A Pilot Study to Determine the Safety and Tolerability of Sirolimus Given With Hyper-CVAD Chemotherapy

• Sponsor: Sidney Kimmel Cancer Center at Thomas Jefferson University (Other)
• Overall Status: Completed
• CT.gov ID: NCT01184885
• Collaborator: American Society of Clinical Oncology (Other)
• Enrollment: 7
• Locations: 2
• Arm: 1
• Duration (Months): 33
• Patients Per Site: 3.5
• Patients Per Site Per Month: 0.1

Study Details

Study Description

Brief Summary

This is a pilot study, assessing the feasibility, safety and toxicity of an mTOR (mammalian target of Rapamycin) inhibitor (MTI), rapamycin, when administered with HyperCVAD (Hyperfractionated Cyclophosphamide, Vincristine, Doxorubicine and Dexamethasone), with an ultimate goal to perform a phase II study to evaluate response rates and survival in adults with Acute Lymphoblastic Leukemia (ALL) and aggressive lymphoid malignancies.

Condition or Disease	Intervention/Treatment	Phase
Lymphoid Malignancies (New or Relapsed); Acute Lymphoblastic Leukemia; Burkitt Lymphoma; Lymphoblastic Lymphoma; Mantle Cell Lymphoma; Adult T-cell Leukemia/Lymphoma	Drug: Hyper-CVAD; Drug: Sirolimus	Early Phase 1

Detailed Description

The primary objective of this trial is to characterize the feasibility, safety and tolerability of therapy with Hyper-CVAD and Rapamycin in adults with ALL and other aggressive lymphoid malignancies.

This study will evaluate the effectiveness of Rapamycin given in combination with Hyper-CVAD during A treatment cycles, and Methotrexate and Cytarabine in B treatment cycles. Both cycles will also contain the drug Rituximab if the patient has a B cell type of leukemia or lymphoma.

This combination of drugs are being studied to determine whether or not these drugs will have an effect in treating this disease.

Current therapeutic regimens for induction of remission in ALL are broadly similar. There is no single best regimen for induction therapy. The hyper-CVAD regimen is of particular interest because it does not include asparaginase as part of the therapeutic regimen and the results of induction are similar to other published regimens.

The HyperCVAD regimen with or without rituximab is also an accepted induction regimen for lymphoblastic lymphoma, Burkitt and Burkitt like lymphoma, Mantle Cell Lymphoma, and ALL in the elderly. The regimen has also been used as a salvage regimen in patients with the above diagnoses who have relapsed after another induction regimen.

This trial will add a novel agent, an mTOR inhibitor (MTI), rapamycin, to act synergistically with the HyperCVAD regimen. This is a pilot study, assessing the feasibility, safety and toxicity of this regimen, with an ultimate goal to perform a phase II study to evaluate response rates and survival.

This is a pilot study of the Hyper-CVAD regimen with Rapamycin for the treatment of adults with acute lymphoblastic leukemia or other aggressive lymphoid malignancies. The standard Hyper-CVAD regimen will be used, with the addition of the investigational agent, Rapamycin. Hyper-CVAD alone is one of the current standard induction and salvage regimens used to treat ALL and other aggressive lymphoid malignancies.

Subjects included will have either de novo, relapsed, or refractory ALL or another aggressive lymphoid malignancy.

Chemotherapy will consist of 4 'A' cycles alternating with 4 'B' cycles, every 21 days, or as count recovery allows (at least 14 days apart) as follows: 1A; 1B; 2A; 2B, 3A; 3B; 4A; 4B. This is dependent on white blood cell count recovery.

