Myelodysplastic Syndromes, Leukemia, Myelomonocytic, Chronic
Conditions
Keywords
MBG453, Phase III, TIM-3, azacitidine, myelodysplastic syndrome, MDS, chronic myelomonocytic leukemia, CMML-2, Sabatolimab, high or, very high risk myelodysplastic syndrome, Chronic Myelomonocytic Leukemia-2
Brief summary
This was a Phase III multi-center, randomized, two-arm parallel-group, double-blind, placebo-controlled study of MBG453 or placebo added to azacitidine in adult participants with intermediate, high or very high-risk myelodysplastic syndrome (MDS) as per IPSS-R, or Chronic Myelomonocytic Leukemia-2 (CMML-2) who are not eligible for intensive chemotherapy or hematopoietic stem cell transplantation (HSCT) according to medical judgment by the investigator. The purpose of the current study was to assess clinical effects of MBG453 in combination with azacytidine in adult participants with IPSS-R intermediate, high, very high risk MDS and CMML-2.
Detailed description
This was a Phase III multi-center, randomized, two-arm parallel-group, double-blind, placebo-controlled study of MBG453 or placebo added to azacitidine in adult participants with intermediate, high or very high-risk myelodysplastic syndrome (MDS) as per IPSS-R, or Chronic Myelomonocytic Leukemia-2 (CMML-2). The primary objective of this study was to compare overall survival (OS) in the MBG453 plus azacitidine arm versus placebo plus azacitidine arm where OS was the time from randomization until death due to any cause. Participants were randomized in a 1:1 ratio to treatment arms as follow: MBG453 800 mg IV Q4W plus azacitidine, Placebo IV Q4W plus azacitidine. The randomization was stratified into 4 groups: intermediate risk MDS, high risk MDS, very high risk MDS and CMML-2. All participants who discontinued both study treatments were to have entered a long-term post-treatment follow-up including response and PRO assessments, and/or survival follow-up for up to 5 years after the last participant was randomized. Participants were receiving treatment until they experienced progression of disease (including transformation to acute leukemia per WHO 2016 classification), experienced unacceptable toxicity or discontinued the study treatment for other reasons. Continuation of study treatment beyond progression (excluding transformation to acute leukemia: continuation in this case was not possible) could have been possible in selected participants.
Interventions
A dose of MBG453 800 mg was administered intravenously (IV) every 4 weeks (Q4W).
A dose of Azacitidine 75 mg/m2 was administered IV or subcutaneously (SC) on Day 1-7, or Day 1-5, 8 and 9.
A dose of placebo 800 mg was administered intravenously every 4 weeks (Q4W).
Sponsors
Study design
Intervention model description
Randomized, double-blind
Eligibility
Inclusion criteria
* Signed informed consent must be obtained prior to participation in the study * Age ≥ 18 years at the date of signing the informed consent form * Morphologically confirmed diagnosis of myelodysplastic syndrome (MDS) based on WHO 2016 classification (Arber et al 2016) by local investigator assessment with one of the following Prognostic Risk Categories, based on the revised International Prognostic Scoring System (IPSS-R): * Very high (\> 6 points) * High (\> 4.5 - ≤ 6 points) * Intermediate (\> 3 - ≤ 4.5 points) Or Morphologically confirmed diagnosis of Chronic Myelomonocytic Leukemia -2 based on WHO 2016 classification (Arber et al 2016, including persistent monocytosis) by local investigator assessment with WBC \< 13 x 109/L at time of initial diagnosis * Indication for azacitidine treatment according to the investigator, based on local standard medical practice and institutional guidelines for treatment decisions * Not eligible at time of screening for intensive chemotherapy according to the investigator, based on local standard medical practice and institutional guidelines for treatment decisions, including assessment of individual clinical factors such as age, comorbidities and performance status * Not eligible at time of screening for hematopoietic stem cell transplantation (HSCT) according to the investigator, based on local standard medical practice and institutional guidelines for treatment decisions, including assessment of individual clinical factors such as age, comorbidities, performance status, and donor availability * Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2
Exclusion criteria
* Prior exposure to TIM-3 directed therapy at any time. Prior therapy with immune checkpoint inhibitors (e.g, anti-CTLA4, anti-PD-1, anti-PD-L1, or anti-PD-L2), cancer vaccines is allowed except if the drug was administered within 4 months prior to randomization * Previous first-line treatment for intermediate, high, very high risk myelodysplastic syndromes (based on IPSS-R) or CMML with any antineoplastic agents including for example chemotherapy, lenalidomide and hypomethylating agents (HMAs) such as decitibine and azacitidine. However, previous treatment with hydroxyurea or leukopheresis to reduce WBC count is allowed prior to randomization. * Investigational treatment received within 4 weeks or 5 half-lives of this investigational treatment, whatever is longer, prior to randomization. In case of a checkpoint inhibitor: a minimal interval of 4 months prior to randomization is necessary to allow randomization. * Subjects with Myelodysplastic syndrome (MDS) based on 2016 WHO classification (Arber et al 2016) with revised International Prognostic Scoring System (IPSS-R) ≤ 3 * Diagnosis of acute myeloid leukemia (AML) including acute promyelocytic leukemia and extra-medullary acute myeloid leukemia, primary or secondary myelofibrosis based on WHO 2016 classification (Arber et al 2016) * Diagnosis of therapy related myeloid neoplasms based on WHO 2016 classification (Arber et al 2016) * History of organ or allogeneic hematopoietic stem cell transplant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) (Primary Efficacy Results) | up to approx. 39 months | OS is the time from randomization until death due to any cause. |
