Myelodysplastic Syndromes
Conditions
Keywords
Myelodysplastic Syndromes, Lenalidomide
Brief summary
The purpose of this clinical experience study is to determine whether CC-5013 is safe and effective (to include studying the process by which a drug is absorbed, distributed, metabolized, and eliminated by the body \[pharmacokinetics\]) in Japanese subjects with low- or intermediate-1-risk MDS (IPSS risk categories) associated with a deletion 5(q31-33) abnormality and symptomatic anemia.
Interventions
Oral 10mg daily on Days 1-21 days every 28 days until disease progression/relapse or CC-5013 is permanently discontinued for any reason for up to 156 weeks (3 years).
Sponsors
Study design
Eligibility
Inclusion criteria
* Must understand and voluntarily sign an informed consent form. * Age ≥ 20 years at the time of signing the informed consent form. * Must be able to adhere to the study visit schedule and other protocol requirements. * Diagnosis of Myelodysplastic Syndrome (MDS) that meets International Prognostic Scoring System (IPSS) criteria for low- or intermediate-1-risk disease associated with a deletion 5(q31-33) abnormality * Symptomatic anemia secondary to MDS defined as:Untransfused Hb level \< 10.0 g/dL and a Functional Assessment of Cancer Therapy (FACT)-anemia subscale score of ≤ 74 or Transfusion dependent anemia
Exclusion criteria
* Pregnant or lactating females. * Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study. * Prior therapy with lenalidomide. * Patients with any of the following laboratory abnormalities within 14 days of starting study drug: Absolute Neutrophil Count (ANC) \< 750 cells/μL (0.75 x 10\^9/L) Platelet count \< 50,000/μL (50x10\^9/L) Serum creatinine \> 2.5 mg/dL Aspartate Aminotransferase (AST) or Alanine Aminotransferase (ALT) \> 3.0 x Upper Limit of Normal (ULN)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Adverse Events (AE) | After the first study dose until 28 days after completion of/discontinuation from the study (maximum time on study was 155 weeks). | An AE that resulted in any of the following outcomes was defined as a serious adverse event (SAE): * Death; * Life-threatening event; * Any inpatient hospitalization or prolongation of existing hospitalization; * Persistent or significant disability or incapacity; * Congenital anomaly or birth defect; * Any other important medical event. The investigator determined the relationship of an AE to study drug based on the timing of the AE relative to drug administration and whether or not other drugs, therapeutic interventions, or underlying conditions could provide a sufficient explanation for the event. The severity of an AE was evaluated by the investigator according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) (Version 3.0) where Grade 1 = Mild, Grade 2 = Moderate, Grade 3 = Severe, Grade 4 = Life-threatening and Grade 5 = Death. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Maximum Plasma Concentration (Tmax) of Lenalidomide | Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose. | Time to maximum observed plasma concentration of lenalidomide after a single dose on Day 1 and multiple doses (Day 4). |
| Area Under the Plasma Concentration-time Curve From Time Zero to the Last Measurable Concentration (AUCt) of Lenalidomide | Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose. | Area under the plasma concentration-time curve from time zero to the last measurable concentration (AUCt) of lenalidomide after a single dose on Day 1 and multiple doses (Day 4). |
| Area Under the Plasma Concentration-time Curve Over the Dosing Interval (AUCτ) of Lenalidomide | Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, 12 and 24 hours post-dose. | Area under the plasma concentration-time curve over the dosing interval (AUCτ) of lenalidomide after a single dose on Day 1 and multiple doses (Day 4). |
| Area Under the Plasma Concentration-time Curve From Time Zero to Infinity (AUC∞) of Lenalidomide | Day 1 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, 12 and 24 hours post-dose. | Area under the plasma concentration-time curve from time zero to infinity (AUC∞) of lenalidomide after a single dose on Day 1. |
| Terminal Half-life (T1/2) of Lenalidomide | Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose. | The apparent terminal half-life is the time required for plasma concentration to decrease by 50% after pseudo-equilibrium of distribution has been reached, and calculated as the natural logarithm of 2 (0.693) / Apparent terminal rate constant (λz). |
| Apparent Volume of Distribution (VzF) of Lenalidomide | Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose. | Apparent volume of distribution of lenalidomide after a single dose on Day 1 and multiple doses (Day 4). |
| Apparent Total Plasma Clearance (CL/F) of Lenalidomide | Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose. | Apparent total plasma clearance (CL/F) of lenalidomide after a single dose on Day 1 and multiple doses (Day 4). |