Study Design

• Study Type: Interventional
• Actual Enrollment: 7 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Pilot Study of Hyperfractionated Cyclophosphamide, Vincristine, Doxorubicin, and Dexamethasone (Hyper-CVAD) With Sirolimus for the Treatment of Adult Acute Lymphoblastic Leukemia and Aggressive Lymphoid Malignancies
• Study Start Date: Jul 1, 2010
• Actual Primary Completion Date: Mar 1, 2011
• Actual Study Completion Date: Apr 1, 2013

Arms and Interventions

Arm

Intervention/Treatment

Experimental: Hyper-CVAD and Sirolimus Hyper-CVAD and Sirolimus

Drug: Hyper-CVAD; Cycle A: Cyclophosphamide 300mg/m2 every 12 hours on days 3-5; Vincristine 2mg/day on days 6 and 13; Doxorubicin 50mg/m2 on day 6; Decadron 40mg/ day po on days 3-6 and 13-16; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. Cycle B: Methotrexate 1000mg/m2 on day 3; Leucovorin 50mg every 6 hours starting 24 hours from the beginning of the MTX infusion until MTX levels are < 0.1 umol/L; Ara-C 3000mg/m2 every 12 hours on days 4 and 5; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. Rituximab (if given) will be 375 mg/m2 on Days 3 and 13 of Cycle A and on Days 4 and 9 of cycle B, for a total of 8 doses over the first 4 courses.; Other Names: Cytoxan Endoxan Neosar Procytox Revimmune Cytophosphane Oncovin Leurocristine Adriamycin Hydroxydaunorubicin MTX Amethopterin ; Drug: Sirolimus; Sirolimus loading dose of 12mg on day 1 followed by a single daily dose of 4 mg/ day on days 2 through 7 (Cycle A) and on days 2 through 6 (Cycle B); Other Names: Rapamycin

Outcome Measures

Primary Outcome Measures

1. Number of Participants With Count Recovery That Allows for Starting a Phase II Study to Evaluate Response Rates and Survival [18 months]

   This will be assessed by evaluating the tolerability of this regimen compared to historical controls who received Hyper-CVAD or Hyper-CVAD/ Rituximab regimens. The treatment will be designated feasible for an individual subject if in 80% of chemotherapy cycles the subject has count recovery that allows for starting the subsequent cycle by Day 28. Count recovery is defined as ANC (absolute neutrophil count) of > 0.5 x 10^9/L and platelet count > 50 x 10^9/L. Hyper-CVAD/Rapamycin will be deemed acceptable if it is feasible to administer in 80% or more of subjects.

Secondary Outcome Measures

1. Induction Mortality [18 months]

   Induction mortality. Hyper-CVAD/ Rapamycin will be considered acceptable if induction mortality does not exceed 31% in patients older than 60, or 15% in those younger than 60

2. Complete Response [Every 21 days or as count recovery allows (at least 14 days apart) up to 24 weeks]

   To describe response rates to hyper-CVAD and sirolimus in adults with ALL and other aggressive lymphoid malignancies. Bone marrow (<5% blasts) with adequate bone marrow cellularity, no evidence of circulating blasts or extramedullary disease and normalization of peripheral blood counts except for platelets (neutrophil count =1,000/µL).

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

1. Patients must have a diagnosis of one of the following lymphoid malignancies (new or relapsed):

• Acute Lymphoblastic Leukemia (B and T cell, Philadelphia Chromosome Negative)

• Burkitt Lymphoma

• Burkitt - type Lymphoma

• Lymphoblastic Lymphoma

• Mantle Cell Lymphoma

• Adult T cell Leukemia/ lymphoma

1. Patients must be >18 years old

2. Patients must have an ECOG performance status of 0 or 1(see attachment 1).

3. Patients must have a life expectancy of at least 4 weeks.

4. Patients must be able to consume oral medication.

5. Patients must have completed any radiotherapy four weeks prior to study entry, 0-2 weeks for local palliative XRT (small port).

6. Patients must have recovered from the toxic effects of any prior chemotherapy to < grade 2 (except alopecia).

7. Required initial laboratory values: Creatinine < or = 2.0mg/dL; total or direct bilirubin < or = 1.5mg/dL (if not due to the leukemia or lymphoma itself); SGPT(ALT) < or = 3xULN; glucose <200 mg/dL, negative pregnancy test for women with child-bearing potential.

8. Patients must be able to sign consent and be willing and able to comply with scheduled visits, treatment plan and laboratory testing.

9. Patients may have had a prior stem cell transplant (autologous or allogeneic), however they may not have active GvHD, nor be on any immunosuppression

Exclusion Criteria:

1. Patients must not be receiving any chemotherapy agents (except Hydroxyurea)

2. Intrathecal ARA-C and intrathecal methotrexate are permissible (as they are not systemic and only isolated to the central nervous system).

