Errata for
Note: Corrections to the briefing document
are highlighted in yellow with the changed information included as a
strikethrough.
Update to Section 2.6.1.6., page 24, Section Header
2.6.1.6 FDA-required Post-hoc
Analysis: Overall Survival Post-transplantation Post-randomization (Study
Update to Section 2.6.2.1, page 27, 3rd
paragraph, second sentence:
At study day 30 (the primary endpoint evaluation), significantly more
subjects in the BDP group than in the placebo group succeeded in achieving
≥ 70% of their estimated daily caloric requirements without flares
of aGVHD (71% [22/31] in the BDP group versus 41% [13/3112/29] in the placebo
group; p = 0.02 by the chi-square test).
Update to Section 2.6.2.1, page 28, 1st full paragraph on
page, 2nd and 5th sentences.
As for Study
ratio
= 0.34; 95% CI: 0.07-1.72; p = 0.1881 by the Cochran-Mantel-Haenszel test) (Figure 2-8). Similarly,
the risk of mortality by 200 days post-transplantation 56% lower for the BDP
group compared with the placebo group (hazard ratio = 0.44; p = 0.2415 by Wald
chisquare test). After 1 year from the date of randomization in Study 875, 6 of
the 31 subjects (19%) who were randomized to receive BDP had died versus 9 of
the 29 (31%) subjects who were randomized to receive placebo. The risk of
mortality during this 1-year period was 45% lower for subjects in the BDP group
compared with the placebo group (hazard ratio = 0.55; 95% CI: 0.20-1.56; p =
0.2556 by the stratified logrank test) (Figure 2-10) (Figure 2-9).
Update to Section 4.2, page 58, Table 4-3.
Table 4-3. Primary Cancer Diagnosis (Study
|
|
|
|
|||
Subjects randomized |
67 |
62 |
129 |
|||
|
|
|
|
|||
Primary cancer
diagnosis |
|
|
|
|
|
|
Acute myelogenous
leukemia |
22 |
33% |
19 |
31% |
41 |
32% |
Acute lymphocytic
leukemia |
7 |
10% |
9 |
14% |
16 |
12% |
Chronic myelogenous
leukemia |
8 |
12% |
8 |
13% |
16 |
12% |
Non-Hodgkin’s lymphoma |
7 |
10% |
6 |
10% |
13 |
10% |
Myelodysplastic
syndrome |
6 |
9% |
2 |
3% |
8 |
6% |
Multiple myeloma |
1 |
1% |
6 |
10% |
7 |
5% |
Chronic lymphocytic
leukemia |
4 |
6% |
2 |
3% |
6 |
5% |
Chronic myelomonocytic
leukemia |
3 |
5% |
2 |
3% |
5 |
4% |
Aplastic anemia |
2 |
3% |
1 |
2% |
3 |
2% |
Hodgkin’s disease |
2 |
3% |
1 |
2% |
3 |
2% |
Myelofibrosis |
2 |
3% |
1 |
2% |
3 |
2% |
Acute promyelocytic
leukemia |
0 |
0% |
2 |
3% |
2 |
2% |
Othera |
|
|
|
|
|
|
|
|
|
|
|||
Acute myelogenous leukemia |
22 |
33% |
19 |
31% |
41 |
32% |
In first remission |
15 |
22% |
9 |
15% |
24 |
19% |
In second or later
remission |
5 |
7% |
5 |
8% |
10 |
8% |
Persistent or relapsed
disease |
2 |
3% |
5 |
8% |
7 |
5% |
|
|
|
|
|||
Chronic myelogenous leukemia |
8 |
12% |
8 |
13% |
16 |
12% |
In chronic phase |
4 |
6% |
5 |
8% |
9 |
7% |
In accelerated phase or
blast crisis |
3 |
5% |
3 |
5% |
6 |
5% |
Not reported |
1 |
1% |
0 |
0% |
1 |
<1% |
|
|
|
|
|||
Risk of relapse post-transplantb |
|
|
|
|
|
|
Higher risk |
29 |
43% |
40 |
65% |
69 |
53% |
Lower risk |
|
|
22 |
35% |
60 |
47% |
a Other primary diagnoses include (1
each): Biphenotypic acute leukemia,
extramedullary leukemia tumor, renal
cell carcinoma, myeloproliferative syndrome, plasmacytic leukemia, and
polythyemia vera. |
||||||
b Subjects
were considered to have a lower risk of relapse post-transplantation if the
indication for transplantation was one of the following diagnoses: aplastic anemia, chronic lymphocytic
leukemia, chronic myelogenous leukemia in chronic phase, chronic
myelomonocytic leukemia, acute myelogenous leukemia in first remission,
myelodysplastic syndrome, myelofibrosis, myeloproliferative syndrome, and
polycythemia vera. Subjects with other
diagnoses were considered to have a higher risk of relapse post-transplant. |
Update to Section 4.2.1,
page 60, Table 4-5.
