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NCT02005471: MURANO

A Study to Evaluate the Benefit of Venetoclax Plus Rituximab Compared With Bendamustine Plus Rituximab in Participants With Relapsed or Refractory Chronic Lymphocytic Leukemia (CLL)

Completed Phase 3 Results posted Last updated 17 October 2023
What this trial tests

Phase 3 trial testing Bendamustine in Chronic Lymphocytic Leukemia in 389 participants. Completed in 3 August 2022.

Timeline
17 March 2014
Primary endpoint
8 May 2017
3 August 2022

Quick facts

Lead sponsorHoffmann-La Roche
PhasePhase 3
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingnone
Primary purposetreatment
Enrollment389
Start date17 March 2014
Primary completion8 May 2017
Estimated completion3 August 2022
Sites111 locations across Italy, Taiwan, Poland, South Korea, Denmark, New Zealand, Netherlands, Russia

Drugs / interventions tested

Conditions studied

Sponsor

Hoffmann-La Roche — full company profile →

Who can join

18 and older, any sex, with Chronic Lymphocytic Leukemia. 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.

Percentage of Participants With PD as Assessed by the Investigator Using Standard International Workshop on Chronic Lymphocytic Leukemia (iwCLL) Guidelines or Death Primary · Baseline up to PD or death from any cause, whichever occurred first (up to approximately 8 years 5 months)

Assessment of response was performed by the investigator according to the iwCLL guidelines. PD was defined as occurrence of one of the following events: appearance of any new extra nodal lesion; new palpable lymph node (greater than \[\>\] 1.5 centimeters \[cm\]); unequivocal progression of non-target lesion; an increase of greater than or equal to (\>/=) 50 percent (%) compared to baseline in splenomegaly, hepatomegaly, number of blood lymphocytes with lymphocyte count \>/=5000 per microliter (mcL), or in longest diameter of any extra nodal lesion; transformation to a more aggressive histolog

GroupValue95% CI
Bendamustine + Rituximab Main Study88.7
Venetoclax + Rituximab Main Study70.1
Progression-Free Survival (PFS) as Assessed by the Investigator Using Standard iwCLL Guidelines Primary · Baseline up to PD or death, whichever occurred first (up to approximately 8 years 5 months)

PFS was defined as the time from randomization until first occurrence of PD/relapse as assessed by the investigator using iwCLL guidelines, or death from any cause, whichever occurred first. PD: occurrence of one of the following: new lesion; new palpable lymph node (\>1.5 cm); unequivocal progression of non-target lesion; increase of \>/=50% in splenomegaly, hepatomegaly, blood lymphocytes with count \>/=5000/mcL, longest diameter of any lesion; transformation to more aggressive histology; decrease of \>/=50% in platelet or neutrophil count, or hemoglobin level by \>2 g/dL or to \<10 g/dL. Pa

GroupValue95% CI
Bendamustine + Rituximab Main Study17.015.5 – 21.7
Venetoclax + Rituximab Main Study54.752.3 – 59.9
Percentage of Participants With PD or Death as Assessed by the Independent Review Committee (IRC) Using Standard iwCLL Guidelines Secondary · Baseline up to PD or death, whichever occurred first (up to approximately 3 years)

Assessment of response was performed by the IRC according to the iwCLL guidelines. PD was defined as occurrence of one of the following events: appearance of any new extra nodal lesion; new palpable lymph node (\>1.5 cm); unequivocal progression of non-target lesion; an increase of \>/=50% compared to baseline in splenomegaly, hepatomegaly, number of blood lymphocytes with lymphocyte count \>/=5000/mcL, or in longest diameter of any extra nodal lesion; transformation to a more aggressive histology; decrease of \>/=50% compared to baseline in platelet or neutrophil count; or decrease in hemoglo

GroupValue95% CI
Bendamustine + Rituximab Main Study54.4
Venetoclax + Rituximab Main Study18.0
PFS as Assessed by the IRC Using Standard iwCLL Guidelines Secondary · Baseline up to PD or death, whichever occurred first (up to approximately 3 years)

PFS was defined as the time from randomization until first occurrence of PD/relapse as assessed by the IRC using iwCLL guidelines, or death from any cause, whichever occurred first. PD: occurrence of one of the following: new lesion; new palpable lymph node (\>1.5 cm); unequivocal progression of non-target lesion; increase of \>/=50% in splenomegaly, hepatomegaly, blood lymphocytes with count \>/=5000/mcL, longest diameter of any lesion; transformation to more aggressive histology; decrease of \>/=50% in platelet or neutrophil count, or hemoglobin level by \>2 g/dL or to \<10 g/dL. Participant