| Overall Survival (OS) (Final Efficacy Results) | up to approx. 52 months | OS is the time from randomization until death due to any cause. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Key Secondary Endpoint 2: Red Blood Cell (RBC) Annualized Transfusion Free Rate for Transfusion | up to approx. 52 months | Annualized transfusion free rate is defined as the average number of days in RBC transfusion-free intervals in a year (i.e., the total number of days in RBC transfusion-free intervals divided by the total days in the study multiplied by 365.25), where RBC transfusion-free intervals correspond to cumulative times of intervals with no evidence of RBC transfusion for at least 8 weeks at any point after randomization until death due to any cause. |
| Key Secondary Endpoint 3: Percentage of Participants With at Least 3 Point Confirmed Improvement From Baseline in FACIT-fatigue Scores | up to approx. 52 months | FACIT-Fatigue score is a 13-item questionnaire designed to assess fatigue in cancer participants. All items use a 5-point scale ranging from 0 to 4 (0=Not at All to 4=Very Much). The total score ranges from 0 to 52 with higher values representing better quality of life. The responder is defined as having 3 points improvement from baseline confirmed by a second improvement of 3 points at any time, regardless of preceding worsening. A participant who could not improve was considered as a non-responder. |
| Key Secondary Endpoint 4: Percentage of Participants With at Least 10 Point Confirmed Improvement From Baseline in Physical Functioning Using European Organization for Research and Treatment of Cancer's Core Quality of Life Questionnaire (EORTC QLQ-C30) | up to approx. 52 months | EORTC-QLQ-C30 is a 30-item questionnaire developed to assess the quality of life of cancer participants. Participants' responses to 5 questions about their physical functioning (Items 1-5) are scored on a 4-point scale (1=Not at All to 4=Very Much). Using linear transformation, raw scores are standardized, so that scores range from 0 to 100. A high score indicates a high / healthy level of functioning. The responder is defined as having 10 points improvement from baseline confirmed by a second improvement of 10 points at any time, regardless of preceding worsening. A participant who could not improve was considered as a non-responder. |
| Key Secondary Endpoint 5: Percentage of Participants With at Least 10 Point Confirmed Improvement From Baseline in Emotional Functioning Using EORTC-QLQ-C30 | up to approx. 52 months | EORTC-QLQ-C30 is a 30-item questionnaire developed to assess the quality of life of cancer participants. Participants' responses to 4 questions about their emotional functioning (Items 21-24) are scored on a 4-point scale (1=Not at All to 4=Very Much). Using linear transformation, raw scores are standardized, so that scores range from 0 to 100. A high score indicates a high / healthy level of functioning. The responder is defined as having 10 points improvement from baseline confirmed by a second improvement of 10 points at any time, regardless of preceding worsening. A participant who could not improve was considered as a non-responder. |
| Percentage of Participants With Either CR, or mCR, or PR, or HI in Each Treatment Arm According to International Working Group for MDS (IWG-MDS) as Per Investigator Assessment | up to approx. 52 months | Response rate of participants with complete remission (CR), or marrow remission (mCR), or partial remission (PR), or hematologic improvement (HI). CR: where the Bone marrow: ≤ 5% blasts with normal maturation of all cell lineages and Peripheral blood: where Hgb ≥ 10 g/dL AND Platelets ≥ 100\*109/L AND Neutrophils ≥ 1.0\*109/L AND Peripheral blasts 0%. mCR: Bone marrow: ≤ 5% blasts and blast count decrease by ≥ 50% compared to baseline; Peripheralblood/transfusion: Marrow CR may be achieved with or without improved blood counts or with or without transfusions PR: All CR criteria except bone marrow: ≥50% decrease from baseline in blasts in bone marrow AND blast count in bone marrow \>5%. HI: restoration or enhancement of the function of the body's blood cell-producing system that must last as least 8 weeks. |
| Percentage of Participants With Stable Disease (SD) According to International Working Group for MDS (IWG-MDS) as Per Investigator Assessment | up to approx. 52 months | Response rate of participants with stable disease. SD is the failure to achieve at least partial response (PR), but no evidence of progression for \>8 weeks. |
| Progression Free Survival (PFS) | up to approx. 52 months | PFS is defined as the time from randomization to disease progression (including transformation to acute leukemia per WHO 2016), relapse from CR (IWG-MDS), or death. Disease progression: bone marrow blasts increase ≥ 50% over baseline, to \> 5% if initially \< 5%, \> 10% if 5%-\<10%, or \> 20% if 10%-\<20%. Includes a peripheral blood count decrease ≥ 50% from maximum remission/response levels: neutrophils \< 1.0x109/L, platelets \< 100x109/L, or hemoglobin drop ≥ 2 g/dL to \< 10 g/dL, becoming transfusion-dependent. Relapse from CR: baseline bone marrow blast % return, neutrophils decrease ≥ 50% to \< 1.0x109/L, platelets decrease ≥ 50% to \< 100x109/L, or hemoglobin drop ≥ 1.5 g/dL to \< 10 g/dL, becoming transfusion-dependent. Leukemia transformation: \> 20% blasts per WHO 2016 (Arber et al 2016). |
