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| ID | Type | Description | Link |
|---|---|---|---|
| CLBH589BUS20T | Other Identifier | Novartis |
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| Name | Class |
|---|---|
| Novartis | INDUSTRY |
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To test a new agent, LBH589, in combination with glucocorticoids as initial therapy of acute graft versus host disease (GVHD).
Dose escalation study to test the safety (Phase I), pharmacology and preliminary clinical activity (Phase II) of a Novel histone deacetylase (HDAC) inhibitor, LBH589, in the treatment of the following GVHD presentations: Classic, Late-onset acute GVHD, Recurrent acute GVHD, Overlap syndrome.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| LBH589, in Addition to Glucocorticoids | Experimental | Phase I Dose Escalation, Followed by Phase II Treatment at Maximum Tolerated Dose (MTD) of LBH589, in Addition to Glucocorticoids. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Panobinostat (LBH589) | Drug | Phase I Initial Treatment Plan - Intravenous (IV) Formulation: Up to 4 dose levels (DL) of LBH589 IV formulation to establish LBH589 Maximum Tolerated Dose (MTD) in acute GVHD treatment. The first 4 participants began this treatment plan, before the IV Formulation became unavailable. DL -1: 1.25 mg/m^2 IV; DL 1: 2.5 mg/m^2 IV; DL 2: 5 mg/m^2 IV; DL 3: 7.5 mg/m^2 IV; DL 4: 10 mg/m^2 IV. Phase I Revised Treatment Plan - Oral Formulation (to replace IV Formulation): Dose escalation levels for LBH589; participants treated with LBH589 by mouth (PO) 3 times a week (48 hours apart) every week for 4 weeks. DL -1: 5 mg PO; DL 1: 10 mg PO (starting dose level); DL 2: 15 mg PO; DL 3: 20 mg PO; DL 4: 25 mg PO. Phase II Treatment Plan: LBH589 PO at MTD, 3 times a week (48 hours apart) every week for 4 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| Phase I: Maximum Tolerated Dose (MTD) in Milligrams | MTD of LBH589 in addition to glucocorticoids as treatment for Graft Versus Host Disease (GVHD) manifestations. MTD in Milligrams (mg), taken by mouth (PO), 3 times per week, for 4 weeks. The oral formulation replaced the IV formulation (which became unavailable) after the first 4 participants were treated. Dose limiting toxicity (DLT) is defined by the occurrence of Common Toxicity Criteria (CTC) grade 3 or greater toxicity that is unexpected with transplantation, except for hematological toxicity, where DLT is defined as absolute neutrophil count (ANC) <750, and for those participants who were platelet transfusion independent is defined as platelets <10 K. | 2 years, 8 months |
| Phase II: Overall Rate of Response (ORR) | Rate of Complete Response (CR), Partial Response (PR), Progressive Disease (PD) and Stable Disease (SD). Assessment of GVHD will include the skin, liver and gut. Other possible etiologies of organ disease such as C difficile enterocolitis, viral infection, drug reaction, veno-occlusive disease of the liver, etc., will be excluded by appropriate tests. CR is defined as resolution of GVHD in all evaluable organs with no subsequent additional treatment given for acute GVHD. PR is defined as improvement in ≥ one evaluable organ without deterioration in at least one other. PD is defined as deterioration in at least on evaluable organ. SD is defined as the absence of any difference sufficient to meet minimal criteria for improvement or deterioration in any evaluable organs. | 1 year, 2 months |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of GVHD Flares Requiring Increasing Immune Suppressive Therapy | Number of participants with GVHD flares requiring increasing immune suppressive therapy within 36 days of study initiation. Cumulative incidence of GVHD flares requiring increasing immune suppressive therapy will be analyzed using the competing risk method by Gray (1988). GVHD flares (progressive disease (PD)) may result in discontinuation from Panobinostat. |
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Inclusion Criteria:
Patients receiving allogeneic hematopoietic cell transplantation (HCT) with peripheral blood, bone marrow or cord blood stem cells regardless of initial diagnosis who develop a clinical diagnosis of acute GVHD as defined in Section 2 diagnosed and treated with systemic glucocorticoids within 72 hours prior to enrollment. Biopsy of involved skin and gastrointestinal tract is strongly encouraged, but not required for study entry. For patients with aspartic transaminase (AST) or alanine transaminase (ALT) or Alkaline phosphatase with gamma-glutamyltransferase (GGT) elevations without bilirubin elevation must have a liver biopsy to document GVHD diagnosis. Patients should meet one of the following criteria:
If GVHD is present in an isolated organ:
If GVHD presentation involves >/= 2 organs: GVHD Grade >/= II as defined in Table D of protocol.