GroupValue95% CI
Bendamustine + Rituximab Main Study18.115.8 – 22.3
Venetoclax + Rituximab Main StudyNANA – NA
Percentage of Participants With PD or Death as Assessed by the Investigator Using Standard iwCLL Guidelines in Participants With 17p Deletion as Identified by Fluorescence In-situ Hybridization (FISH) Test Secondary · Baseline up to PD or death, whichever occurred first (up to approximately 8 years 5 months)

Assessment of response was performed by the investigator according to the iwCLL guidelines. PD was defined as occurrence of one of the following events: appearance of any new extra nodal lesion; new palpable lymph node (\>1.5 cm); unequivocal progression of non-target lesion; an increase of \>/=50% compared to baseline in splenomegaly, hepatomegaly, number of blood lymphocytes with lymphocyte count \>/=5000/mcL, or in longest diameter of any extra nodal lesion; transformation to a more aggressive histology; decrease of \>/=50% compared to baseline in platelet or neutrophil count; or decrease i

GroupValue95% CI
Bendamustine + Rituximab 17p Del. Population80.4
Venetoclax + Rituximab 17p Del. Population80.4
PFS as Assessed by the Investigator Using Standard iwCLL Guidelines in Participants With 17p Deletion as Identified by FISH Test Secondary · Baseline up to PD or death, whichever occurred first (up to approximately 8 years 5 months)

PFS was defined as the time from randomization until first occurrence of PD/relapse as assessed by the investigator using iwCLL guidelines, or death from any cause, whichever occurred first. PD: occurrence of one of the following: new lesion; new palpable lymph node (\>1.5 cm); unequivocal progression of non-target lesion; increase of \>/=50% in splenomegaly, hepatomegaly, blood lymphocytes with count \>/=5000/mcL, longest diameter of any lesion; transformation to more aggressive histology; decrease of \>/=50% in platelet or neutrophil count, or hemoglobin level by \>2 g/dL or to \<10 g/dL. Pa

GroupValue95% CI
Bendamustine + Rituximab 17p Del. Population15.410.0 – 21.0
Venetoclax + Rituximab 17p Del. Population47.937.4 – 59.9
Percentage of Participants With PD or Death as Assessed by the IRC Using Standard iwCLL Guidelines in Participants With 17p Deletion as Identified by FISH Test Secondary · Baseline up to PD or death, whichever occurred first (up to approximately 3 years)

Assessment of response was performed by the IRC according to the iwCLL guidelines. PD was defined as occurrence of one of the following events: appearance of any new extra nodal lesion; new palpable lymph node (\>1.5 cm); unequivocal progression of non-target lesion; an increase of \>/=50% compared to baseline in splenomegaly, hepatomegaly, number of blood lymphocytes with lymphocyte count \>/=5000/mcL, or in longest diameter of any extra nodal lesion; transformation to a more aggressive histology; decrease of \>/=50% compared to baseline in platelet or neutrophil count; or decrease in hemoglo

GroupValue95% CI
Bendamustine + Rituximab 17p Del. Population47.8
Venetoclax + Rituximab 17p Del. Population19.6
PFS as Assessed by the IRC Using Standard iwCLL Guidelines in Participants With 17p Deletion as Identified by FISH Test Secondary · Baseline up to PD or death, whichever occurred first (up to approximately 3 years)

PFS was defined as the time from randomization until first occurrence of PD/relapse as assessed by the IRC using iwCLL guidelines, or death from any cause, whichever occurred first. PD: occurrence of one of the following: new lesion; new palpable lymph node (\>1.5 cm); unequivocal progression of non-target lesion; increase of \>/=50% in splenomegaly, hepatomegaly, blood lymphocytes with count \>/=5000/mcL, longest diameter of any lesion; transformation to more aggressive histology; decrease of \>/=50% in platelet or neutrophil count, or hemoglobin level by \>2 g/dL or to \<10 g/dL. Participant

GroupValue95% CI
Bendamustine + Rituximab 17p Del. Population16.113.6 – 22.3
Venetoclax + Rituximab 17p Del. PopulationNA27.6 – NA
Percentage of Participants With Best Overall Response of Complete Response (CR), CR With Incomplete Bone Marrow Recovery (CRi), Nodular Partial Response (nPR), or Partial Response (PR) as Assessed by the Investigator Using iwCLL Guidelines Secondary · Baseline up to approximately 8 years 5 months