| Pharmacokinetics of MBG453 (Parameter AUC) | 0 hr (pre-dose) & 2 hrs (post-dose) of Cycle (C) 1 Day (D) 8 and 0 hr (pre-dose) & 2 hrs (post-dose) of C3D8 | AUCinf is the AUC from time zero to infinity (mass x time x volume-1). |
| Number of Participants Who Become Red Blood Cells (RBC) Transfusion Independent After Randomization | up to approx. 52 months | Improvement in RBC transfusion independence as per International Working Group for MDS (IWG-MDS) criteria. RBC transfusion independence was defined as having received 0 units of RBC transfusions during at least 8 consecutive weeks after randomization. The number of participants was shown in only those with transfusion dependence at baseline (BL). |
| Number of Participants Who Become Platelets Transfusion Independent After Randomization | up to approx. 52 months | Improvement in Platelets transfusion independence as per International Working Group for MDS (IWG-MDS) criteria. Platelets transfusion independence was defined as having received 0 units of Platelets transfusions during at least 8 consecutive weeks after randomization. The number of participants was shown in only those with transfusion dependence at baseline (BL). |
| Pharmacokinetics of MBG453 (Parameter Cmax) | 0 hr (pre-dose) & 2 hrs (post-dose) of Cycle (C) 1 Day (D) 8 and 0 hr (pre-dose) & 2 hrs (post-dose) of C3D8 | Cmax is the maximum (peak) observed drug concentration after single dose administration (mass x volume-1). |
| ADA Prevalence at Baseline and ADA-positive Participants On-treatment | Baseline, up to approx. 39 months | Anti-drug Antibody (ADA) prevalence is the number of participants with at least one sample meeting the criteria at baseline. ADA-positive participants were calculated as the number of participants with at least one on-treatment ADA-positive sample divided by the number of participants with a determinant baseline IG sample and at least one determinant post-baseline IG sample. |
| Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Baseline, every 3 cycles up to C48D1 (1 cycle = 28 days) | The EQ-5D-5L comprises 5 dimensions: mobility, self-care, usual activities, pain/discomfort, anxiety/depression. For each of the 5 dimensions, subject's responses are scored on a 5-point scale (1=no problem to 5=extreme problems). Change from baseline is being presented for EQ Index score. Index score is defined as a weighted combination of the levels of the 5-dimention scales, ranging from 0 to 1 (perfect health), with higher scores indicating better health-related quality of life. The United States value set from Pickard et al 2019 was used. |
| Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Baseline, every 3 cycles up to C48D1 (1 cycle = 28 days) | The EQ-5D-5L VAS records the participant's self-rated health on a visual analogue scale numbered from 0 to 100, with 0 being the worst health you can imagine and 100 being the best health you can imagine. Change from baseline was presented. |
| Change From Baseline of Global Health Status/Quality of Life Scores Using European Organization for Research and Treatment of Cancer's Core Quality of Life Questionnaire (EORTC-QLQ-C30). | Up to Cycle 12 Day 1 (C12D1) (1 cycle = 28 days) | EORTC-QLQ-C30 is a 30-item questionnaire developed to assess the quality of life of cancer participants. Participant's responses to 2 questions (Items 29+30: How would you rate your overall health during the past week? and How would you rate your overall quality of life during the past week?) are scored on a 7-point scale (1=Very Poor to 7=Excellent). Using linear transformation, raw scores are standardized, so that scores range from 0 to 100. A higher score indicates a better overall outcome. Change from baseline to Cycle 12 Day 1 as presented. |
| Leukemia-free Survival (LFS) | up to approx. 52 months | LFS is defined as the time from randomization to ≥ 20% blasts in bone marrow/peripheral blood (per WHO 2016 classification) or diagnosis of extramedullary acute leukemia, or death due to any cause |
| Key Secondary Endpoint 1: Time to Definitive Deterioration of Fatigue Using Functional Assessment of Cancer Therapy (FACIT)-Fatigue Score | up to approx. 52 months | FACIT-Fatigue score is a 13-item questionnaire designed to assess fatigue in cancer participants. All items use a 5-point scale ranging from 0 to 4 (0=Not at All to 4=Very Much). The total score ranges from 0 to 52 with higher values representing better quality of life. Time to definitive deterioration of fatigue is defined as time from randomization to at least 3 points worsening from baseline in FACIT-fatigue scores with no subsequently observed improvement above this threshold, or death due to any cause, whichever occurred first. |
Countries
Argentina, Australia, Austria, Belgium, Brazil, Canada, Chile, China, Colombia, Czechia, Finland, France, Germany, Greece, India, Israel, Italy, Japan, Lebanon, Lithuania, Malaysia, Mexico, Netherlands, Oman, Portugal, Russia, Saudi Arabia, Singapore, South Korea, Spain, Switzerland, Taiwan, Thailand, Turkey (Türkiye), United Kingdom, United States
Participant flow
Recruitment details
This study randomized participants in 149 centers in 36 participating countries.
