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NCT01313689

Ofatumumab vs Physician's Choice in Subjects With Bulky Fludarabine-Refractory Chronic Lymphocytic Leukemia

Completed Phase 3 Results posted Last updated 8 November 2018
What this trial tests

Phase 3 trial testing Ofatumumab in Leukaemia in 122 participants. Completed in 24 April 2017.

Timeline
14 April 2011
Primary endpoint
18 March 2014
24 April 2017

Quick facts

Lead sponsorNovartis Pharmaceuticals
PhasePhase 3
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingnone
Primary purposetreatment
Enrollment122
Start date14 April 2011
Primary completion18 March 2014
Estimated completion24 April 2017
Sites80 locations across France, Italy, Slovakia, Russia, Ukraine, Belgium, Austria, Sweden

Drugs / interventions tested

Conditions studied

Sponsor

Novartis Pharmaceuticals — full company profile →

Who can join

18 and older, any sex, with Leukaemia. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Progression-free Survival (PFS) as Assessed by Independent Review Committee (IRC) Primary · From the randomization date up to 60 months post the randomization date.

PFS is the interval of time between the date of first randomization to the date of disease progression (PD) or death due to any reason, whichever occurred first. The date of PD was defined as the first occurrence of any criteria of progression. PD criteria requires at least one of the following: progression of lymphadenopathy, \>=50% increase in liver or spleen size, \>=50% increase in number of lymphocytes per microliter, more aggressive histology, occurence of cytopenia after treatment attributable to CLL. Disease progression was determined according to the 2008 International Workshop for Ch

GroupValue95% CI
Any Ofatumumab (OFA)5.364.30 – 6.97
Physician's Choice (PC)3.611.87 – 6.74
Ofatumumab Extended (OFA Ext)10.057.23 – 13.80
Ofatumumab Observation (OFA Observ.)7.165.36 – 9.49
Progression-free Survival (PFS) as Assessed by Investigator Secondary · From the randomization date up to 60 months post the randomization date.

PFS is the interval of time between the date of first randomization to the date of disease progression (PD) or death due to any reason, whichever occurred first. The date of PD was defined as the first occurrence of any criteria of progression. PD criteria requires at least one of the following: progression of lymphadenopathy, \>=50% increase in liver or spleen size, \>=50% increase in number of lymphocytes per microliter, more aggressive histology, occurence of cytopenia after treatment attributable to CLL. Disease progression was determined according to the 2008 International Workshop for Ch

GroupValue95% CI
Any Ofatumumab (OFA)7.005.42 – 8.25
Physician's Choice (PC)4.501.97 – 5.62
Ofatumumab Extended (OFA Ext)12.6810.09 – 14.29
Ofatumumab Observation (OFA Observ.)9.497.00 – 12.12
Overall Response Rate (ORR) as Assessed by the IRC Secondary · From the randomization date up to 60 months post the randomization date.

ORR is defined as the number of participants achieving either complete response (CR) or partial response (PR). ORR was measured using the IWCLL updated NCI-WG guidelines 2008. CR requires all of the following criteria: no lymphadenopathy(Ly)/ hepatomegaly, splenomegaly, constitutional symptoms; neutrophils \>1500 per microliter(µL), platelets(PL) \>100,000/µL, hemoglobin(Hb) \>11 grams/deciliter(g/dL), lymphocytes(LC) \<4000/µL, bone marrow(BM) sample must be normocellular for age, \<30% LC and no lymphoid nodules. PR requires the following criteria for at least 2 months: \>=50% decrease in LC