| Apparent Terminal Elimination Rate Constant of Lenalidomide | Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose. | Apparent terminal elimination rate constant of lenalidomide determined after a single dose on Day 1 and multiple doses (Day 4). |
| Number of Participants With a Erythroid Response | Response was assessed every 28 days through Week 156. | Erythroid response was determined using the International Working Group (IWG) 2000 criteria, categorized as a major response or minor response. A major response in patients with transfusion-dependent anemia (receiving ≥ 4.5 units of red blood cell (RBC) transfusion during 56 consecutive days at Baseline) is defined as RBC transfusion independence accompanied by a ≥1.0 g/dL increase from Baseline in hemoglobin sustained for 56 days consecutively during the treatment period. In patients with transfusion-independent anemia with hemoglobin \< 10 g/dL at Baseline a major response is defined as a \> 2.0 g/dL increase from Baseline in hemoglobin sustained for consecutive 56 days. Minor response in patients with transfusion-dependent anemia defined as ≥ 50% decrease from Baseline in transfusion requirements sustained for consecutive 56 days, and in transfusion-independent patients as 1.0 to 2.0 g/dL increase from Baseline in hemoglobin sustained for consecutive 56 days. |
| Maximum Observed Plasma Concentration (Cmax) of Lenalidomide | Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose. | Maximum observed plasma concentration of lenalidomide after a single dose on Day and after multiple doses (Day 4). |
| Duration of Erythroid Response | From the first dose of study drug through Week 156 | Duration of erythroid response was calculated as the time from the start of the first major or minor erythroid response to the end of the response. Similarly, duration of major erythroid response was calculated as the time from the start of the first major erythroid response to the end of the response. Response duration was censored at the last adequate assessment for patients who maintained response. |
| Change From Baseline in Hemoglobin Concentration | Baseline and from Day1 until the maximum observed value (up to 155 weeks) | Change in hemoglobin concentration from Baseline to the maximum observed value during the major erythroid response period for major erythroid responders. |
| Number of Participants With a Neutrophil Response | Response was assessed every 28 days through Week 156 | Neutrophil response was determined using the IWG (2000) criteria. A major response for participants with a Baseline neutrophil count \< 1,500/mm\^3 is defined as a ≥ 100% increase or a ≥ 500/mm\^3 increase, whichever is greater, sustained for consecutive 56 days during the treatment period. A minor response for participants with a Baseline neutrophil count \< 1,500/mm\^3 is defined as a ≥ 100% increase, but an absolute increase \< 500/mm\^3, sustained for consecutive 56 days during the treatment period. |
| Number of Participants With a Platelet Response | Response was assessed every 28 days through Week 156 | Platelet response was determined using the IWG (2000) criteria. Major response in patients with Baseline platelet count \< 100,000/mm\^3 is defined as a ≥ 30,000/mm\^3 increase sustained for consecutive 56 days during the treatment period. In platelet-transfusion-dependent patients at Baseline a major response is defined as stabilization of platelet counts and platelet transfusion independence sustained for consecutive 56 days during the treatment period. Minor response in patients with Baseline platelet count \< 100,000/mm\^3 is defined as a ≥ 50% increase in platelet count with an absolute increase \> 10,000/mm\^3 and \< 30,000/mm\^3 sustained for consecutive 56 days during the treatment period. |
| Number of Participants With a Cytogenetic Response | Response was assessed every 12 weeks through Week 156 | Cytogenetic (chromosome structure) abnormalities were assessed by a central cytogenetic reviewer based on prints and cytogenetic reports of the bone marrow sample from the central laboratory. Cytogenetic response was determined using the IWG (2000) criteria and categorized as either a major response or minor response. Twenty metaphases were analyzed for the determination of cytogenetic response. A major response was defined as no detectable cytogenetic abnormality, if an abnormality was present at Baseline, sustained for consecutive 56 days during the treatment period. A minor response was defined as ≥ 50% reduction from Baseline in abnormal metaphases sustained for consecutive 56 days during the treatment period. |
| Change From Baseline in Percentage of Bone Marrow Erythroblasts | Baseline, at the end of Cycle 3 (Day 85) and Cycle 6 (Day 169). | Bone marrow morphology was assessed by the central hematologic reviewers based on the locally-prepared bone marrow smear slide and clot section. |