Participants by arm
| Arm | Count |
|---|---|
| Sabatolimab (MBG453) + Azacitidine Participants were randomized to sabatolimab plus Azacitidine | 265 |
| Placebo + Azacitidine Participants were randomized to placebo plus Azacitidine | 265 |
| Total | 530 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 41 | 43 |
| Overall Study | Death | 26 | 35 |
| Overall Study | Guardian Decision | 1 | 0 |
| Overall Study | Hematopoietic Stem-Cell Transplantation (HSCT) Planned | 22 | 22 |
| Overall Study | Lost to Follow-up | 1 | 0 |
| Overall Study | New Therapy for Study Indication | 2 | 4 |
| Overall Study | Participant Decision | 22 | 28 |
| Overall Study | Participants Not Treated | 1 | 1 |
| Overall Study | Physician Decision | 14 | 9 |
| Overall Study | Progressive Disease | 111 | 92 |
| Overall Study | Protocol Deviation | 2 | 4 |
| Overall Study | Study Terminated by Sponsor | 22 | 27 |
Baseline characteristics
| Characteristic | Sabatolimab (MBG453) + Azacitidine | Placebo + Azacitidine | Total |
|---|---|---|---|
| Age, Continuous | 70.2 Years STANDARD_DEVIATION 11.46 | 69.1 Years STANDARD_DEVIATION 11.23 | 69.6 Years STANDARD_DEVIATION 11.35 |
| ECOG performance status ECOG performance status: 0 | 92 Participants | 101 Participants | 193 Participants |
| ECOG performance status ECOG performance status: 1 | 161 Participants | 141 Participants | 302 Participants |
| ECOG performance status ECOG performance status: 2 | 12 Participants | 23 Participants | 35 Participants |
| Race/Ethnicity, Customized American Indian or Alaska Native | 1 Participants | 2 Participants | 3 Participants |
| Race/Ethnicity, Customized Asian | 111 Participants | 124 Participants | 235 Participants |
| Race/Ethnicity, Customized Black or African American | 3 Participants | 4 Participants | 7 Participants |
| Race/Ethnicity, Customized Unknown | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized White | 150 Participants | 134 Participants | 284 Participants |
| Sex: Female, Male Female | 104 Participants | 79 Participants | 183 Participants |
| Sex: Female, Male Male | 161 Participants | 186 Participants | 347 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 161 / 265 | 160 / 265 |
| other Total, other adverse events | 256 / 263 | 255 / 265 |
| serious Total, serious adverse events | 174 / 263 | 164 / 265 |
Outcome results
Overall Survival (OS) (Final Efficacy Results)
OS is the time from randomization until death due to any cause.
Time frame: up to approx. 52 months
Population: FAS comprised of all participants to whom study treatment had been assigned by randomization.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Overall Survival (OS) (Final Efficacy Results) | 22.18 Months |
| Placebo + Azacitidine | Overall Survival (OS) (Final Efficacy Results) | 18.83 Months |
Overall Survival (OS) (Primary Efficacy Results)
OS is the time from randomization until death due to any cause.
Time frame: up to approx. 39 months
Population: FAS comprised of all participants to whom study treatment had been assigned by randomization.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Overall Survival (OS) (Primary Efficacy Results) | 22.31 Months |
| Placebo + Azacitidine | Overall Survival (OS) (Primary Efficacy Results) | 18.83 Months |
ADA Prevalence at Baseline and ADA-positive Participants On-treatment
Anti-drug Antibody (ADA) prevalence is the number of participants with at least one sample meeting the criteria at baseline. ADA-positive participants were calculated as the number of participants with at least one on-treatment ADA-positive sample divided by the number of participants with a determinant baseline IG sample and at least one determinant post-baseline IG sample.
Time frame: Baseline, up to approx. 39 months
Population: Immunogenicity Incidence Set includes all participants in the Immunogenicity prevalence set with a non-missing baseline ADA sample and at least one non-missing post-baseline ADA sample.~The Immunogenicity prevalence set includes all participants in the Safety Set with a non-missing baseline ADA sample or at least one non-missing post-baseline ADA sample.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | ADA Prevalence at Baseline and ADA-positive Participants On-treatment | ADA prevalence (i.e., ADA positive) at baseline | 24 Participants |
| Sabatolimab (MBG453) + Azacitidine | ADA Prevalence at Baseline and ADA-positive Participants On-treatment | ADA-positive participants on-treatment | 34 Participants |
Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time
The EQ-5D-5L comprises 5 dimensions: mobility, self-care, usual activities, pain/discomfort, anxiety/depression. For each of the 5 dimensions, subject's responses are scored on a 5-point scale (1=no problem to 5=extreme problems). Change from baseline is being presented for EQ Index score. Index score is defined as a weighted combination of the levels of the 5-dimention scales, ranging from 0 to 1 (perfect health), with higher scores indicating better health-related quality of life. The United States value set from Pickard et al 2019 was used.
