A Phase II Dose-escalation Study Characterizing the PK of Eltrombopag in Pediatric Patients With Previously Untreated or Relapsed Severe Aplastic Anemia or Recurrent Aplastic Anemia

Status: Recruiting
Phase:
DFCI Protocol ID:

This is a phase II, open label, multi-center, intra-patient dose escalation study to characterize the pharmacokinetics after oral administration of eltrombopag in combination with immunosuppressive therapy in pediatric patients with previously untreated or relapsed/refractory severe aplastic anemia or recurrent aplastic anemia. All patients will be treated with eltrombopag for the 26-week Treatment Period, followed by a 52-week Follow-Up Period. Patients who have been previously untreated with immunosuppressive therapy will be treated according to the standard of care, hATG/cyclosporine, in addition to eltrombopag. Patients with relapsed/refractory SAA or recurrent AA will be enrolled into one of two treatment options: hATG/cyclosporine plus eltrombopag or cyclosporine plus eltrombopag, depending on prior treatment with immunosuppressive therapy. After initiating treatment with eltrombopag, patients will have their dose assessed and modified as tolerated, until the targeted platelet count or maximum dose is achieved. Pharmacokinetic assessments will be performed at time points intended to capture steady state PK of the starting dose and highest dose achieved. Upon completion of the Treatment and Follow-Up Periods, all patients will be offered the opportunity to enroll in an additional 3 year Long Term Follow-Up Period.

Conducting Institutions:

Children's Hospital Boston, Dana-Farber Cancer Institute

Overall PI:

Akiko Shimamura, MD, Boston Children's Hospital

Site-responsible Investigators:

Contacts:

Dana-Farber Cancer Institute: Childrens Hospital Pediatric Clinical Translation Investigation Program CTIP, ctip@partners.org

Eligibility Criteria

For Cohort A:

  1. Prior history of diagnosis of SAA

  2. Diagnosis of relapsed/refractory SAA or recurrent AA following IST for SAA at the time
     of enrollment. Patients with recurrent AA (e.g., losing their response) are exempt
     from meeting the diagnostic criteria for relapsed SAA at the time of enrollment, but
     must have been previously diagnosed with SAA.

  3. Agree to concurrent eltrombopag treatment with appropriate, investigator-selected IST
     with either hATG + CsA or CsA.

     For Cohort B:

  4. Diagnosis of SAA at the time of enrollment

  5. Patients must not have been previously treated for SAA

  6. Patients must agree to treatment with hATG + CsA concurrent with eltrombopag.

     For all patients, regardless of cohort:

  7. Age 1 to <18 years

  8. Where appropriate, assessments to rule out congenital/inherited bone marrow failure
     syndromes and other causes of immune-mediated pancytopenia, which may be treated with
     transplant, must be completed prior to enrollment.

  9. Hematopoietic stem cell transplantation (HSCT) is not available or suitable as a
     treatment option or has been refused by the patient. (Candidacy for HSCT will be
     determined as per local practice.)

 10. Bone marrow aspirate and biopsy at any time during the 4 weeks prior to first dose of
     eltrombopag

 11. Normal karyotype with FISH for chromosomes 7 and 8

 12. Performance status score: Karnofsky ≥50 or Lansky ≥50 (depending on age)

 13. Serum creatinine ≤2.5 × ULN

 14. Total bilirubin ≤1.5 × ULN

 15. Written informed consent signed by a parent or legal guardian prior to initiation of
     any study specific procedure.

Exclusion Criteria:

  1. Prior and/or active medical history of:

       -  Fanconi anemia (via chromosomal breakage test or growth arrest by flow cytometry)

       -  Other known underlying congenital/inherited marrow failure syndromes

       -  Symptomatic Paroxysmal Nocturnal Hemoglobinuria (PNH) and/or PNH clones >50% of
  PMN or RBC at time of enrollment

       -  Any cytogenetic abnormalities, including but not limited to chromosome 7 or
  myelodysplasia, in bone marrow within 4 weeks of study enrollment

       -  Myelodysplastic syndrome (MDS)

       -  Other known or suspected underlying primary immunodeficiency

       -  Any malignancy

  2. Active infection not responding to appropriate therapy

  3. Prior eltrombopag or other thrombopoietin receptor (TPO-R) agonist treatment for at
     least 2 months and a lack of response.

  4. Any out of range lab values Creatinine >2.5 × upper limit of normal (ULN), Total
     bilirubin >1.5 × ULN Aspartate aminotransferase (AST) or alanine aminotransferase
     (ALT) >2.5 × ULN

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