Response was assessed by investigator according to iwCLL guidelines and was confirmed by repeat assessment \>/=4 weeks after initial documentation. CR: peripheral blood lymphocytes \<4000/mcL; absence of any new lesion, nodal disease, lymphadenopathy, hepatomegaly, splenomegaly, and constitutional symptoms; neutrophils \>1500/mcL, platelets \>100000/mcL, hemoglobin \>11.0 g/dL without need for transfusion or exogenous growth factors; normocellular bone marrow with \<30% lymphocytes; no lymphoid nodules. CRi: fulfilling all CR criteria but persistent cytopenia. PR: \>/=50% reduction in two of f

CR
GroupValue95% CI
Bendamustine + Rituximab Main Study8.24.76 – 12.98
Venetoclax + Rituximab Main Study26.320.24 – 33.07
CRi
GroupValue95% CI
Bendamustine + Rituximab Main Study0.50.01 – 2.82
Venetoclax + Rituximab Main Study1.50.32 – 4.45
nPR
GroupValue95% CI
Bendamustine + Rituximab Main Study6.23.22 – 10.50
Venetoclax + Rituximab Main Study3.61.46 – 7.29
PR
GroupValue95% CI
Bendamustine + Rituximab Main Study52.845.56 – 59.99
Venetoclax + Rituximab Main Study61.954.62 – 68.72
Percentage of Participants With Best Overall Response of CR, CRi, nPR, or PR as Assessed by the IRC Using iwCLL Guidelines Secondary · Baseline up to last FUV (up to approximately 3 years)

Response was assessed by IRC according to iwCLL guidelines and was confirmed by repeat assessment \>/=4 weeks after initial documentation. CR: peripheral blood lymphocytes \<4000/mcL; absence of any new lesion, nodal disease, lymphadenopathy, hepatomegaly, splenomegaly, constitutional symptoms; neutrophils \>1500/mcL, platelets \>100000/mcL, hemoglobin \>11.0 g/dL without need for transfusion or exogenous growth factors; normocellular bone marrow with \<30% lymphocytes; no lymphoid nodules. CRi: fulfilling all CR criteria but persistent cytopenia. PR: \>/=50% reduction in 2 of following: perip

GroupValue95% CI
Bendamustine + Rituximab Main Study67.760.64 – 74.20
Venetoclax + Rituximab Main Study93.388.81 – 96.38
Percentage of Participants With Overall Response of CR, Cri, nPR, or PR at End of Combination Treatment Visit as Assessed by the Investigator Using iwCLL Guidelines Secondary · End of combination treatment response (EoCTR) visit (8 to 12 weeks after Cycle [C] 6 Day [1]); Cycle length = 28 days

Response was assessed by investigator according to iwCLL guidelines and was confirmed by repeat assessment \>/=4 weeks after initial documentation. CR: peripheral blood lymphocytes \<4000/mcL; absence of any new lesion, nodal disease, lymphadenopathy, hepatomegaly, splenomegaly, and constitutional symptoms; neutrophils \>1500/mcL, platelets \>100000/mcL, hemoglobin \>11.0 g/dL without need for transfusion or exogenous growth factors; normocellular bone marrow with \<30% lymphocytes; no lymphoid nodules. CRi: fulfilling all CR criteria but persistent cytopenia. PR: \>/=50% reduction in 2 of fol

GroupValue95% CI
Bendamustine + Rituximab Main Study63.155.89 – 69.86
Venetoclax + Rituximab Main Study88.182.74 – 92.33
Percentage of Participants With Overall Response of CR, Cri, nPR, or PR at End of Combination Treatment Visit as Assessed by the IRC Using iwCLL Guidelines Secondary · EoCTR visit (8 to 12 weeks after C6D1); Cycle length = 28 days

Response was assessed by the IRC according to the iwCLL guidelines and was confirmed by repeat assessment \>/=4 weeks after initial documentation. CR: peripheral blood lymphocytes \<4000/mcL; absence of any new lesion, nodal disease, lymphadenopathy, hepatomegaly, splenomegaly, and constitutional symptoms; neutrophils \>1500/mcL, platelets \>100000/mcL, hemoglobin \>11.0 g/dL without need for transfusion or exogenous growth factors; normocellular bone marrow with \<30% lymphocytes; no lymphoid nodules. CRi: fulfilling all CR criteria but persistent cytopenia. PR: \>/=50% reduction in two of th

GroupValue95% CI
Bendamustine + Rituximab Main Study62.655.37 – 69.37
Venetoclax + Rituximab Main Study87.181.57 – 91.48

Adverse events — posted to ClinicalTrials.gov

Time frame: From signing of informed consent form up to approximately 8 years 5 months. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Bendamustine + Rituximab Main Study
Serious: 84/188 (45%)
Deaths: 84/188
Venetoclax + Rituximab Main Study
Serious: 101/194 (52%)
Deaths: 60/194
Bendamustine + Rituximab Crossover Substudy
Serious: 5/9 (56%)
Deaths: 1/9
Venetoclax + Rituximab Re-Treatment Substudy
Serious: 13/25 (52%)
Deaths: 8/25