3. Patients must not be receiving growth factors, except for erythropoietin.

4. Patients with a current second malignancy requiring systemic therapy, other than non-melanoma skin cancers, are not eligible.

5. Patients with uncontrolled high blood pressure, unstable angina, symptomatic congestive heart failure, myocardial infarction within the past 6 months or serious uncontrolled cardiac arrhythmia are not eligible.

6. Patients taking any of the following drugs while on-study are not eligible:

7. Carbamazepine (e.g. Tegretol)

8. Rifabutin (e.g. Mycobutin)

9. Rifampin (e.g. Rifadin)

10. Rifapentine (e.g. Priftin)

11. St. John's Wort- may decrease the effects of sirolimus by decreasing the amount of sirolimus in the body

12. Clarithromycin (e.g. Biaxin)

13. Cyclosporin e.g. (Neorla or Sandimmune)

14. Diltiazem (e.g. Cardizem)

15. Erythromycin (e.g. Akne-Mycin, Ery-Tab)

16. Itraconazole (e.g. Sporanox)

17. Ketoconazole (e.g. Nizoral)

18. Telithromycin (e.g. Ketek)

19. Verapamil (e.g. Calan SR, Isoptin, Verelan)

20. Voriconazole (e.g. VFEND) - May increase the effects of sirolimus by increasing the amount of this medicine in the body. [Cannot be taken within 72 hours prior to or subsequent to receiving rapamycin, but may be taken prior to or after the above time period]

21. Tacrolimus (e.g. Prograf) - May cause liver transplant rejection or serious side effects in patients on sirolimus.

22. Patients with known HIV positivity or AIDS-related illness are not eligible.

23. Patients with other severe concurrent disease which in the judgment of the investigator would make the patient inappropriate for entry into this study are ineligible.

24. Patients must not have evidence of cerebellar dysfunction or prior history of cerebellar dysfunction with Ara-C administration.

25. Patients must not have received any investigational agents within 30 days of study entry.

26. Patients must not be pregnant or breastfeeding. Pregnancy tests must be obtained for all females of child-bearing potential. Pregnant or lactating patients are ineligible for this study due to the unknown human fetal or teratogenic toxicities of rapamycin. Males or females of reproductive age may not participate unless they have agreed to use an effective contraceptive method.

27. Patients who have uncontrolled infection are not eligible. Patients must have any active infections under control. Fungal disease must be stable for at least 2 weeks before study entry. Patients with bacteremia must have documented negative blood cultures prior to study entry.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	University of Pennsylvania	Philadelphia	Pennsylvania	United States	19104
2	Thomas Jefferson University	Philadelphia	Pennsylvania	United States	19107

Sponsors and Collaborators

• Sidney Kimmel Cancer Center at Thomas Jefferson University
• American Society of Clinical Oncology

Investigators

• Principal Investigator: Margaret Kasner, MD, Thomas Jefferson University

Study Documents (Full-Text)

None provided.

More Information

Additional Information:

• Kimmel Cancer Center at Thomas Jefferson University, an NCI-Designated Cancer Center
• Thomas Jefferson University Hospitals

Publications

None provided.

• Responsible Party: Sidney Kimmel Cancer Center at Thomas Jefferson University
• ClinicalTrials.gov Identifier: NCT01184885
• Other Study ID Numbers: 09G.474; 2009-35
• First Posted: Aug 19, 2010
• Last Update Posted: Dec 18, 2017
• Last Verified: Nov 1, 2017

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No
• Product Manufactured in and Exported from the U.S.: Yes
• Keywords provided by Sidney Kimmel Cancer Center at Thomas Jefferson University: hyperCVAD; rapamycin; lymphoid malignancies; lymphoblastic leukemia; B and T cell; philadelphia chromosome negative; burkitt lymphoma; burkitt-type lymphoma; lymphoblastic lymphoma; mantle cell lymphoma; adult t cell leukemia; adult t cell lymphoma
• Additional relevant MeSH terms: Burkitt Lymphoma; Lymphoma; Leukemia; Neoplasms; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Leukemia, Lymphoid; Lymphoma, Mantle-Cell; Leukemia, T-Cell; Leukemia-Lymphoma, Adult T-Cell; Sirolimus; Cyclophosphamide