Male or female patients aged 18 or older at time of enrollment
Signed informed consent
Absolute neutrophil count (ANC) greater than 500/μL, platelets >/= 20 x 10^9/L supported by platelet transfusion and hemoglobin >/= 8 g/dl supported by red cell transfusion.
Calculated creatinine clearance (CrCl) >/= 30 mL/min (MDRD Formula)
Serum potassium >/= lower limit of normal (LLN), Total serum calcium [corrected for serum albumin] or ionized calcium >/= LLN, Serum magnesium >/= LLN and Serum phosphorus >/= LLN on the day of LBH589 administration
Thyroid-stimulating hormone (TSH) </= ULN and free T4 within normal limits at the time of patient enrollment within baseline laboratories. Patients are permitted to receive thyroid hormone replacement to treat underlying hypothyroidism
Baseline multiple gated acquisition scan (MUGA) or echocardiogram (ECHO) must demonstrate left ventricular ejection fraction (LVEF) >/= the lower limit of the institutional normal before transplantation.
Exclusion Criteria:
Women who are pregnant or breast feeding or women of childbearing potential (WOCBP) not using an effective method of birth control. WOCBP are defined as sexually mature women who have not undergone a hysterectomy or who have not been naturally postmenopausal for at least 12 consecutive months (i.e., who has had menses any time in the preceding 12 consecutive months). Women of childbearing potential must have a negative serum pregnancy test within 24 hrs of receiving the first dose of study medication if a pregnancy test was not done pre-transplant. Male patients whose sexual partners are WOCBP not using effective birth control
Patients requiring mechanical ventilation support.
Active, uncontrolled life threatening viral or fungal disease, such as cytomegalovirus (CMV) pneumonia or gastroenteritis, Aspergillus pneumonia or brain abscess. For bacterial or viral infections, patients must be receiving therapy and have no signs of progression for 48 hours prior to enrollment. For fungal infection patients must be receiving systemic anti-fungal therapy and have no signs of progression for 1 week prior to enrollment. Progressing infection is defined as hemo-dynamic instability attributable to sepsis or new symptoms, worsening physical signs or radiographic findings attributable to infections. Persisting fever without other signs of symptoms will not be interpreted as progressing infections.
Receipt of other investigational new drugs for GVHD including agents used for GVHD prophylaxis within 30 days. The following agents are not considered experimental and therefore are not excluded: cyclosporine, tacrolimus, sirolimus, glucocorticoids, antithymocyte globulin, replacement corticosteroid therapy for hypoadrenalism and methotrexate.
HDAC, DAC, HSP90 inhibitors or valproic acid for the treatment of cancer within 30 days.
Patients who will need valproic acid for any medical condition during the study or within 5 days prior to first LBH589 treatment.
Impaired cardiac function or clinically significant cardiac diseases, including any one of the following:
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| Name | Affiliation | Role |
|---|---|---|
| Lia Perez, MD | H. Lee Moffitt Cancer Center and Research Institute | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| H Lee Moffitt Cancer Center and Research Institute | Tampa | Florida | 33612 | United States |
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| Label | URL |
|---|---|
| H. Lee Moffitt Cancer Center \& Research Institute | View source |
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Participants were enrolled at Moffitt Cancer Center, September 2010 through December 2014.
