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Quality Assurance of Secondary Immunodeficiencies (SID) in CLL/MM Patients

Quality Assurance on Diagnosis and Therapy of Secondary Immunodeficiencies (SID) in Patients With Chronic Lymphocytic Leukemia (CLL) or Multiple Myeloma (MM) in Germany (QS-SID)

Status
Completed
Phases
Unknown
Study type
Observational
Source
ClinicalTrials.gov
Registry ID
NCT04172467
Acronym
QS-SID
Enrollment
1086
Registered
2019-11-21
Start date
2020-01-28
Completion date
2020-08-03
Last updated
2022-01-10

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Secondary Immunodeficiencies (SID)

Keywords

Secondary immunodeficiencies (SID), Chronic lymphocytic leukemia (CLL), Multiple myeloma (MM)

Brief summary

Retrospective, representative registry for quality assurance on diagnosis and therapy of secondary immunodeficiencies (SID) in patients with chronic lymphocytic leukemia (CLL) or multiple myeloma (MM)

Detailed description

Treatment structure analysis and recruitment (phase 1): In a first step, data on care facilities, that treat patients with CLL or MM in Germany is obtained. In phase 1 all centers in Germany that potentially treat patients with the CLL or MM are contacted and data of its facility care level and its number of treated patients is recorded using a one-sided pen-to-paper form. In addition, the willingness of care facilities to become involved in patients' documentation is elicited (phase 2). Patient documentation (phase 2) To achieve a reliable, representative sample of patients treated in Germany, the distribution of cases to be documented is specified in the individual indications amongst the facilities involved. This is done using the facilities' data on patient numbers and treatment structure obtained in phase I: The participating centers are assigned to clusters based on key distinguishing features (facility type, care level and number of patients treated). This sample is modulated according to the previous treatment structure analysis. By taking this approach, the actual percentages of the various care facilities in an indication area can be reflected proportionally in the patient documentation sample. In phase 2 a electronic case record form (eCRF) is completed in order to collect the original patient and treatment data, which are relevant to the purpose of the study. All data is gathered retrospectively and anonymously using the patient files. Patient and disease related variables (age, general condition according to the Eastern Cooperative Oncology Group (ECOG), relevant comorbidity, staging and relevant mutations), systemic antineoplastic treatment (chemotherapy, antibodies, kinase-inhibitors, relevant co-medication etc.) are recorded. Also, data on diagnosis of Ig-levels (IgG, IgA, IgM), therapy of secondary immunodeficiencies as well as the number and severity of occurred infections and their treatment is collected. Clusters for classification of infections will be developed (e.g. life-threatening, need for hospitalization). In order to ensure data quality, the scientific project lead will provide training for two employees of the commissioned institute on matters regarding the content of the study. This knowledge will be incorporated into the programming of the user interface and the patient databases so that the program will check for completeness and, as far as possible, plausibility, on the basis of defined requirements and constraints. These checks accompany the process of entering data into the eCRF and allow for validating data instantly. If inconsistencies, mistakes or omissions are detected, data will be validated by an integrated query management system. Physicians questionnaire (phase 3) In an additional step and alongside the patient documentation, the attending physicians in participating centers will be surveyed (phase 3) on their competency profile, their assessment of guideline quality and their approach to avoid infections of CLL and MM patients.

Interventions

non-interventional retrospective epidemiological observational study

Sponsors

Prof. Hartmut Link
CollaboratorUNKNOWN
Takeda
CollaboratorINDUSTRY
MMF GmbH
CollaboratorINDUSTRY
AIO AG Supportivtherapie
CollaboratorOTHER
AG Supportive Maßnahmen in der Onkologie
CollaboratorOTHER
AIO-Studien-gGmbH
Lead SponsorOTHER

Study design

Observational model
OTHER
Time perspective
RETROSPECTIVE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* patients with CLL or MM * anti-neoplastic systemic therapy (all therapy lines) between July 1st 2017 and June 30th 2018

Exclusion criteria

\- patient in terminal phase of the disease, life expectancy less than three months

Design outcomes

Primary

MeasureTime frameDescription
Guideline Adherence (GLAD)Median study observation period of 18.2 monthsFor SID, immunoglobulin substitution (IgRT) is mandatory only for patients with an IgG level \< 4g/l (or IgG subclass deficiency) and additionally more than 3 infections or a severe infection (≥ grade 3) and is optional (may be appropriate) if IgG level \< 4g/l and/or 1-3 less severe infections (≤ grade 2). IgRT is not indicated if patients do not fulfil either condition. Scoring system: GLAD-Score 2: full guideline adherence GLAD-Score 1: deviations in dose or interval (+/- 10%) or a late start of IgRT (\>28 days after a severe infection (≥ grade 3). GLAD-Score 0: IgRT without indication (overuse) or omitted IgRT despite recommendation (underuse). Likewise, 0 points were awarded if both the dose and the interval deviated from the GL recommendations (e.g. underdosed single dose) or if IgRT was not started until more than 3 months after hypogammaglobulinemia and at least one severe infection.