CR
GroupValue95% CI
Any Ofatumumab (OFA)0
Physician's Choice (PC)0
Ofatumumab Extended (OFA Ext)0
Ofatumumab Observation (OFA Observ.)0
PR
GroupValue95% CI
Any Ofatumumab (OFA)30
Physician's Choice (PC)7
Ofatumumab Extended (OFA Ext)18
Ofatumumab Observation (OFA Observ.)8
nPR
GroupValue95% CI
Any Ofatumumab (OFA)0
Physician's Choice (PC)0
Ofatumumab Extended (OFA Ext)0
Ofatumumab Observation (OFA Observ.)0
Stable Disease
GroupValue95% CI
Any Ofatumumab (OFA)36
Physician's Choice (PC)22
Ofatumumab Extended (OFA Ext)5
Ofatumumab Observation (OFA Observ.)5
Progressive Disease
GroupValue95% CI
Any Ofatumumab (OFA)9
Physician's Choice (PC)8
Ofatumumab Extended (OFA Ext)1
Ofatumumab Observation (OFA Observ.)0
Not Evaluable
GroupValue95% CI
Any Ofatumumab (OFA)4
Physician's Choice (PC)6
Ofatumumab Extended (OFA Ext)0
Ofatumumab Observation (OFA Observ.)0
Missing
GroupValue95% CI
Any Ofatumumab (OFA)0
Physician's Choice (PC)0
Ofatumumab Extended (OFA Ext)0
Ofatumumab Observation (OFA Observ.)0
Overall Response Rate (ORR) as Assessed by the Investigator Secondary · From the randomization date up to 60 months post the randomization date.

ORR is defined as the number of participants achieving either complete response (CR) or partial response (PR). Overall response was measured using the IWCLL updated NCI-WG guidelines 2008. CR requires all of the following criteria: no lymphadenopathy(Ly)/ hepatomegaly, splenomegaly, constitutional symptoms; neutrophils \>1500 per microliter(µL), platelets(PL) \>100,000/µL, hemoglobin(Hb) \>11 grams/deciliter(g/dL), lymphocytes(LC) \<4000/µL, bone marrow(BM) sample must be normocellular for age, \<30% LC and no lymphoid nodules. PR requires the following criteria for at least 2 months: \>=50% d

CR
GroupValue95% CI
Any Ofatumumab (OFA)2
Physician's Choice (PC)2
Ofatumumab Extended (OFA Ext)1
Ofatumumab Observation (OFA Observ.)1
OFA First Randomization Only (OFA FRO)0
PR
GroupValue95% CI
Any Ofatumumab (OFA)36
Physician's Choice (PC)12
Ofatumumab Extended (OFA Ext)17
Ofatumumab Observation (OFA Observ.)7
OFA First Randomization Only (OFA FRO)12
nPR
GroupValue95% CI
Any Ofatumumab (OFA)1
Physician's Choice (PC)2
Ofatumumab Extended (OFA Ext)0
Ofatumumab Observation (OFA Observ.)1
OFA First Randomization Only (OFA FRO)0
Stable Disease
GroupValue95% CI
Any Ofatumumab (OFA)34
Physician's Choice (PC)14
Ofatumumab Extended (OFA Ext)6
Ofatumumab Observation (OFA Observ.)4
OFA First Randomization Only (OFA FRO)24
Progressive Disease
GroupValue95% CI
Any Ofatumumab (OFA)2
Physician's Choice (PC)10
Ofatumumab Extended (OFA Ext)0
Ofatumumab Observation (OFA Observ.)0
OFA First Randomization Only (OFA FRO)2
Not Evaluable
GroupValue95% CI
Any Ofatumumab (OFA)0
Physician's Choice (PC)0
Ofatumumab Extended (OFA Ext)0
Ofatumumab Observation (OFA Observ.)0
OFA First Randomization Only (OFA FRO)0
Missing
GroupValue95% CI
Any Ofatumumab (OFA)4
Physician's Choice (PC)3
Ofatumumab Extended (OFA Ext)0
Ofatumumab Observation (OFA Observ.)0
OFA First Randomization Only (OFA FRO)4
Overall Survival Secondary · From the randomization date up to 60 months post the randomization date.

Overall survival (OS) is defined as the time from randomization to death due to any cause. Kaplan-Meier plots were used to estimate the reported median OS time.

GroupValue95% CI
Any Ofatumumab (OFA)19.1912.19 – 29.11
Physician's Choice (PC)14.528.94 – 24.97
Ofatumumab Extended (OFA Ext)31.5419.19 – 51.25
Ofatumumab Observation (OFA Observ.)45.5014.69 – NA
OFA First Randomization Only (OFA FRO)8.574.93 – 16.76
Time to Progression as Assessed by IRC Secondary · From the randomization date up to 60 months post the randomization date.