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| ID | Title | Description |
|---|---|---|
| FG000 | Phase I Participants Not Evaluable for MTD | Participants who began treatment before the formulation change. |
| FG001 | Phase I Participants Evaluable for MTD | Participants treated after the formulation change. |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| Up to 36 days per participant |
| Overall Survival (OS) | Overall Survival (OS) at one year post initiation of therapy. | 1 year |
| Occurrence of Discontinuation of All Immune Suppression | Number of participants discontinuing all immune suppression without subsequent flare by 1 year post initiation of therapy. | 1 year |
| Chronic GVHD Onset | Chronic GVHD onset in participants without overlap syndrome at initiation of study therapy. Number of participants with overlap syndrome at MTD. | Up to 1 year |
| Chronic GVHD Severity at MTD | Chronic GVHD maximum severity grade at MTD, in participants without overlap syndrome at initiation of study therapy. Maximum c-GVHD severity: Mild, Moderate, Severe. | Up to 1 year |
| Stable or Improved Chronic GVHD Severity Score | Stable or improved Chronic GVHD score: Improved Mild to None; Improved Severe to Moderate; Improved Moderate to None, Remained Stable at Mild. | 1 year |
| Occurrence of Possibly Related Adverse Events | Number of participants with adverse events possibly related to study treatment, per event category. | 5 years, 3 months |
| FG002 | Phase II Participants Treated at MTD | All participants enrolled during Phase II. |
| COMPLETED |
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| NOT COMPLETED |
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All participants. All participants received study treatment.
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| ID | Title | Description |
|---|---|---|
| BG000 | LBH589, in Addition to Glucocorticoids | Phase I Dose Escalation, Followed by Phase II Treatment at Maximum Tolerated Dose (MTD) of LBH589, in Addition to Glucocorticoids. |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants | Participants |
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| Age, Continuous | Mean | Full Range | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Phase I: Maximum Tolerated Dose (MTD) in Milligrams | MTD of LBH589 in addition to glucocorticoids as treatment for Graft Versus Host Disease (GVHD) manifestations. MTD in Milligrams (mg), taken by mouth (PO), 3 times per week, for 4 weeks. The oral formulation replaced the IV formulation (which became unavailable) after the first 4 participants were treated. Dose limiting toxicity (DLT) is defined by the occurrence of Common Toxicity Criteria (CTC) grade 3 or greater toxicity that is unexpected with transplantation, except for hematological toxicity, where DLT is defined as absolute neutrophil count (ANC) <750, and for those participants who were platelet transfusion independent is defined as platelets <10 K. | All participants treated with Oral Formulation LBH589, during Phase I Dose Escalation. | Posted | Number | MTD of oral LBH589 in milligrams | 2 years, 8 months |
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| Primary | Phase II: Overall Rate of Response (ORR) | Rate of Complete Response (CR), Partial Response (PR), Progressive Disease (PD) and Stable Disease (SD). Assessment of GVHD will include the skin, liver and gut. Other possible etiologies of organ disease such as C difficile enterocolitis, viral infection, drug reaction, veno-occlusive disease of the liver, etc., will be excluded by appropriate tests. CR is defined as resolution of GVHD in all evaluable organs with no subsequent additional treatment given for acute GVHD. PR is defined as improvement in ≥ one evaluable organ without deterioration in at least one other. PD is defined as deterioration in at least on evaluable organ. SD is defined as the absence of any difference sufficient to meet minimal criteria for improvement or deterioration in any evaluable organs. | All participants treated at maximum tolerated dose (MTD) of Oral Formulation LBH589, and evaluable at planned time of analysis. | Posted | Number | participants | 1 year, 2 months |
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| Secondary | Incidence of GVHD Flares Requiring Increasing Immune Suppressive Therapy | Number of participants with GVHD flares requiring increasing immune suppressive therapy within 36 days of study initiation. Cumulative incidence of GVHD flares requiring increasing immune suppressive therapy will be analyzed using the competing risk method by Gray (1988). GVHD flares (progressive disease (PD)) may result in discontinuation from Panobinostat. | All participants that received Oral Formulation LBH589 at MTD (5 mg) 3 times per week, for 4 weeks. | Posted | Number | participants | Up to 36 days per participant |