Study Results

Participant Flow

Arm/Group Title	Hyper-CVAD and Sirolimus
Arm/Group Description	Hyper-CVAD and Sirolimus Hyper-CVAD : - Cycle A: Cyclophosphamide 300mg/m2 every 12 hours on days 3-5; Vincristine 2mg/day on days 6 and 13; Doxorubicin 50mg/m2 on day 6; Decadron 40mg/ day po on days 3-6 and 13-16; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. Cycle B: Methotrexate 1000mg/m2 on day 3; Leucovorin 50mg every 6 hours starting 24 hours from the beginning of the MTX infusion until MTX levels are < 0.1 umol/L; Ara-C 3000mg/m2 every 12 hours on days 4 and 5; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. Rituximab (if given) will be 375 mg/m2 on Days 3 and 13 of Cycle A and on Days 4 and 9 of cycle B, for a total of 8 doses over the first 4 courses. Sirolimus : Sirolimus loading dose of 12mg on day 1 followed by a single daily dose of 4 mg/ day on days 2 through 7 (Cycle A) and on days 2 through 6 (Cycle B)
Period Title: Overall Study
STARTED	7
COMPLETED	7
NOT COMPLETED	0

Baseline Characteristics

Arm/Group Title	Hyper-CVAD and Sirolimus
Arm/Group Description	Hyper-CVAD and Sirolimus Hyper-CVAD : - Cycle A: Cyclophosphamide 300mg/m2 every 12 hours on days 3-5; Vincristine 2mg/day on days 6 and 13; Doxorubicin 50mg/m2 on day 6; Decadron 40mg/ day po on days 3-6 and 13-16; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. Cycle B: Methotrexate 1000mg/m2 on day 3; Leucovorin 50mg every 6 hours starting 24 hours from the beginning of the MTX infusion until MTX levels are < 0.1 umol/L; Ara-C 3000mg/m2 every 12 hours on days 4 and 5; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. Rituximab (if given) will be 375 mg/m2 on Days 3 and 13 of Cycle A and on Days 4 and 9 of cycle B, for a total of 8 doses over the first 4 courses. Sirolimus : Sirolimus loading dose of 12mg on day 1 followed by a single daily dose of 4 mg/ day on days 2 through 7 (Cycle A) and on days 2 through 6 (Cycle B)
Overall Participants	7
Age (Count of Participants)
<=18 years	0 0%
Between 18 and 65 years	6 85.7%
>=65 years	1 14.3%
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	41.68 (18.94)
Sex: Female, Male (Count of Participants)
Female	2 28.6%
Male	5 71.4%
Region of Enrollment (participants) [Number]
United States	7 100%

Outcome Measures

1. Primary Outcome

Title	Number of Participants With Count Recovery That Allows for Starting a Phase II Study to Evaluate Response Rates and Survival
Description	This will be assessed by evaluating the tolerability of this regimen compared to historical controls who received Hyper-CVAD or Hyper-CVAD/ Rituximab regimens. The treatment will be designated feasible for an individual subject if in 80% of chemotherapy cycles the subject has count recovery that allows for starting the subsequent cycle by Day 28. Count recovery is defined as ANC (absolute neutrophil count) of > 0.5 x 10^9/L and platelet count > 50 x 10^9/L. Hyper-CVAD/Rapamycin will be deemed acceptable if it is feasible to administer in 80% or more of subjects.
Time Frame	18 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Hyper-CVAD and Sirolimus
Arm/Group Description	Hyper-CVAD and Sirolimus Hyper-CVAD : - Cycle A: Cyclophosphamide 300mg/m^2 every 12 hours on days 3-5; Vincristine 2mg/day on days 6 and 13; Doxorubicin 50mg/m^2 on day 6; Decadron 40mg/day po on days 3-6 and 13-16; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. Cycle B: Methotrexate 1000mg/m^2 on day 3; Leucovorin 50mg every 6 hours starting 24 hours from the beginning of the MTX infusion until MTX levels are < 0.1 umol/L; Ara-C 3000mg/m^2 every 12 hours on days 4 and 5; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. Rituximab (if given) will be 375 mg/m^2 on Days 3 and 13 of Cycle A and on Days 4 and 9 of cycle B, for a total of 8 doses over the first 4 courses. Sirolimus : Sirolimus loading dose of 12mg on day 1 followed by a single daily dose of 4 mg/day on days 2 through 7 (Cycle A) and on days 2 through 6 (Cycle B)
Measure Participants	7
Number [participants]	7 100%