Time to progression is defined as the time from the date of randomization to disease progression (PD). PD requires at least one of the following: lymphadenopathy, appearance of any new lesion such as enlarged lymph nodes (\>1.5 cm) spleen or liver or other infiltrates or an increase by 50% or more in the greatest diameter of any previous site; an increase by 50% or more in the previously noted enlargement of the liver or spleen, an increase by 50% or more in the numbers of blood lymphocytes with at least 5000 lymphocytes per microliter, transformation to a more aggressive histology, or occurre

GroupValue95% CI
Any Ofatumumab (OFA)6.314.83 – 7.33
Physician's Choice (PC)5.322.14 – 8.08
Ofatumumab Extended (OFA Ext)10.057.23 – 13.80
Ofatumumab Observation (OFA Observ.)7.165.36 – 9.49
Time to Next Anti-cancer Therapy by Investigator Secondary · From the randomization date up to 60 months post the randomization date.

Time to next therapy is defined as the time from randomization until the start of the next line of treatment.

GroupValue95% CI
Any Ofatumumab (OFA)11.508.51 – 13.80
Physician's Choice (PC)6.542.66 – 8.08
Ofatumumab Extended (OFA Ext)15.4711.86 – NA
Ofatumumab Observation (OFA Observ.)9.008.08 – 14.16
Time to Response as Assessed by the IRC Secondary · From the randomization date up to 60 months post the randomization date.

Time to response is defined as the time from randomization to the first response (Complete Remission\[CR\], Complete Remission with incomplete bone marrow recovery\[CRi\], partial response\[PR\], or nodular PR\[nPR\]). CR(all the criteria at least 2 months after last treatment): no lymphadenopathy(Ly) \> 1.5 cm/ hepatomegaly/ splenomegaly/ constitutional symptoms; neutrophils \>1500 per microliter(µL), platelets(PL) \>100,000/µL, hemoglobin(Hb) \>11 grams/deciliter(g/dL), lymphocytes(LC) \<4000/µL, bone marrow(BM) sample must be normocellular for age, \<30% LC, no lymphoid nodule. CRi: CR crit

GroupValue95% CI
Any Ofatumumab (OFA)1.171.02 – 1.91
Physician's Choice (PC)2.560.76 – 3.48
Ofatumumab Extended (OFA Ext)1.861.05 – 1.94
Ofatumumab Observation (OFA Observ.)1.150.92 – 1.94
Duration of Response as Assessed by the IRC Secondary · From the randomization date up to 60 months post the randomization date.

DOR is defined as the time from the initial response (CR, CRi, nPR, or PR) to the first documented sign of PD or death due to any cause. PD requires at least one of the following: lymphadenopathy, appearance of any new lesion such as enlarged lymph nodes (\>1.5 cm) spleen or liver or other infiltrates or an increase by 50% or more in the greatest diameter of any previous site; an increase by 50% or more in the previously noted enlargement of the liver or spleen, an increase by 50% or more in the numbers of blood lymphocytes with at least 5000 lymphocytes per microliter, transformation to a mor

GroupValue95% CI
Any Ofatumumab (OFA)6.245.32 – 12.22
Physician's Choice (PC)6.954.47 – NA
Number of Participants With Any Adverse Event (AE), Any Serious Adverse Event (SAE), Any Fatal Serious Adverse Event (FSAE), or Deaths Secondary · From the first dose of study medication to 60 days after the last dose of study medication and until follow-up for SAEs unless initiation of subsequent anti-CLL therapy

An AE is defined as any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of a medicinal product. A SAE is defined as any untoward medical occurrence that, at any dose, results in death, is life threatening, requires hospitalization or prolongation of existing hospitalization, results in disability or incapacity, is a congenital anomaly or birth defect.

Any AE
GroupValue95% CI
Any Ofatumumab (OFA)71
Physician's Choice (PC)37
Ofatumumab Extended (OFA Ext)22
Ofatumumab Observation (OFA Observ.)10
OFA First Randomization Only (OFA FRO)39
OFA Salvage20
Any SAE
GroupValue95% CI
Any Ofatumumab (OFA)43
Physician's Choice (PC)23
Ofatumumab Extended (OFA Ext)12
Ofatumumab Observation (OFA Observ.)5
OFA First Randomization Only (OFA FRO)26
OFA Salvage10
Any FSAE
GroupValue95% CI
Any Ofatumumab (OFA)14
Physician's Choice (PC)6
Ofatumumab Extended (OFA Ext)2
Ofatumumab Observation (OFA Observ.)3
OFA First Randomization Only (OFA FRO)9
OFA Salvage5
Deaths
GroupValue95% CI
Any Ofatumumab (OFA)1
Physician's Choice (PC)0
Ofatumumab Extended (OFA Ext)0
Ofatumumab Observation (OFA Observ.)0
OFA First Randomization Only (OFA FRO)1
OFA Salvage0
Number of Participants With Any Adverse Event (AE) of Special Interest Secondary · From the first dose of study medication to 60 days after the last dose of study medication and until follow-up for SAEs unless initiation of subsequent anti-CLL therapy