Table 4-5. GVHD Treatment Failure Status through Study
Day 50 (Study
|
|
|
|
|||
Subjects randomized |
67 |
62 |
129 |
|||
|
|
|
|
|||
Met criteria for GVHD
treatment failure |
|
|
|
|
|
|
Yes |
30 |
45% |
18 |
29% |
48 |
37% |
No |
37 |
55% |
44 |
71% |
81 |
63% |
Completed 50-day treatment perioda |
30 |
45% |
37 |
60% |
67 |
52% |
Withdrawn from study early |
7 |
10% |
7 |
11% |
14 |
11% |
Adverse event |
3 |
4% |
3 |
5% |
6 |
5% |
Protocol violation |
1 |
1% |
4 |
6% |
5 |
4% |
Non-compliance |
3 |
4% |
0 |
0% |
3 |
2% |
|
|
|
|
|||
Action
which resulted in GVHD treatment failure |
|
|
|
|
|
|
Increased dose of
corticosteroids |
28 |
42% |
18 |
29% |
46 |
36% |
Changed
immunosuppressant medications |
1 |
1% |
0 |
0% |
1 |
<1% |
Received open-label BDP |
1 |
1% |
0 |
0% |
1 |
<1% |
|
|
|
|
|||
Sites
of recurrent GVHD which resulted in
treatment failure |
|
|
|
|
|
|
Gut |
23 |
34% |
15 |
24% |
38 |
29% |
Skin |
4 |
6% |
0 |
0% |
4 |
3% |
Gut & skin |
0 |
0% |
2 |
3% |
2 |
2% |
Liver |
1 |
1% |
1 |
2% |
2 |
2% |
Lung |
1 |
1% |
0 |
0% |
1 |
<1% |
Not reported |
1 |
1% |
0 |
0% |
1 |
<1% |
|
|
|
|
|
|
|
a Completed the 50-day protocol treatment
period without meeting the criteria for GVHD treatment failure. |
Update to Section 4.2, page 93, Figure 4-12.
Figure 4-12. FDA Requested Post-Hoc Analysis: Overall Survival
Post-Randomization (Study 875:
Hazard
ratio estimated from a Cox proportional hazards model stratified by the
two-level factor for donor type (HLA-matched sibling vs. unrelated or
HLA-mismatched donor). P-value
calculated from the stratified log-rank test.
Nominal significance level of 0.05 (two-sided). No adjustment for multiple testing.
Changes in above Figure:
|
0-2 |
3-4 |
5-6 |
7-8 |
9-10 |
11-12 |
BDP |
9/31 |
1/22 |
0/21 |
0/21 |
|
0/8 |
Placebo |
11/29 |
2/18 |
1/16 |
|
|
0/7 |
Update to Section 4.4, page 98, Figure 4-15.
Figure 4-15. Overall Survival for Studies 875 and
(Integrated
P-value
is based on the log-rank test (stratified by donor type and study). Nominal significance level of 0.05
(two-sided). No adjustment for multiple
testing.
Changes in above Figure:
|
0-2 |
3-4 |
5-6 |
7-8 |
9-10 |
11-12 |
BDP |
33/93 |
4/52 |
0/23 |
0/21 |
|
0/8 |
Placebo |
42/96 |
3/46 |
1/18 |
|
|
0/7 |
Update to Table
5-14, page 134, Title
Reference Limits for Normal