2. Secondary Outcome

Title	Induction Mortality
Description	Induction mortality. Hyper-CVAD/ Rapamycin will be considered acceptable if induction mortality does not exceed 31% in patients older than 60, or 15% in those younger than 60
Time Frame	18 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title

Arm/Group Description

3. Secondary Outcome

Title	Complete Response
Description	To describe response rates to hyper-CVAD and sirolimus in adults with ALL and other aggressive lymphoid malignancies. Bone marrow (<5% blasts) with adequate bone marrow cellularity, no evidence of circulating blasts or extramedullary disease and normalization of peripheral blood counts except for platelets (neutrophil count =1,000/µL).
Time Frame	Every 21 days or as count recovery allows (at least 14 days apart) up to 24 weeks

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Hyper-CVAD and Sirolimus
Arm/Group Description	Hyper-CVAD and Sirolimus Hyper-CVAD : - Cycle A: Cyclophosphamide 300mg/m2 every 12 hours on days 3-5; Vincristine 2mg/day on days 6 and 13; Doxorubicin 50mg/m2 on day 6; Decadron 40mg/ day po on days 3-6 and 13-16; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. Cycle B: Methotrexate 1000mg/m2 on day 3; Leucovorin 50mg every 6 hours starting 24 hours from the beginning of the MTX infusion until MTX levels are < 0.1 umol/L; Ara-C 3000mg/m2 every 12 hours on days 4 and 5; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. Rituximab (if given) will be 375 mg/m2 on Days 3 and 13 of Cycle A and on Days 4 and 9 of cycle B, for a total of 8 doses over the first 4 courses. Sirolimus : Sirolimus loading dose of 12mg on day 1 followed by a single daily dose of 4 mg/ day on days 2 through 7 (Cycle A) and on days 2 through 6 (Cycle B)
Measure Participants	7
Number [participants]	4 57.1%