AEs of special interest included cytopenias (neutropenia \[decreased neutrophil count\], anaemia \[decreased hemoglobin\], and thrombocytopenia \[decreased platelet count\]), autoimmune haematologic complications (autoimmune haemolytic anaemia and haemolytic anaemia), infusion reactions, infections, mucocutaneous reactions, Tumour Lysis Syndrome (TLS), cardiovascular events, and small bowel obstruction.

Any AE of decreased neutrophil count
GroupValue95% CI
Any Ofatumumab (OFA)23
Physician's Choice (PC)15
Ofatumumab Extended (OFA Ext)11
Ofatumumab Observation (OFA Observ.)2
Any AE of decreased hemoglobin
GroupValue95% CI
Any Ofatumumab (OFA)9
Physician's Choice (PC)9
Ofatumumab Extended (OFA Ext)3
Ofatumumab Observation (OFA Observ.)2
Any AE of decreased platelet count
GroupValue95% CI
Any Ofatumumab (OFA)10
Physician's Choice (PC)5
Ofatumumab Extended (OFA Ext)3
Ofatumumab Observation (OFA Observ.)1
Any AE of autoimmune haemolytic anaemia
GroupValue95% CI
Any Ofatumumab (OFA)0
Physician's Choice (PC)2
Ofatumumab Extended (OFA Ext)0
Ofatumumab Observation (OFA Observ.)0
Any AE of haemolytic anaemia
GroupValue95% CI
Any Ofatumumab (OFA)1
Physician's Choice (PC)0
Ofatumumab Extended (OFA Ext)1
Ofatumumab Observation (OFA Observ.)0
Any infusion related AE
GroupValue95% CI
Any Ofatumumab (OFA)33
Physician's Choice (PC)11
Ofatumumab Extended (OFA Ext)8
Ofatumumab Observation (OFA Observ.)4
Any AE of Infection
GroupValue95% CI
Any Ofatumumab (OFA)46
Physician's Choice (PC)24
Ofatumumab Extended (OFA Ext)16
Ofatumumab Observation (OFA Observ.)8
Any AE of mucocutaneous reaction
GroupValue95% CI
Any Ofatumumab (OFA)20
Physician's Choice (PC)4
Ofatumumab Extended (OFA Ext)6
Ofatumumab Observation (OFA Observ.)3
Mean Immunoglobulin (Ig) Antibodies IgA, IgG, and IgM Over Time Secondary · Screening and every 3 months during treatment, every 6 months after last treatment until PD or until 42 Month Follow-up Visit

Immunoglobulins or antibodies are large proteins used by the immune system to identify and neutralize foreign particles such as bacteria and viruses. Their normal blood levels indicate proper immune status. Low levels indicate immuno-suppression. IgA, IgG, and IgM were measured in the blood samples of the participants. Immunoglobulin testing was performed at Screening (SCR), Cycle 3 Week 4 (C3W4), Cycle 7 Week 4 (C3W4) ,Cycle 9 Week 4 (C3W4), 6 Month Follow-up Visit (6M FU), 9 Month Follow-up (9M FU), 12 Month Follow-up (12M FU), 18 Month Follow-up (18M FU), 24 Month Follow-up (24M FU), 30 Mon