Time frame: Baseline, every 3 cycles up to C48D1 (1 cycle = 28 days)
Population: FAS population with non-missing baseline EQ-5D-5L assessments. For each post-baseline timepoint, FAS population with non-missing baseline and post-baseline EQ-5D-5L assessment. FAS comprised of all patients to whom study treatment had been assigned by randomization.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C30D1 | -0.03 Scores on a scale | Standard Deviation 0.315 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C39D1 | -0.16 Scores on a scale | Standard Deviation 0.36 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C33D1 | -0.01 Scores on a scale | Standard Deviation 0.211 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C9D1 | 0.03 Scores on a scale | Standard Deviation 0.232 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C36D1 | -0.07 Scores on a scale | Standard Deviation 0.333 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C18D1 | -0.02 Scores on a scale | Standard Deviation 0.208 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C6D1 | -0.02 Scores on a scale | Standard Deviation 0.26 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C42D1 | -0.09 Scores on a scale | Standard Deviation 0.262 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C21D1 | 0.00 Scores on a scale | Standard Deviation 0.208 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C45D1 | -0.12 Scores on a scale | Standard Deviation 0.262 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at Cycle (C) 3 Day (D) 1 | 0.00 Scores on a scale | Standard Deviation 0.215 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C48D1 | -0.07 Scores on a scale | Standard Deviation 0 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C24D1 | 0.00 Scores on a scale | Standard Deviation 0.157 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Baseline (BL) | 0.78 Scores on a scale | Standard Deviation 0.204 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C12D1 | 0.02 Scores on a scale | Standard Deviation 0.163 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C27D1 | -0.09 Scores on a scale | Standard Deviation 0.283 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C15D1 | -0.02 Scores on a scale | Standard Deviation 0.238 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C27D1 | 0.00 Scores on a scale | Standard Deviation 0.213 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at Cycle (C) 3 Day (D) 1 | -0.03 Scores on a scale | Standard Deviation 0.222 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C6D1 | -0.02 Scores on a scale | Standard Deviation 0.305 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C9D1 | -0.01 Scores on a scale | Standard Deviation 0.226 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C24D1 | 0.02 Scores on a scale | Standard Deviation 0.225 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C15D1 | 0.01 Scores on a scale | Standard Deviation 0.221 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C18D1 | 0.00 Scores on a scale | Standard Deviation 0.226 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C21D1 | 0.00 Scores on a scale | Standard Deviation 0.256 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Baseline (BL) | 0.78 Scores on a scale | Standard Deviation 0.239 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C30D1 | 0.02 Scores on a scale | Standard Deviation 0.256 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C33D1 | -0.02 Scores on a scale | Standard Deviation 0.218 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C36D1 | -0.07 Scores on a scale | Standard Deviation 0.395 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C39D1 | 0.02 Scores on a scale | Standard Deviation 0.143 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C42D1 | -0.13 Scores on a scale | Standard Deviation 0.309 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C45D1 | 0.17 Scores on a scale | Standard Deviation 0.069 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C48D1 | 0.06 Scores on a scale | Standard Deviation 0.087 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQol) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Score Over Time | Change from BL at C12D1 | -0.05 Scores on a scale | Standard Deviation 0.261 |
Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time
The EQ-5D-5L VAS records the participant's self-rated health on a visual analogue scale numbered from 0 to 100, with 0 being the worst health you can imagine and 100 being the best health you can imagine. Change from baseline was presented.
Time frame: Baseline, every 3 cycles up to C48D1 (1 cycle = 28 days)
Population: FAS population with non-missing baseline EQ-5D-5L assessments. For each post-baseline timepoint, FAS population with non-missing baseline and post-baseline EQ-5D-5L assessment. FAS comprised of all patients to whom study treatment had been assigned by randomization.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C9D1 | 5.28 Scores on a scale | Standard Deviation 20.528 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C27D1 | -0.44 Scores on a scale | Standard Deviation 21.139 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at Cycle 3 Day 1 (C3D1) | 1.39 Scores on a scale | Standard Deviation 21.029 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C30D1 | 3.13 Scores on a scale | Standard Deviation 26.829 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C12D1 | 5.55 Scores on a scale | Standard Deviation 21.38 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C33D1 | 5.41 Scores on a scale | Standard Deviation 26.923 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Baseline (BL) | 68.91 Scores on a scale | Standard Deviation 18.371 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C36D1 | -1.50 Scores on a scale | Standard Deviation 25.714 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C15D1 | 2.87 Scores on a scale | Standard Deviation 21.94 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C39D1 | 3.57 Scores on a scale | Standard Deviation 28.281 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C6D1 | 2.60 Scores on a scale | Standard Deviation 25.218 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C42D1 | -11.89 Scores on a scale | Standard Deviation 22.469 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C18D1 | 3.80 Scores on a scale | Standard Deviation 20.474 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C45D1 | 2.00 Scores on a scale | Standard Deviation 15.113 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C24D1 | 1.73 Scores on a scale | Standard Deviation 21.288 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C48D1 | 7.00 Scores on a scale | Standard Deviation 0 |
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C21D1 | 3.70 Scores on a scale | Standard Deviation 23.541 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C48D1 | 5.50 Scores on a scale | Standard Deviation 34.648 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C21D1 | 5.71 Scores on a scale | Standard Deviation 18.577 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Baseline (BL) | 68.04 Scores on a scale | Standard Deviation 18.762 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at Cycle 3 Day 1 (C3D1) | 0.40 Scores on a scale | Standard Deviation 18.767 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C6D1 | 2.08 Scores on a scale | Standard Deviation 23.294 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C9D1 | 2.55 Scores on a scale | Standard Deviation 20.805 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C12D1 | 1.18 Scores on a scale | Standard Deviation 22.728 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C15D1 | 3.72 Scores on a scale | Standard Deviation 21.564 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C18D1 | 6.87 Scores on a scale | Standard Deviation 19.369 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C24D1 | 7.68 Scores on a scale | Standard Deviation 18.781 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C27D1 | 4.63 Scores on a scale | Standard Deviation 19.792 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C30D1 | 4.76 Scores on a scale | Standard Deviation 14.998 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C33D1 | 1.64 Scores on a scale | Standard Deviation 17.705 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C36D1 | -2.80 Scores on a scale | Standard Deviation 29.617 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C39D1 | 1.70 Scores on a scale | Standard Deviation 20.078 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C42D1 | -0.75 Scores on a scale | Standard Deviation 26.55 |
| Placebo + Azacitidine | Change From Baseline in the European Quality of Life (EuroQoL) - 5 Dimensions, 5 Level Questionnaire (EQ-5D-5L) Visual Analogue Scale (VAS) Over Time | Change from BL at C45D1 | -2.00 Scores on a scale | Standard Deviation 24.042 |
Change From Baseline of Global Health Status/Quality of Life Scores Using European Organization for Research and Treatment of Cancer's Core Quality of Life Questionnaire (EORTC-QLQ-C30).