| Percentage of Bone Marrow Myeloblasts | Baseline, at the end of Cycle 3 (Day 85) and Cycle 6 (Day 169). | Bone marrow morphology was assessed by the central hematologic reviewers based on the locally-prepared bone marrow smear slide and clot section. |
| Percentage of Bone Marrow Promyelocytes | Baseline, at the end of Cycle 3 (Day 85) and Cycle 6 (Day 169). | Bone marrow morphology was assessed by the central hematologic reviewers based on the locally-prepared bone marrow smear slide and clot section. |
| Time to Erythroid Response | From the first dose of study drug through Week 156 | Time to erythroid response was calculated as the time from the first dose of study drug to the start of the first major or minor erythroid response. Similarly, time to major erythroid response was calculated as the time from the first dose of study drug to the start of the first major erythroid response. |
Countries
Japan
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Lenalidomide 10 mg of lenalidomide was administered orally once daily on Days 1 to 21 of every 28-day cycle, for up to 156 weeks (3 years). | 11 |
| Total | 11 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Disease progression | 1 |
| Overall Study | No further treatment required | 1 |
| Overall Study | Relapse after erythroid response | 6 |
| Overall Study | Study closed due to marketing approval | 3 |
Baseline characteristics
| Characteristic | Lenalidomide |
|---|---|
| Age, Continuous | 71.8 years STANDARD_DEVIATION 5.95 |
| Bone Marrow Cellularity Aplastic (0%) | 0 participants |
| Bone Marrow Cellularity Hypercellular (> 60% to ≤ 90%) | 2 participants |
| Bone Marrow Cellularity Hypocellular (> 0% to ≤ 30%) | 3 participants |
| Bone Marrow Cellularity Missing | 1 participants |
| Bone Marrow Cellularity Normocellular (> 30% to ≤ 60%) | 5 participants |
| Bone Marrow Cellularity Packed (> 90% to ≤ 100%) | 0 participants |
| Duration of MDS | 2.0 years STANDARD_DEVIATION 1.44 |
| French-American-British (FAB) classification of MDS Chronic myelomonocytic leukemia (CMML) | 0 participants |
| French-American-British (FAB) classification of MDS RAEB in transformation (RAEB-t) | 0 participants |
| French-American-British (FAB) classification of MDS Refractory anemia (RA) | 9 participants |
| French-American-British (FAB) classification of MDS Refractory anemia with excess blasts (RAEB) | 2 participants |
| French-American-British (FAB) classification of MDS Refractory anemia with ringed sideroblasts (RARS) | 0 participants |
| International Prognostic Scoring System (IPSS) Score High risk | 0 participants |
| International Prognostic Scoring System (IPSS) Score Intermediate-1 risk | 9 participants |
| International Prognostic Scoring System (IPSS) Score Intermediate-2 risk | 0 participants |
| International Prognostic Scoring System (IPSS) Score Low risk | 2 participants |
| Region of Enrollment Japan | 11 participants |
| Sex: Female, Male Female | 7 Participants |
| Sex: Female, Male Male | 4 Participants |
| Transfusion Dependency No | 6 participants |
| Transfusion Dependency Yes | 5 participants |
| World Health Organization Classification of MDS MDS associated with isolated del(5q) | 8 participants |
| World Health Organization Classification of MDS MDS, unclassified (MDS-U) | 0 participants |
| World Health Organization Classification of MDS RA with ringed sideroblasts (RARS) | 0 participants |
| World Health Organization Classification of MDS RCMD and ringed sideroblasts (RCMD-RS) | 0 participants |
| World Health Organization Classification of MDS Refractory anemia (RA) | 0 participants |
| World Health Organization Classification of MDS Refractory anemia with excess blasts-1 (RAEB-1) | 2 participants |
| World Health Organization Classification of MDS Refractory anemia with excess blasts-2 (RAEB-2) | 0 participants |
| World Health Organization Classification of MDS Refractory cytopenia multilineage dysplasia (RCMD) | 1 participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 11 / 11 |
| serious Total, serious adverse events | 3 / 11 |
Outcome results
Number of Participants With Adverse Events (AE)
An AE that resulted in any of the following outcomes was defined as a serious adverse event (SAE): * Death; * Life-threatening event; * Any inpatient hospitalization or prolongation of existing hospitalization; * Persistent or significant disability or incapacity; * Congenital anomaly or birth defect; * Any other important medical event. The investigator determined the relationship of an AE to study drug based on the timing of the AE relative to drug administration and whether or not other drugs, therapeutic interventions, or underlying conditions could provide a sufficient explanation for the event. The severity of an AE was evaluated by the investigator according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) (Version 3.0) where Grade 1 = Mild, Grade 2 = Moderate, Grade 3 = Severe, Grade 4 = Life-threatening and Grade 5 = Death.
