turku , Turku, Finland
                [6 ]departmentDepartment of Hematology , Akershus University Hospital , Lorenskog, Norway
                [7 ]departmentHOVON Data Center, Department of Hematology , Erasmus MC , Rotterdam, Zuid-Holland, The Netherlands
                [8 ]departmentDepartment of Hematology , Rigshospitalet , Copenhagen, Denmark
                Author notes
                [Correspondence to ] Professor Arnon Kater; a.p.kater@ 123456amsterdamumc.nl
                Author information
                http://orcid.org/0000-0003-2139-3547
                Article
                bmjopen-2020-039168
                10.1136/bmjopen-2020-039168
                7566731
                33060089
                24980847-89e5-41ce-aadc-d61cc27e8b04
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 06 April 2020
                : 09 August 2020
                : 18 August 2020
                Funding
                Funded by: Novo Nordisk Foundation grant;
                Award ID: NNF16OC0019302
                Funded by: FundRef http://dx.doi.org/10.13039/100008897, Janssen Pharmaceuticals;
                Funded by: FundRef http://dx.doi.org/10.13039/100006483, AbbVie;
                Categories
                Haematology (Incl Blood Transfusion)
                1506
                1700
                Protocol
                Custom metadata
                unlocked

                Medicine
                leukaemia,lymphoma,clinical trials,toxicity
                Medicine
                leukaemia, lymphoma, clinical trials, toxicity

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