EORTC-QLQ-C30 is a 30-item questionnaire developed to assess the quality of life of cancer participants. Participant's responses to 2 questions (Items 29+30: How would you rate your overall health during the past week? and How would you rate your overall quality of life during the past week?) are scored on a 7-point scale (1=Very Poor to 7=Excellent). Using linear transformation, raw scores are standardized, so that scores range from 0 to 100. A higher score indicates a better overall outcome. Change from baseline to Cycle 12 Day 1 as presented.
Time frame: Up to Cycle 12 Day 1 (C12D1) (1 cycle = 28 days)
Population: FAS population with non-missing baseline (Cycle 1 Day 1) and Cycle 12 Day 1 EORTC-QLQ-C30 assessments. FAS comprised of all patients to whom study treatment had been assigned by randomization.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Change From Baseline of Global Health Status/Quality of Life Scores Using European Organization for Research and Treatment of Cancer's Core Quality of Life Questionnaire (EORTC-QLQ-C30). | 8.72 Scores on a scale | Standard Deviation 23.071 |
| Placebo + Azacitidine | Change From Baseline of Global Health Status/Quality of Life Scores Using European Organization for Research and Treatment of Cancer's Core Quality of Life Questionnaire (EORTC-QLQ-C30). | 8.20 Scores on a scale | Standard Deviation 19.932 |
Key Secondary Endpoint 1: Time to Definitive Deterioration of Fatigue Using Functional Assessment of Cancer Therapy (FACIT)-Fatigue Score
FACIT-Fatigue score is a 13-item questionnaire designed to assess fatigue in cancer participants. All items use a 5-point scale ranging from 0 to 4 (0=Not at All to 4=Very Much). The total score ranges from 0 to 52 with higher values representing better quality of life. Time to definitive deterioration of fatigue is defined as time from randomization to at least 3 points worsening from baseline in FACIT-fatigue scores with no subsequently observed improvement above this threshold, or death due to any cause, whichever occurred first.
Time frame: up to approx. 52 months
Population: FAS comprised of all participants to whom study treatment had been assigned by randomization.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Key Secondary Endpoint 1: Time to Definitive Deterioration of Fatigue Using Functional Assessment of Cancer Therapy (FACIT)-Fatigue Score | 13.37 Months |
| Placebo + Azacitidine | Key Secondary Endpoint 1: Time to Definitive Deterioration of Fatigue Using Functional Assessment of Cancer Therapy (FACIT)-Fatigue Score | 11.76 Months |
Key Secondary Endpoint 2: Red Blood Cell (RBC) Annualized Transfusion Free Rate for Transfusion
Annualized transfusion free rate is defined as the average number of days in RBC transfusion-free intervals in a year (i.e., the total number of days in RBC transfusion-free intervals divided by the total days in the study multiplied by 365.25), where RBC transfusion-free intervals correspond to cumulative times of intervals with no evidence of RBC transfusion for at least 8 weeks at any point after randomization until death due to any cause.
Time frame: up to approx. 52 months
Population: FAS comprised of all participants to whom study treatment had been assigned by randomization.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Key Secondary Endpoint 2: Red Blood Cell (RBC) Annualized Transfusion Free Rate for Transfusion | 184.3 days per year |
| Placebo + Azacitidine | Key Secondary Endpoint 2: Red Blood Cell (RBC) Annualized Transfusion Free Rate for Transfusion | 175.7 days per year |
Key Secondary Endpoint 3: Percentage of Participants With at Least 3 Point Confirmed Improvement From Baseline in FACIT-fatigue Scores
FACIT-Fatigue score is a 13-item questionnaire designed to assess fatigue in cancer participants. All items use a 5-point scale ranging from 0 to 4 (0=Not at All to 4=Very Much). The total score ranges from 0 to 52 with higher values representing better quality of life. The responder is defined as having 3 points improvement from baseline confirmed by a second improvement of 3 points at any time, regardless of preceding worsening. A participant who could not improve was considered as a non-responder.
Time frame: up to approx. 52 months
Population: FAS comprised of all participants to whom study treatment had been assigned by randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Key Secondary Endpoint 3: Percentage of Participants With at Least 3 Point Confirmed Improvement From Baseline in FACIT-fatigue Scores | 39.6 Percentage of participants with response |
| Placebo + Azacitidine | Key Secondary Endpoint 3: Percentage of Participants With at Least 3 Point Confirmed Improvement From Baseline in FACIT-fatigue Scores | 40.8 Percentage of participants with response |
Key Secondary Endpoint 4: Percentage of Participants With at Least 10 Point Confirmed Improvement From Baseline in Physical Functioning Using European Organization for Research and Treatment of Cancer's Core Quality of Life Questionnaire (EORTC QLQ-C30)
EORTC-QLQ-C30 is a 30-item questionnaire developed to assess the quality of life of cancer participants. Participants' responses to 5 questions about their physical functioning (Items 1-5) are scored on a 4-point scale (1=Not at All to 4=Very Much). Using linear transformation, raw scores are standardized, so that scores range from 0 to 100. A high score indicates a high / healthy level of functioning. The responder is defined as having 10 points improvement from baseline confirmed by a second improvement of 10 points at any time, regardless of preceding worsening. A participant who could not improve was considered as a non-responder.