Time frame: After the first study dose until 28 days after completion of/discontinuation from the study (maximum time on study was 155 weeks).
Population: Safety population: all patients who received at least 1 dose of study drug.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Lenalidomide | Number of Participants With Adverse Events (AE) | Any adverse event (AE) | 11 participants |
| Lenalidomide | Number of Participants With Adverse Events (AE) | AE related to study drug | 11 participants |
| Lenalidomide | Number of Participants With Adverse Events (AE) | Grade 3 or 4 AE | 11 participants |
| Lenalidomide | Number of Participants With Adverse Events (AE) | Grade 3 or 4 AE related to study drug | 11 participants |
| Lenalidomide | Number of Participants With Adverse Events (AE) | Serious AE (SAE) | 3 participants |
| Lenalidomide | Number of Participants With Adverse Events (AE) | SAE related to study drug | 1 participants |
| Lenalidomide | Number of Participants With Adverse Events (AE) | AE leading to discontinuation of study drug | 0 participants |
| Lenalidomide | Number of Participants With Adverse Events (AE) | Related AE leading to discontinuation | 0 participants |
| Lenalidomide | Number of Participants With Adverse Events (AE) | AE leading to a dose reduction or interruption | 10 participants |
| Lenalidomide | Number of Participants With Adverse Events (AE) | Related AE leading to dose reduction/interruption | 9 participants |
| Lenalidomide | Number of Participants With Adverse Events (AE) | Deaths | 0 participants |
Apparent Terminal Elimination Rate Constant of Lenalidomide
Apparent terminal elimination rate constant of lenalidomide determined after a single dose on Day 1 and multiple doses (Day 4).
Time frame: Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose.
Population: PK population with available data
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| Lenalidomide | Apparent Terminal Elimination Rate Constant of Lenalidomide | 0.213 1/h | Geometric Coefficient of Variation 23 |
| Lenalidomide: Day 4 | Apparent Terminal Elimination Rate Constant of Lenalidomide | 0.194 1/h | Geometric Coefficient of Variation 39 |
Apparent Total Plasma Clearance (CL/F) of Lenalidomide
Apparent total plasma clearance (CL/F) of lenalidomide after a single dose on Day 1 and multiple doses (Day 4).
Time frame: Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose.
Population: PK population with available data
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| Lenalidomide | Apparent Total Plasma Clearance (CL/F) of Lenalidomide | 189.8 mL/minute | Geometric Coefficient of Variation 45.1 |
| Lenalidomide: Day 4 | Apparent Total Plasma Clearance (CL/F) of Lenalidomide | 189.9 mL/minute | Geometric Coefficient of Variation 43 |
Apparent Volume of Distribution (VzF) of Lenalidomide
Apparent volume of distribution of lenalidomide after a single dose on Day 1 and multiple doses (Day 4).
Time frame: Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose.
Population: PK population with available data
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| Lenalidomide | Apparent Volume of Distribution (VzF) of Lenalidomide | 53.6 liters | Geometric Coefficient of Variation 30.9 |
| Lenalidomide: Day 4 | Apparent Volume of Distribution (VzF) of Lenalidomide | 58.6 liters | Geometric Coefficient of Variation 25.8 |
Area Under the Plasma Concentration-time Curve From Time Zero to Infinity (AUC∞) of Lenalidomide
Area under the plasma concentration-time curve from time zero to infinity (AUC∞) of lenalidomide after a single dose on Day 1.