Adverse Events

Arm/Group Title	Hyper-CVAD and Sirolimus
Arm/Group Description	Hyper-CVAD and Sirolimus Hyper-CVAD : - Cycle A: Cyclophosphamide 300mg/m2 every 12 hours on days 3-5; Vincristine 2mg/day on days 6 and 13; Doxorubicin 50mg/m2 on day 6; Decadron 40mg/ day po on days 3-6 and 13-16; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. Cycle B: Methotrexate 1000mg/m2 on day 3; Leucovorin 50mg every 6 hours starting 24 hours from the beginning of the MTX infusion until MTX levels are < 0.1 umol/L; Ara-C 3000mg/m2 every 12 hours on days 4 and 5; Methotrexate 12mg IT on day 4; Ara-C 100mg IT on day 9. Rituximab (if given) will be 375 mg/m2 on Days 3 and 13 of Cycle A and on Days 4 and 9 of cycle B, for a total of 8 doses over the first 4 courses. Sirolimus : Sirolimus loading dose of 12mg on day 1 followed by a single daily dose of 4 mg/ day on days 2 through 7 (Cycle A) and on days 2 through 6 (Cycle B)
All Cause Mortality
	Hyper-CVAD and Sirolimus
	Affected / at Risk (%)	# Events
Total	/ (NaN)
Serious Adverse Events
	Hyper-CVAD and Sirolimus
	Affected / at Risk (%)	# Events
Total	6/7 (85.7%)
Blood and lymphatic system disorders
Febrile neutropenia	5/7 (71.4%)	8
Hypotension	2/7 (28.6%)	2
General disorders
Fever	1/7 (14.3%)	1
Speech impairment	1/7 (14.3%)	1
Face pain	1/7 (14.3%)	1
Immune system disorders
Gram negative sepsis	1/7 (14.3%)	1
Septic shock	1/7 (14.3%)	1
Infections and infestations
Infection	2/7 (28.6%)	2
Nervous system disorders
Ataxia	1/7 (14.3%)	1
Respiratory, thoracic and mediastinal disorders
Shortness of breath	1/7 (14.3%)	1
Adult respiratory distress syndrome	1/7 (14.3%)	1
Skin and subcutaneous tissue disorders
Edema	1/7 (14.3%)	1
Other (Not Including Serious) Adverse Events
	Hyper-CVAD and Sirolimus
	Affected / at Risk (%)	# Events
Total	7/7 (100%)
Blood and lymphatic system disorders
Hyponatremia	1/7 (14.3%)	1
Positive blood culture	2/7 (28.6%)	3
Low platelets	1/7 (14.3%)	1
Low hemoglobin	1/7 (14.3%)	1
Pulse oxygen dropped	1/7 (14.3%)	1
Hypertension	2/7 (28.6%)	3
Anemia	1/7 (14.3%)	1
Pancytopenia	2/7 (28.6%)	3
Hypophosphatemia	1/7 (14.3%)	1
Neutropenia	1/7 (14.3%)	2
Lactic acidosis	1/7 (14.3%)	1
Hyperglycemia	1/7 (14.3%)	1
Hypokalemia	1/7 (14.3%)	1
Cardiac disorders
Tachycardia	5/7 (71.4%)	11
Irregular heartbeat	1/7 (14.3%)	1
Eye disorders
Blurred vision	1/7 (14.3%)	1
Eye pain	1/7 (14.3%)	2
Double vision	1/7 (14.3%)	1
Unable to move right eye	1/7 (14.3%)	1
Dry eyes	1/7 (14.3%)	1
Eye conjunctival redness	1/7 (14.3%)	1
Eyes appear uncoordinated	1/7 (14.3%)	1
Gastrointestinal disorders
Dyspepsia	1/7 (14.3%)	1
Gastric reflux	2/7 (28.6%)	2
Stomach upset	2/7 (28.6%)	2
Diarrhea	5/7 (71.4%)	9
Gas/bloating	2/7 (28.6%)	2
Decreased bowel sounds	1/7 (14.3%)	1
General disorders
Shoulder pain	1/7 (14.3%)	1
Abdominal pain	4/7 (57.1%)	5
Weight gain	2/7 (28.6%)	2
Fatigue	7/7 (100%)	15
Constipation	2/7 (28.6%)	4
Extremity swelling	1/7 (14.3%)	1
Itching	4/7 (57.1%)	4
Weakness	7/7 (100%)	10
Bad taste in mouth	1/7 (14.3%)	1
Nightmares	1/7 (14.3%)	1
Blood in stool	1/7 (14.3%)	1
Weight loss	2/7 (28.6%)	3
Sweats	4/7 (57.1%)	7
Chest pain	4/7 (57.1%)	6