Time frame: up to approx. 52 months
Population: FAS comprised of all participants to whom study treatment had been assigned by randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Key Secondary Endpoint 4: Percentage of Participants With at Least 10 Point Confirmed Improvement From Baseline in Physical Functioning Using European Organization for Research and Treatment of Cancer's Core Quality of Life Questionnaire (EORTC QLQ-C30) | 30.2 Percentage of participants with response |
| Placebo + Azacitidine | Key Secondary Endpoint 4: Percentage of Participants With at Least 10 Point Confirmed Improvement From Baseline in Physical Functioning Using European Organization for Research and Treatment of Cancer's Core Quality of Life Questionnaire (EORTC QLQ-C30) | 22.6 Percentage of participants with response |
Key Secondary Endpoint 5: Percentage of Participants With at Least 10 Point Confirmed Improvement From Baseline in Emotional Functioning Using EORTC-QLQ-C30
EORTC-QLQ-C30 is a 30-item questionnaire developed to assess the quality of life of cancer participants. Participants' responses to 4 questions about their emotional functioning (Items 21-24) are scored on a 4-point scale (1=Not at All to 4=Very Much). Using linear transformation, raw scores are standardized, so that scores range from 0 to 100. A high score indicates a high / healthy level of functioning. The responder is defined as having 10 points improvement from baseline confirmed by a second improvement of 10 points at any time, regardless of preceding worsening. A participant who could not improve was considered as a non-responder.
Time frame: up to approx. 52 months
Population: FAS comprised of all participants to whom study treatment had been assigned by randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Key Secondary Endpoint 5: Percentage of Participants With at Least 10 Point Confirmed Improvement From Baseline in Emotional Functioning Using EORTC-QLQ-C30 | 31.7 Percentage of participants |
| Placebo + Azacitidine | Key Secondary Endpoint 5: Percentage of Participants With at Least 10 Point Confirmed Improvement From Baseline in Emotional Functioning Using EORTC-QLQ-C30 | 28.3 Percentage of participants |
Leukemia-free Survival (LFS)
LFS is defined as the time from randomization to ≥ 20% blasts in bone marrow/peripheral blood (per WHO 2016 classification) or diagnosis of extramedullary acute leukemia, or death due to any cause
Time frame: up to approx. 52 months
Population: FAS comprised of all participants to whom study treatment had been assigned by randomization.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Leukemia-free Survival (LFS) | 19.84 Months |
| Placebo + Azacitidine | Leukemia-free Survival (LFS) | 13.73 Months |
Number of Participants Who Become Platelets Transfusion Independent After Randomization
Improvement in Platelets transfusion independence as per International Working Group for MDS (IWG-MDS) criteria. Platelets transfusion independence was defined as having received 0 units of Platelets transfusions during at least 8 consecutive weeks after randomization. The number of participants was shown in only those with transfusion dependence at baseline (BL).
Time frame: up to approx. 52 months
Population: Participants of the full analysis set (FAS) who were Platelets transfusion dependent at baseline.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Number of Participants Who Become Platelets Transfusion Independent After Randomization | 11 Participants |
| Placebo + Azacitidine | Number of Participants Who Become Platelets Transfusion Independent After Randomization | 10 Participants |
Number of Participants Who Become Red Blood Cells (RBC) Transfusion Independent After Randomization
Improvement in RBC transfusion independence as per International Working Group for MDS (IWG-MDS) criteria. RBC transfusion independence was defined as having received 0 units of RBC transfusions during at least 8 consecutive weeks after randomization. The number of participants was shown in only those with transfusion dependence at baseline (BL).
Time frame: up to approx. 52 months
Population: Participants of the full analysis set (FAS) who were RBC transfusion dependent at baseline.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Number of Participants Who Become Red Blood Cells (RBC) Transfusion Independent After Randomization | 50 Participants |
| Placebo + Azacitidine | Number of Participants Who Become Red Blood Cells (RBC) Transfusion Independent After Randomization | 53 Participants |
Percentage of Participants With Either CR, or mCR, or PR, or HI in Each Treatment Arm According to International Working Group for MDS (IWG-MDS) as Per Investigator Assessment
Response rate of participants with complete remission (CR), or marrow remission (mCR), or partial remission (PR), or hematologic improvement (HI). CR: where the Bone marrow: ≤ 5% blasts with normal maturation of all cell lineages and Peripheral blood: where Hgb ≥ 10 g/dL AND Platelets ≥ 100\*109/L AND Neutrophils ≥ 1.0\*109/L AND Peripheral blasts 0%. mCR: Bone marrow: ≤ 5% blasts and blast count decrease by ≥ 50% compared to baseline; Peripheralblood/transfusion: Marrow CR may be achieved with or without improved blood counts or with or without transfusions PR: All CR criteria except bone marrow: ≥50% decrease from baseline in blasts in bone marrow AND blast count in bone marrow \>5%. HI: restoration or enhancement of the function of the body's blood cell-producing system that must last as least 8 weeks.