IgA, SCR
GroupValue95% CI
Any Ofatumumab (OFA)0.793± 0.6680
Physician's Choice (PC)0.685± 0.5518
Ofatumumab Extended (OFA Ext)0.807± 0.7426
Ofatumumab Observation (OFA Observ.)1.095± 0.7535
OFA First Randomization Only (OFA FRO)0.688± 0.5749
IgG, SCR
GroupValue95% CI
Any Ofatumumab (OFA)6.909± 4.6836
Physician's Choice (PC)8.615± 12.1625
Ofatumumab Extended (OFA Ext)6.270± 3.8573
Ofatumumab Observation (OFA Observ.)8.128± 4.7569
OFA First Randomization Only (OFA FRO)6.898± 5.1142
IgM, SCR
GroupValue95% CI
Any Ofatumumab (OFA)0.800± 1.3154
Physician's Choice (PC)0.601± 0.7061
Ofatumumab Extended (OFA Ext)0.800± 1.6649
Ofatumumab Observation (OFA Observ.)0.468± 0.3801
OFA First Randomization Only (OFA FRO)0.907± 1.2822
IgA, C3W4
GroupValue95% CI
Any Ofatumumab (OFA)0.721± 0.6355
Physician's Choice (PC)0.675± 0.4819
Ofatumumab Extended (OFA Ext)0.808± 0.7931
Ofatumumab Observation (OFA Observ.)0.977± 0.6458
OFA First Randomization Only (OFA FRO)0.514± 0.3621
OFA Salvage0.486± 0.3868
IgG, C3W4
GroupValue95% CI
Any Ofatumumab (OFA)5.925± 3.5059
Physician's Choice (PC)5.481± 2.1226
Ofatumumab Extended (OFA Ext)5.949± 3.4089
Ofatumumab Observation (OFA Observ.)7.232± 4.0103
OFA First Randomization Only (OFA FRO)5.276± 3.3056
OFA Salvage5.974± 2.7992
IgM, C3W4
GroupValue95% CI
Any Ofatumumab (OFA)0.692± 1.3420
Physician's Choice (PC)0.485± 0.4929
Ofatumumab Extended (OFA Ext)0.882± 1.9833
Ofatumumab Observation (OFA Observ.)0.429± 0.3497
OFA First Randomization Only (OFA FRO)0.636± 0.7764
OFA Salvage0.488± 0.4816
IgA, C7W4
GroupValue95% CI
Any Ofatumumab (OFA)0.793± 0.6608
Ofatumumab Extended (OFA Ext)0.723± 0.6730
Ofatumumab Observation (OFA Observ.)0.945± 0.6724
OFA First Randomization Only (OFA FRO)0.725± 0.6011
OFA Salvage0.537± 0.4356
IgG, C7W4
GroupValue95% CI
Any Ofatumumab (OFA)6.250± 3.5225
Ofatumumab Extended (OFA Ext)5.817± 3.4944
Ofatumumab Observation (OFA Observ.)7.254± 3.7588
OFA First Randomization Only (OFA FRO)5.420± 2.2062
OFA Salvage5.135± 2.6309

Adverse events — posted to ClinicalTrials.gov

Time frame: SAEs & AEs were collected from first dose of study medication to 60 days after last dose of study medication & until end of the follow-up period (60 months post the randomization date) for SAEs unless initiation of subsequent anti-CLL therapy. AEs reported in this record are from date of First Patient First Treatment until Last Patient Last Visit. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Any Ofatumumab
Serious: 43/78 (55%)
Deaths: 16/78
Ofatumumab Extended
Serious: 12/24 (50%)
Deaths: 2/24
Ofatumumab Observation
Serious: 5/13 (38%)
Deaths: 3/13
Ofatumumab
Serious: 26/41 (63%)
Deaths: 11/41
Physicians Choice
Serious: 23/43 (53%)
Deaths: 8/43
Ofatumumab Salvage
Serious: 10/22 (45%)
Deaths: 5/22

Serious adverse events (92 terms)