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| Secondary | Overall Survival (OS) | Overall Survival (OS) at one year post initiation of therapy. | All participants that received Oral Formulation LBH589 at MTD (5 mg) 3 times per week, for 4 weeks. | Posted | Number | participants | 1 year |
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| Secondary | Occurrence of Discontinuation of All Immune Suppression | Number of participants discontinuing all immune suppression without subsequent flare by 1 year post initiation of therapy. | All participants that received Oral Formulation LBH589 at MTD (5 mg) 3 times per week, for 4 weeks and were evaluable at 365 days. | Posted | Number | participants | 1 year |
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| Secondary | Chronic GVHD Onset | Chronic GVHD onset in participants without overlap syndrome at initiation of study therapy. Number of participants with overlap syndrome at MTD. | All participants that received Oral Formulation LBH589 at MTD (5 mg) 3 times per week, for 4 weeks. | Posted | Number | participants | Up to 1 year |
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| Secondary | Chronic GVHD Severity at MTD | Chronic GVHD maximum severity grade at MTD, in participants without overlap syndrome at initiation of study therapy. Maximum c-GVHD severity: Mild, Moderate, Severe. | All participants that received Oral Formulation LBH589 at MTD (5 mg) 3 times per week, for 4 weeks, had overlap syndrome at MTD and were evaluable at time of analysis. | Posted | Number | participants | Up to 1 year |
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| Secondary | Stable or Improved Chronic GVHD Severity Score | Stable or improved Chronic GVHD score: Improved Mild to None; Improved Severe to Moderate; Improved Moderate to None, Remained Stable at Mild. | All participants that received Oral Formulation LBH589 at MTD (5 mg) 3 times per week, for 4 weeks, had overlap syndrome at MTD and were evaluable at 1 year. | Posted | Number | participants | 1 year |
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| Secondary | Occurrence of Possibly Related Adverse Events | Number of participants with adverse events possibly related to study treatment, per event category. | All participants | Posted | Number | participants | 5 years, 3 months |
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5 years, 3 months
All participants. All events are listed regardless of causality.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | LBH589, in Addition to Glucocorticoids | Phase I Dose Escalation, Followed by Phase II Treatment at Maximum Tolerated Dose (MTD) of LBH589, in Addition to Glucocorticoids. | 11 | 22 | 20 | 22 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Anemia | Blood and lymphatic system disorders | CTCAE (4.0) | Systematic Assessment |
| |
| Thrombocytopenia | Blood and lymphatic system disorders | CTCAE (4.0) | Systematic Assessment |
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| Pancytopenia | Blood and lymphatic system disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Hyponatremia | Blood and lymphatic system disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Atrial fibrillation | Cardiac disorders | CTCAE (4.0) | Systematic Assessment |
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| Atrial flutter | Cardiac disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Cardiac disorders - Other, Hypotension | Cardiac disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Heart failure | Cardiac disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Gastrointestinal disorders - Other, severe diarrhea | Gastrointestinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Gastrointestinal disorders - Other, GVHD/VOD | Gastrointestinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Gastrointestinal disorders - Other, Severe GVHD | Gastrointestinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Gastrointestinal pain | Gastrointestinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Hepatic failure | Hepatobiliary disorders | CTCAE (4.0) | Systematic Assessment |
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| Hepatobiliary disorders - Other, suspected drug toxicity to liver | Hepatobiliary disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Infections and infestations - Other, cellulitis | Infections and infestations | CTCAE (4.0) | Non-systematic Assessment |
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| Sepsis | Infections and infestations | CTCAE (4.0) | Non-systematic Assessment |
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| Hypertriglyceridemia | Metabolism and nutrition disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Renal and urinary disorders - Other, put on dialysis | Renal and urinary disorders | CTCAE (4.0) | Systematic Assessment |
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| Toxic epidermal necrolysis | Skin and subcutaneous tissue disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Platelet count decreased | Investigations | CTCAE (4.0) | Systematic Assessment |