Time frame: up to approx. 52 months
Population: FAS comprised of all participants to whom study treatment had been assigned by randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Percentage of Participants With Either CR, or mCR, or PR, or HI in Each Treatment Arm According to International Working Group for MDS (IWG-MDS) as Per Investigator Assessment | 58.1 Percentage of participants |
| Placebo + Azacitidine | Percentage of Participants With Either CR, or mCR, or PR, or HI in Each Treatment Arm According to International Working Group for MDS (IWG-MDS) as Per Investigator Assessment | 47.5 Percentage of participants |
Percentage of Participants With Stable Disease (SD) According to International Working Group for MDS (IWG-MDS) as Per Investigator Assessment
Response rate of participants with stable disease. SD is the failure to achieve at least partial response (PR), but no evidence of progression for \>8 weeks.
Time frame: up to approx. 52 months
Population: FAS comprised of all participants to whom study treatment had been assigned by randomization.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Percentage of Participants With Stable Disease (SD) According to International Working Group for MDS (IWG-MDS) as Per Investigator Assessment | 20.0 Percentage of participants |
| Placebo + Azacitidine | Percentage of Participants With Stable Disease (SD) According to International Working Group for MDS (IWG-MDS) as Per Investigator Assessment | 19.6 Percentage of participants |
Pharmacokinetics of MBG453 (Parameter AUC)
AUCinf is the AUC from time zero to infinity (mass x time x volume-1).
Time frame: 0 hr (pre-dose) & 2 hrs (post-dose) of Cycle (C) 1 Day (D) 8 and 0 hr (pre-dose) & 2 hrs (post-dose) of C3D8
Population: Pharmacokinetic Analysis Set (PAS) included all participants in the Safety Set, who had at least one evaluable PK concentration.~Safety Set included all participants who received at least one dose of any component of the study treatment, and they were analyzed according to the study treatment they received.
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Pharmacokinetics of MBG453 (Parameter AUC) | Cycle 1 | 2670 day*ug/ml | Geometric Coefficient of Variation 45.9 |
| Sabatolimab (MBG453) + Azacitidine | Pharmacokinetics of MBG453 (Parameter AUC) | Cycle 3 | 4930 day*ug/ml | Geometric Coefficient of Variation 1.5 |
Pharmacokinetics of MBG453 (Parameter Cmax)
Cmax is the maximum (peak) observed drug concentration after single dose administration (mass x volume-1).
Time frame: 0 hr (pre-dose) & 2 hrs (post-dose) of Cycle (C) 1 Day (D) 8 and 0 hr (pre-dose) & 2 hrs (post-dose) of C3D8
Population: Pharmacokinetic Analysis Set (PAS) included all participants in the Safety Set, who had at least one evaluable PK concentration.~Safety Set included all participants who received at least one dose of any component of the study treatment, and they were analyzed according to the study treatment they received.
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) | Dispersion |
|---|---|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Pharmacokinetics of MBG453 (Parameter Cmax) | Cycle 1 | 232 ug/ml | Geometric Coefficient of Variation 20.9 |
| Sabatolimab (MBG453) + Azacitidine | Pharmacokinetics of MBG453 (Parameter Cmax) | Cycle 3 | 239 ug/ml | Geometric Coefficient of Variation 39.5 |
Progression Free Survival (PFS)
PFS is defined as the time from randomization to disease progression (including transformation to acute leukemia per WHO 2016), relapse from CR (IWG-MDS), or death. Disease progression: bone marrow blasts increase ≥ 50% over baseline, to \> 5% if initially \< 5%, \> 10% if 5%-\<10%, or \> 20% if 10%-\<20%. Includes a peripheral blood count decrease ≥ 50% from maximum remission/response levels: neutrophils \< 1.0x109/L, platelets \< 100x109/L, or hemoglobin drop ≥ 2 g/dL to \< 10 g/dL, becoming transfusion-dependent. Relapse from CR: baseline bone marrow blast % return, neutrophils decrease ≥ 50% to \< 1.0x109/L, platelets decrease ≥ 50% to \< 100x109/L, or hemoglobin drop ≥ 1.5 g/dL to \< 10 g/dL, becoming transfusion-dependent. Leukemia transformation: \> 20% blasts per WHO 2016 (Arber et al 2016).
Time frame: up to approx. 52 months
Population: FAS comprised of all participants to whom study treatment had been assigned by randomization.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | Progression Free Survival (PFS) | 14.26 Months |
| Placebo + Azacitidine | Progression Free Survival (PFS) | 10.12 Months |
All Collected Deaths
Deaths were collected from randomization until the end of the trial, approx. 52 months, including post-treatment survival follow up period.
Time frame: from randomization until end of trial, up to approx. 52 months
Population: Clinical database population: All randomized participants: participants who died before treatment, during treatment and post-treatment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Sabatolimab (MBG453) + Azacitidine | All Collected Deaths | Post-treatment deaths | 143 Participants |
| Sabatolimab (MBG453) + Azacitidine | All Collected Deaths | Pre-treatment deaths | 0 Participants |
| Sabatolimab (MBG453) + Azacitidine | All Collected Deaths | All deaths | 161 Participants |
| Sabatolimab (MBG453) + Azacitidine | All Collected Deaths | On-treatment deaths | 18 Participants |
| Placebo + Azacitidine | All Collected Deaths | All deaths | 160 Participants |
| Placebo + Azacitidine | All Collected Deaths | On-treatment deaths | 37 Participants |
| Placebo + Azacitidine | All Collected Deaths | Pre-treatment deaths | 1 Participants |
| Placebo + Azacitidine | All Collected Deaths | Post-treatment deaths | 122 Participants |