Time frame: Day 1 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, 12 and 24 hours post-dose.
Population: PK population with available data
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| Lenalidomide | Area Under the Plasma Concentration-time Curve From Time Zero to Infinity (AUC∞) of Lenalidomide | 878.0 ng*h/mL | Geometric Coefficient of Variation 45.1 |
Area Under the Plasma Concentration-time Curve From Time Zero to the Last Measurable Concentration (AUCt) of Lenalidomide
Area under the plasma concentration-time curve from time zero to the last measurable concentration (AUCt) of lenalidomide after a single dose on Day 1 and multiple doses (Day 4).
Time frame: Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose.
Population: PK population
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| Lenalidomide | Area Under the Plasma Concentration-time Curve From Time Zero to the Last Measurable Concentration (AUCt) of Lenalidomide | 718.4 ng*h/mL | Geometric Coefficient of Variation 41.2 |
| Lenalidomide: Day 4 | Area Under the Plasma Concentration-time Curve From Time Zero to the Last Measurable Concentration (AUCt) of Lenalidomide | 803.5 ng*h/mL | Geometric Coefficient of Variation 46.9 |
Area Under the Plasma Concentration-time Curve Over the Dosing Interval (AUCτ) of Lenalidomide
Area under the plasma concentration-time curve over the dosing interval (AUCτ) of lenalidomide after a single dose on Day 1 and multiple doses (Day 4).
Time frame: Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, 12 and 24 hours post-dose.
Population: PK population with available data
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| Lenalidomide | Area Under the Plasma Concentration-time Curve Over the Dosing Interval (AUCτ) of Lenalidomide | 866.5 ng*h/mL | Geometric Coefficient of Variation 44.1 |
| Lenalidomide: Day 4 | Area Under the Plasma Concentration-time Curve Over the Dosing Interval (AUCτ) of Lenalidomide | 877.9 ng*h/mL | Geometric Coefficient of Variation 43 |
Change From Baseline in Hemoglobin Concentration
Change in hemoglobin concentration from Baseline to the maximum observed value during the major erythroid response period for major erythroid responders.
Time frame: Baseline and from Day1 until the maximum observed value (up to 155 weeks)
Population: Efficacy population with a erythroid response
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Lenalidomide | Change From Baseline in Hemoglobin Concentration | Baseline concentration | 7.0 g/dL |
| Lenalidomide | Change From Baseline in Hemoglobin Concentration | Maximum concentration during study | 13.1 g/dL |
| Lenalidomide | Change From Baseline in Hemoglobin Concentration | Change from Baseline to maximum value | 6.0 g/dL |
Change From Baseline in Percentage of Bone Marrow Erythroblasts
Bone marrow morphology was assessed by the central hematologic reviewers based on the locally-prepared bone marrow smear slide and clot section.
Time frame: Baseline, at the end of Cycle 3 (Day 85) and Cycle 6 (Day 169).
Population: Efficacy population with available bone marrow specimens.
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Lenalidomide | Change From Baseline in Percentage of Bone Marrow Erythroblasts | Change from Baseline at the end of Cycle 3 | 36.5 Percentage of Bone Marrow Erythroblasts |
| Lenalidomide | Change From Baseline in Percentage of Bone Marrow Erythroblasts | Change from Baseline at the end of Cycle 6 | 21.5 Percentage of Bone Marrow Erythroblasts |
Duration of Erythroid Response
Duration of erythroid response was calculated as the time from the start of the first major or minor erythroid response to the end of the response. Similarly, duration of major erythroid response was calculated as the time from the start of the first major erythroid response to the end of the response. Response duration was censored at the last adequate assessment for patients who maintained response.
Time frame: From the first dose of study drug through Week 156
Population: Efficacy population with a erythroid response
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Lenalidomide | Duration of Erythroid Response | Duration of erythroid response (major or minor) | 76.6 weeks |
| Lenalidomide | Duration of Erythroid Response | Duration of major erythroid response | 72.1 weeks |
Maximum Observed Plasma Concentration (Cmax) of Lenalidomide
Maximum observed plasma concentration of lenalidomide after a single dose on Day and after multiple doses (Day 4).