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| White blood cell decreased | Investigations | CTCAE (4.0) | Systematic Assessment |
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| Cholesterol high | Investigations | CTCAE (4.0) | Non-systematic Assessment |
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| Alkaline phosphatase increased | Investigations | CTCAE (4.0) | Non-systematic Assessment |
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| Neutrophil count decreased | Investigations | CTCAE (4.0) | Non-systematic Assessment |
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| Blood bilirubin increased | Investigations | CTCAE (4.0) | Non-systematic Assessment |
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| Alkaline aminotransferase increased | Investigations | CTCAE (4.0) | Non-systematic Assessment |
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| Aspartate aminotransferase increased | Investigations | CTCAE (4.0) | Non-systematic Assessment |
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| Creatinine increased | Investigations | CTCAE (4.0) | Non-systematic Assessment |
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| Hypertension | Vascular disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Hypotension | Vascular disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Hypertriglyceridemia | Metabolism and nutrition disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Hyperglycemia | Metabolism and nutrition disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Anemia | Blood and lymphatic system disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Diarrhea | Gastrointestinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Nausea | Gastrointestinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Edema limbs | General disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Fatigue | General disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Cardiac disorders - Other, cardiac arrhythmia | Cardiac disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Sinus tachycardia | Cardiac disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Ventricular arrhythmia | Cardiac disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Acute kidney injury | Renal and urinary disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Dyspnea | Respiratory, thoracic and mediastinal disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Anxiety | Psychiatric disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Insomnia | Psychiatric disorders | CTCAE (4.0) | Non-systematic Assessment |
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| Cardiovascular toxicity | Cardiac disorders | CTCAE (4.0) | Systematic Assessment |
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The discontinuation of the IV Formulation of LBH589 required a treatment plan change to Oral Formulation LBH589, after the first 4 participants were treated. The study accrued fewer participants than investigators had planned to evaluate.
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Lia Perez | H. Lee Moffitt Cancer Center and Research Institute | 813-745-3665 | lia.perez@moffitt.org |
| ID | Term |
|---|---|
| D006086 | Graft vs Host Disease |
| D000092122 | Bronchiolitis Obliterans Syndrome |
| ID | Term |
|---|---|
| D007154 | Immune System Diseases |
| D000092124 | Organizing Pneumonia |
| D001989 | Bronchiolitis Obliterans |
| D001988 | Bronchiolitis |
| D001991 | Bronchitis |
| D001982 | Bronchial Diseases |
| D012140 | Respiratory Tract Diseases |
| D008173 | Lung Diseases, Obstructive |
| D008171 | Lung Diseases |
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| ID | Term |
|---|---|
| D000077767 | Panobinostat |
| ID | Term |
|---|---|
| D006877 | Hydroxamic Acids |
| D006898 | Hydroxylamines |
| D000588 | Amines |
| D009930 | Organic Chemicals |
| D006880 | Hydroxy Acids |
| D002264 | Carboxylic Acids |
| D007211 | Indoles |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
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| Title | Denominators | Categories | ||||
|---|---|---|---|---|---|---|
| OS at 1 year |
| |||||
| Death before 1 year: sepsis |
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| Death before 1 year: relapse |
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| Death before 1 year: GVHD |
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| Death before 1 year: Cardiogenic shock |
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| Title | Denominators | Categories | ||||
|---|---|---|---|---|---|---|
| Thrombocytopenia |
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| Leukopenia |
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| Anemia |
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| Hypertriglyceridemia |
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| Hypercholesterolemia |
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| Fatigue |
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| Hepatobiliary disorders |
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