Opacified left maxillary sinus	1/7 (14.3%)	1
Back pain	4/7 (57.1%)	4
Sinusitis	1/7 (14.3%)	1
Neutropenic fever	3/7 (42.9%)	5
Chills	5/7 (71.4%)	9
Nausea	6/7 (85.7%)	11
Abdominal ascites	1/7 (14.3%)	1
Gingivitis	1/7 (14.3%)	1
Insomnia	4/7 (57.1%)	4
Cough	4/7 (57.1%)	7
Stiff neck	2/7 (28.6%)	2
Congestion	1/7 (14.3%)	1
Fever	5/7 (71.4%)	9
Vomiting	4/7 (57.1%)	5
Post nasal drip	1/7 (14.3%)	1
Nosebleed	4/7 (57.1%)	6
Hypoxia	2/7 (28.6%)	4
Lightheadedness	2/7 (28.6%)	2
Alopecia	4/7 (57.1%)	4
Poor appetite	5/7 (71.4%)	5
Tooth problem	2/7 (28.6%)	2
Mouth sores	1/7 (14.3%)	1
Headache	4/7 (57.1%)	9
Speech impairment	1/7 (14.3%)	1
Throat pain	1/7 (14.3%)	1
Lower abductor pain	1/7 (14.3%)	1
Trouble sleeping	3/7 (42.9%)	3
Taste alteration	1/7 (14.3%)	1
Hip pain	1/7 (14.3%)	1
Cold	1/7 (14.3%)	1
Sinus congestion	2/7 (28.6%)	2
Bone pain	3/7 (42.9%)	3
Sore throat	2/7 (28.6%)	2
Wrist pain	1/7 (14.3%)	1
Ankle pain	1/7 (14.3%)	1
Agitation	2/7 (28.6%)	2
Rigidity	1/7 (14.3%)	1
Difficulty swallowing	1/7 (14.3%)	1
Dizziness	2/7 (28.6%)	2
Puffy face	1/7 (14.3%)	1
Swollen ankles	1/7 (14.3%)	1
Mouth/throat discomfort	1/7 (14.3%)	1
Rectal pain	1/7 (14.3%)	1
Abnormal gait	1/7 (14.3%)	1
Jaw pain	2/7 (28.6%)	2
Leg pain	1/7 (14.3%)	1
Soft tissue swelling	1/7 (14.3%)	1
Achiness	1/7 (14.3%)	1
Sinus headache	1/7 (14.3%)	1
Soreness of tongue	1/7 (14.3%)	1
Stomach pain	1/7 (14.3%)	1
Mucositis	1/7 (14.3%)	1
Bleeding from PICC site	1/7 (14.3%)	1
Transfusion reaction	1/7 (14.3%)	1
Elevated bilirubin	1/7 (14.3%)	2
Bleeding from IV site	1/7 (14.3%)	1
Fall	1/7 (14.3%)	1
Anal incontinence	1/7 (14.3%)	1
Oral bleeding	1/7 (14.3%)	1
Rib pain	1/7 (14.3%)	1
Volume overload	1/7 (14.3%)	1
Abdominal tenderness	1/7 (14.3%)	1
Infections and infestations
Infection	3/7 (42.9%)	4
Respiratory infection	1/7 (14.3%)	1
Metabolism and nutrition disorders
Anorexia	3/7 (42.9%)	4
Musculoskeletal and connective tissue disorders
Muscle pain/tightness	2/7 (28.6%)	2
Increased troponins	1/7 (14.3%)	1
Nervous system disorders
Numbness/tingling	3/7 (42.9%)	4
Neuropathy	4/7 (57.1%)	6
Choreiform movement	1/7 (14.3%)	1
Psychiatric disorders
Anxiety	4/7 (57.1%)	4
Confusion	3/7 (42.9%)	4
Mood alteration	2/7 (28.6%)	2
Psychosis	2/7 (28.6%)	2
Catatonia	1/7 (14.3%)	1
Depression	1/7 (14.3%)	1
Delirium	1/7 (14.3%)	1
Renal and urinary disorders
Nocturia	3/7 (42.9%)	3
Urinary incontinence	1/7 (14.3%)	1
Urinary frequency	1/7 (14.3%)	1
Decreased urine output	1/7 (14.3%)	1
Autodiuresis/polyuria	1/7 (14.3%)	1
Hematuria	1/7 (14.3%)	1
Urinary retention	2/7 (28.6%)	2
Respiratory, thoracic and mediastinal disorders
Shortness of breath	5/7 (71.4%)	8
Pleural effusion	2/7 (28.6%)	2
Tachypnea	1/7 (14.3%)	1
Wheezing	1/7 (14.3%)	1
Absent breath sounds	1/7 (14.3%)	1
Skin and subcutaneous tissue disorders
Edema	5/7 (71.4%)	10
Rash	6/7 (85.7%)	12
Abscess	2/7 (28.6%)	2
Dry skin	1/7 (14.3%)	1
Facial flushing	2/7 (28.6%)	2
Erythema	1/7 (14.3%)	1
Groin nodule	1/7 (14.3%)	1
Hyperpigmented circumscribed areas on scalp	1/7 (14.3%)	1
Blister	1/7 (14.3%)	1
Jaundice	1/7 (14.3%)	1
Petechiae	1/7 (14.3%)	1
Vascular disorders
Phlebitis	1/7 (14.3%)	1

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.