ReactionSystemAny OfatumumabOfatumumab ExtendedOfatumumab ObservationOfatumumabPhysicians ChoiceOfatumumab Salvage
PneumoniaInfections and infestations
Febrile neutropeniaBlood and lymphatic system disorders
AnaemiaBlood and lymphatic system disorders
PyrexiaGeneral disorders
SepsisInfections and infestations
Upper respiratory tract infectionInfections and infestations
Autoimmune haemolytic anaemiaBlood and lymphatic system disorders
Atrial fibrillationCardiac disorders
Cardiac arrestCardiac disorders
Cardiac failureCardiac disorders
Cardiac failure acuteCardiac disorders
CellulitisInfections and infestations
MeningitisInfections and infestations
Neutropenic sepsisInfections and infestations
Renal failureRenal and urinary disorders
PneumonitisRespiratory, thoracic and mediastinal disorders
HypotensionVascular disorders
Haemolytic anaemiaBlood and lymphatic system disorders
LeukopeniaBlood and lymphatic system disorders
NeutropeniaBlood and lymphatic system disorders
ThrombocytopeniaBlood and lymphatic system disorders
Cardiovascular insufficiencyCardiac disorders
Coronary artery insufficiencyCardiac disorders
Myocardial infarctionCardiac disorders
Supraventricular tachycardiaCardiac disorders
Other adverse events (73 terms — click to expand)

ReactionSystemAny OfatumumabOfatumumab ExtendedOfatumumab ObservationOfatumumabPhysicians ChoiceOfatumumab Salvage
NeutropeniaBlood and lymphatic system disorders
CoughRespiratory, thoracic and mediastinal disorders
ChillsGeneral disorders
ThrombocytopeniaBlood and lymphatic system disorders
NauseaGastrointestinal disorders
PyrexiaGeneral disorders
BronchitisInfections and infestations
AnaemiaBlood and lymphatic system disorders
DiarrhoeaGastrointestinal disorders
NasopharyngitisInfections and infestations
Upper respiratory tract infectionInfections and infestations
PruritusSkin and subcutaneous tissue disorders
HypertensionVascular disorders
Abdominal pain upperGastrointestinal disorders
VomitingGastrointestinal disorders
FatigueGeneral disorders
Peripheral swellingGeneral disorders
Cytomegalovirus infectionInfections and infestations
PneumoniaInfections and infestations
SinusitisInfections and infestations
Alanine aminotransferase increasedInvestigations
HyperkalaemiaMetabolism and nutrition disorders
Back painMusculoskeletal and connective tissue disorders
Productive coughRespiratory, thoracic and mediastinal disorders
Cardiac failureCardiac disorders
ConstipationGastrointestinal disorders
AstheniaGeneral disorders
Oedema peripheralGeneral disorders
Urinary tract infectionInfections and infestations
ContusionInjury, poisoning and procedural complications
Aspartate aminotransferase increasedInvestigations
HypercalcaemiaMetabolism and nutrition disorders
HeadacheNervous system disorders
ParaesthesiaNervous system disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
Dry skinSkin and subcutaneous tissue disorders
RashSkin and subcutaneous tissue disorders
UrticariaSkin and subcutaneous tissue disorders
FlushingVascular disorders
LeukopeniaBlood and lymphatic system disorders

Most-reported serious reactions: Pneumonia, Febrile neutropenia, Anaemia, Pyrexia, Sepsis, Upper respiratory tract infection, Autoimmune haemolytic anaemia, Atrial fibrillation.

Data from ClinicalTrials.gov NCT01313689 adverse events section.

Sponsor's own description

The purpose of this study was to confirm the clinical benefit observed in the pivotal registration study, Hx-CD20-406. The Committee for Medicinal Products for Human Use (CHMP) required that a randomized study be conducted in CLL patients with bulky fludarabine-refractory disease as a specific obligation for grant of conditional approval for ARZERRA™ in the European Union (EU). This study compared ofatumumab with the physicians' choice of therapy.

Publications & conference data

3 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Characteristics and follow-up of postmarketing studies of conditionally authorized medicines in the EU.
    Hoekman J, Klamer TT, Mantel-Teeuwisse AK, Leufkens HG, et al · · 2016 · cited 42× · PMID 26992001 · DOI 10.1111/bcp.12940
  2. Phase III, randomized study of ofatumumab versus physicians' choice of therapy and standard versus extended-length ofatumumab in patients with bulky fludarabine-refractory chronic lymphocytic leukemia.
    Österborg A, Udvardy M, Zaritskey A, Andersson PO, et al · · 2016 · cited 21× · PMID 26784000 · DOI 10.3109/10428194.2015.1122783
  3. Ibrutinib: a paradigm shift in management of CLL.
    Badar T, Burger JA, Wierda WG, O'Brien S. · · 2014 · cited 12× · PMID 25387837 · DOI 10.1586/17474086.2014.977862

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