Time frame: Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose.
Population: Pharmacokinetic (PK) population: all patients who adhered to the study treatment during the course of PK assessment (Days 1 to 5 of Cycle 1) and from whom blood and urine samples were collected.
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| Lenalidomide | Maximum Observed Plasma Concentration (Cmax) of Lenalidomide | 136 ng/mL | Geometric Coefficient of Variation 43.1 |
| Lenalidomide: Day 4 | Maximum Observed Plasma Concentration (Cmax) of Lenalidomide | 149 ng/mL | Geometric Coefficient of Variation 31.2 |
Number of Participants With a Cytogenetic Response
Cytogenetic (chromosome structure) abnormalities were assessed by a central cytogenetic reviewer based on prints and cytogenetic reports of the bone marrow sample from the central laboratory. Cytogenetic response was determined using the IWG (2000) criteria and categorized as either a major response or minor response. Twenty metaphases were analyzed for the determination of cytogenetic response. A major response was defined as no detectable cytogenetic abnormality, if an abnormality was present at Baseline, sustained for consecutive 56 days during the treatment period. A minor response was defined as ≥ 50% reduction from Baseline in abnormal metaphases sustained for consecutive 56 days during the treatment period.
Time frame: Response was assessed every 12 weeks through Week 156
Population: Efficacy population
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Lenalidomide | Number of Participants With a Cytogenetic Response | Major response | 1 participants |
| Lenalidomide | Number of Participants With a Cytogenetic Response | Minor response | 5 participants |
Number of Participants With a Erythroid Response
Erythroid response was determined using the International Working Group (IWG) 2000 criteria, categorized as a major response or minor response. A major response in patients with transfusion-dependent anemia (receiving ≥ 4.5 units of red blood cell (RBC) transfusion during 56 consecutive days at Baseline) is defined as RBC transfusion independence accompanied by a ≥1.0 g/dL increase from Baseline in hemoglobin sustained for 56 days consecutively during the treatment period. In patients with transfusion-independent anemia with hemoglobin \< 10 g/dL at Baseline a major response is defined as a \> 2.0 g/dL increase from Baseline in hemoglobin sustained for consecutive 56 days. Minor response in patients with transfusion-dependent anemia defined as ≥ 50% decrease from Baseline in transfusion requirements sustained for consecutive 56 days, and in transfusion-independent patients as 1.0 to 2.0 g/dL increase from Baseline in hemoglobin sustained for consecutive 56 days.
Time frame: Response was assessed every 28 days through Week 156.
Population: Efficacy population: all patients who had a diagnosis of low- or intermediate-1-risk MDS associated with anemia based on confirmation by the central reviewers and received at least 1 dose of study drug.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Lenalidomide | Number of Participants With a Erythroid Response | Erythroid responders (major or minor) | 11 participants |
| Lenalidomide | Number of Participants With a Erythroid Response | Major erythroid responders | 11 participants |
Number of Participants With a Neutrophil Response
Neutrophil response was determined using the IWG (2000) criteria. A major response for participants with a Baseline neutrophil count \< 1,500/mm\^3 is defined as a ≥ 100% increase or a ≥ 500/mm\^3 increase, whichever is greater, sustained for consecutive 56 days during the treatment period. A minor response for participants with a Baseline neutrophil count \< 1,500/mm\^3 is defined as a ≥ 100% increase, but an absolute increase \< 500/mm\^3, sustained for consecutive 56 days during the treatment period.
Time frame: Response was assessed every 28 days through Week 156
Population: Efficacy population with Baseline neutrophil count \< 1,500/mm\^3.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Lenalidomide | Number of Participants With a Neutrophil Response | Minor response | 0 participants |
| Lenalidomide | Number of Participants With a Neutrophil Response | Major response | 1 participants |
Number of Participants With a Platelet Response
Platelet response was determined using the IWG (2000) criteria. Major response in patients with Baseline platelet count \< 100,000/mm\^3 is defined as a ≥ 30,000/mm\^3 increase sustained for consecutive 56 days during the treatment period. In platelet-transfusion-dependent patients at Baseline a major response is defined as stabilization of platelet counts and platelet transfusion independence sustained for consecutive 56 days during the treatment period. Minor response in patients with Baseline platelet count \< 100,000/mm\^3 is defined as a ≥ 50% increase in platelet count with an absolute increase \> 10,000/mm\^3 and \< 30,000/mm\^3 sustained for consecutive 56 days during the treatment period.