Secondary

MeasureTime frameDescription
Guideline Adherence and Susceptibility to InfectionMedian study observation period of 18.2 monthsFor the analysis of susceptibility to infection, the time to next infection was examined using the Andersen-Gill model for recurrent events. For effect estimation, hazard ratios are reported with 95% confidence interval in each case. GLAD-Score 2 is Reference, a higher hazard ratio means a higher susceptibility to infection.

Countries

Germany

Participant flow

Recruitment details

This is a retrospective sample analysis of patients from practices and hospitals in Germany who were representatively screened using previously collected care parameters of the participating institutions. Previous and current treatment and infection data were collected from patients who received a line of therapy for the treatment of CLL or MM started in 2018 (1st, 2nd and 3rd or higher line).

Pre-assignment details

The time period was chosen to ensure that patients have been followed up for at least 12 months in order to collect data on susceptibility to infection and possible secondary immunodeficiencies

Participants by arm

ArmCount
Non-interventional Retrospective Observational Study.
This was a retrospective sample analysis representative for practices and hospitals in Germany. The treatments and infection data were collected from patients with chronic lymphocytic leukaemia (CLL) and multiple myeloma (MM). GL adherence (GLAD) was analysed.
1,086
Total1,086

Baseline characteristics

CharacteristicNon-interventional Retrospective Observational Study.
Age, Categorical
<=18 years
0 Participants
Age, Categorical
>=65 years
819 Participants
Age, Categorical
Between 18 and 65 years
267 Participants
Age, Continuous73 years
Disease
Chronic Lymphocytic Leukaemia (CLL)
490 Participants
Disease
Multiple Myeloma (MM)
596 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
Race (NIH/OMB)
Asian
0 Participants
Race (NIH/OMB)
Black or African American
0 Participants
Race (NIH/OMB)
More than one race
0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
Race (NIH/OMB)
Unknown or Not Reported
1086 Participants
Race (NIH/OMB)
White
0 Participants
Region of Enrollment
Germany
1086 Participants
Sex: Female, Male
Female
475 Participants
Sex: Female, Male
Male
611 Participants
Therapy Line
1st line
539 Participants
Therapy Line
2nd line
317 Participants
Therapy Line
3rd line
230 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
0 / 0
other
Total, other adverse events
0 / 0
serious
Total, serious adverse events
0 / 0

Outcome results

Primary

Guideline Adherence (GLAD)

For SID, immunoglobulin substitution (IgRT) is mandatory only for patients with an IgG level \< 4g/l (or IgG subclass deficiency) and additionally more than 3 infections or a severe infection (≥ grade 3) and is optional (may be appropriate) if IgG level \< 4g/l and/or 1-3 less severe infections (≤ grade 2). IgRT is not indicated if patients do not fulfil either condition. Scoring system: GLAD-Score 2: full guideline adherence GLAD-Score 1: deviations in dose or interval (+/- 10%) or a late start of IgRT (\>28 days after a severe infection (≥ grade 3). GLAD-Score 0: IgRT without indication (overuse) or omitted IgRT despite recommendation (underuse). Likewise, 0 points were awarded if both the dose and the interval deviated from the GL recommendations (e.g. underdosed single dose) or if IgRT was not started until more than 3 months after hypogammaglobulinemia and at least one severe infection.

Time frame: Median study observation period of 18.2 months

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
Non-interventional Retrospective Observational Study.Guideline Adherence (GLAD)GLAD-Score 2889 Participants
Non-interventional Retrospective Observational Study.Guideline Adherence (GLAD)GLAD-Score 175 Participants
Non-interventional Retrospective Observational Study.Guideline Adherence (GLAD)GLAD-Score 0122 Participants
Secondary

Guideline Adherence and Susceptibility to Infection

For the analysis of susceptibility to infection, the time to next infection was examined using the Andersen-Gill model for recurrent events. For effect estimation, hazard ratios are reported with 95% confidence interval in each case. GLAD-Score 2 is Reference, a higher hazard ratio means a higher susceptibility to infection.

Time frame: Median study observation period of 18.2 months

ArmMeasureValue (NUMBER)
Non-interventional Retrospective Observational Study.Guideline Adherence and Susceptibility to Infection250 Number of infectious events
GLAD-Score 1Guideline Adherence and Susceptibility to Infection63 Number of infectious events
GLAD-Score 0Guideline Adherence and Susceptibility to Infection221 Number of infectious events
Comparison: For the analysis of susceptibility to infection, the time to next infection was examined using the Andersen-Gill model. This model is an extension to the proportional hazard model (Cox model) for time to recurrent event analysis. The null hypothesis is that the GLAD-Score has no effect on susceptibility to infection.p-value: <0.00195% CI: [3.72, 5.42]Regression, Cox
Comparison: For the analysis of susceptibility to infection, the time to next infection was examined using the Andersen-Gill model. This model is an extension to the proportional hazard model (Cox model) for time to recurrent event analysis. The null hypothesis is that the GLAD-Score has no effect on susceptibility to infection.p-value: <0.00195% CI: [1.98, 3.21]Regression, Cox

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026