Time frame: Response was assessed every 28 days through Week 156
Population: Efficacy population with a Baseline platelet count of \< 100,000/mm\^3 or who were platelet-transfusion dependent at Baseline. There were no patients with platelet count of \< 100,000/mm3 or who were platelet-transfusion dependent at Baseline, and thus platelet response was not evaluated.
Percentage of Bone Marrow Myeloblasts
Bone marrow morphology was assessed by the central hematologic reviewers based on the locally-prepared bone marrow smear slide and clot section.
Time frame: Baseline, at the end of Cycle 3 (Day 85) and Cycle 6 (Day 169).
Population: Efficacy population with available bone marrow specimens at each time point (indicated by N).
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Lenalidomide | Percentage of Bone Marrow Myeloblasts | Baseline (N=11) | 3.77 Percentage of myeloblasts |
| Lenalidomide | Percentage of Bone Marrow Myeloblasts | End of Cycle 3 (N=10) | 1.47 Percentage of myeloblasts |
| Lenalidomide | Percentage of Bone Marrow Myeloblasts | End of Cycle 6 (N=10) | 1.79 Percentage of myeloblasts |
Percentage of Bone Marrow Promyelocytes
Bone marrow morphology was assessed by the central hematologic reviewers based on the locally-prepared bone marrow smear slide and clot section.
Time frame: Baseline, at the end of Cycle 3 (Day 85) and Cycle 6 (Day 169).
Population: Efficacy population with available bone marrow specimens at each time point (indicated by N).
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Lenalidomide | Percentage of Bone Marrow Promyelocytes | End of Cycle 3 (N=10) | 5 Percentage of promyelocytes |
| Lenalidomide | Percentage of Bone Marrow Promyelocytes | Baseline (N=11) | 5 Percentage of promyelocytes |
| Lenalidomide | Percentage of Bone Marrow Promyelocytes | End of Cycle 6 (N=10) | 5 Percentage of promyelocytes |
Terminal Half-life (T1/2) of Lenalidomide
The apparent terminal half-life is the time required for plasma concentration to decrease by 50% after pseudo-equilibrium of distribution has been reached, and calculated as the natural logarithm of 2 (0.693) / Apparent terminal rate constant (λz).
Time frame: Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose.
Population: PK population with available data
| Arm | Measure | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|
| Lenalidomide | Terminal Half-life (T1/2) of Lenalidomide | 3.26 hours | Geometric Coefficient of Variation 23 |
| Lenalidomide: Day 4 | Terminal Half-life (T1/2) of Lenalidomide | 3.57 hours | Geometric Coefficient of Variation 29.6 |
Time to Erythroid Response
Time to erythroid response was calculated as the time from the first dose of study drug to the start of the first major or minor erythroid response. Similarly, time to major erythroid response was calculated as the time from the first dose of study drug to the start of the first major erythroid response.
Time frame: From the first dose of study drug through Week 156
Population: Efficacy population
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| Lenalidomide | Time to Erythroid Response | Time to erythroid response (major or minor) | 2.1 weeks |
| Lenalidomide | Time to Erythroid Response | Time to major erythroid response | 6.3 weeks |
Time to Maximum Plasma Concentration (Tmax) of Lenalidomide
Time to maximum observed plasma concentration of lenalidomide after a single dose on Day 1 and multiple doses (Day 4).
Time frame: Days 1 and 4 at predose and 0.5, 1, 1.5, 2, 3, 4, 6, 9, and 12 hours post-dose.
Population: PK population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Lenalidomide | Time to Maximum Plasma Concentration (Tmax) of Lenalidomide | 2.52 hours |
| Lenalidomide: Day 4 | Time to Maximum Plasma Concentration (Tmax) of Lenalidomide | 2.93 hours |