Serious adverse events (167 terms)

ReactionSystemBendamustine + Rituximab M…Venetoclax + Rituximab Mai…Bendamustine + Rituximab C…Venetoclax + Rituximab Re-…
PneumoniaInfections and infestations
Febrile neutropeniaBlood and lymphatic system disorders
PyrexiaGeneral disorders
Infusion related reactionInjury, poisoning and procedural complications
AnaemiaBlood and lymphatic system disorders
HypotensionVascular disorders
SepsisInfections and infestations
Upper respiratory tract infectionInfections and infestations
Tumour lysis syndromeMetabolism and nutrition disorders
Autoimmune haemolytic anaemiaBlood and lymphatic system disorders
NeutropeniaBlood and lymphatic system disorders
InfluenzaInfections and infestations
Lung neoplasm malignantNeoplasms benign, malignant and unspecified (incl cysts and polyps)
Squamous cell carcinoma of skinNeoplasms benign, malignant and unspecified (incl cysts and polyps)
ThrombocytopeniaBlood and lymphatic system disorders
Myocardial infarctionCardiac disorders
DiarrhoeaGastrointestinal disorders
AppendicitisInfections and infestations
BronchitisInfections and infestations
PharyngitisInfections and infestations
Respiratory tract infectionInfections and infestations
SinusitisInfections and infestations
DehydrationMetabolism and nutrition disorders
HyperkalaemiaMetabolism and nutrition disorders
HyperphosphataemiaMetabolism and nutrition disorders
Other adverse events (45 terms — click to expand)

ReactionSystemBendamustine + Rituximab M…Venetoclax + Rituximab Mai…Bendamustine + Rituximab C…Venetoclax + Rituximab Re-…
NeutropeniaBlood and lymphatic system disorders
DiarrhoeaGastrointestinal disorders
NauseaGastrointestinal disorders
Upper respiratory tract infectionInfections and infestations
ThrombocytopeniaBlood and lymphatic system disorders
AnaemiaBlood and lymphatic system disorders
Infusion related reactionInjury, poisoning and procedural complications
ConstipationGastrointestinal disorders
FatigueGeneral disorders
CoughRespiratory, thoracic and mediastinal disorders
PyrexiaGeneral disorders
RashSkin and subcutaneous tissue disorders
VomitingGastrointestinal disorders
NasopharyngitisInfections and infestations
HeadacheNervous system disorders
InsomniaPsychiatric disorders
BronchitisInfections and infestations
SinusitisInfections and infestations
Decreased appetiteMetabolism and nutrition disorders
ArthralgiaMusculoskeletal and connective tissue disorders
ChillsGeneral disorders
HypertensionVascular disorders
PharyngitisInfections and infestations
Back painMusculoskeletal and connective tissue disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
Abdominal painGastrointestinal disorders
Neutrophil count decreasedInvestigations
Oral herpesInfections and infestations
Urinary tract infectionInfections and infestations
DizzinessNervous system disorders
Productive coughRespiratory, thoracic and mediastinal disorders
Lower respiratory tract infectionInfections and infestations
HyperkalaemiaMetabolism and nutrition disorders
HypokalaemiaMetabolism and nutrition disorders
Muscle spasmsMusculoskeletal and connective tissue disorders
ConjunctivitisInfections and infestations
Alanine aminotransferase increasedInvestigations
Oropharyngeal painRespiratory, thoracic and mediastinal disorders
PruritusSkin and subcutaneous tissue disorders
Oedema peripheralGeneral disorders

Most-reported serious reactions: Pneumonia, Febrile neutropenia, Pyrexia, Infusion related reaction, Anaemia, Hypotension, Sepsis, Upper respiratory tract infection.

Data from ClinicalTrials.gov NCT02005471 adverse events section.

Sponsor's own description

The purpose of this open-label, multicenter, randomized, Phase III study is to evaluate the benefit of venetoclax in combination with rituximab compared with bendamustine in combination with rituximab in participants with relapsed or refractory CLL. Participants will be randomly assigned in 1:1 ratio to receive either venetoclax + rituximab (Arm A) or bendamustine + rituximab (Arm B).

Publications & conference data

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

  1. Venetoclax-Rituximab in Relapsed or Refractory Chronic Lymphocytic Leukemia.
    Seymour JF, Kipps TJ, Eichhorst B, Hillmen P, et al · · 2018 · cited 696× · PMID 29562156 · DOI 10.1056/nejmoa1713976
  2. ABT-199 (venetoclax) and BCL-2 inhibitors in clinical development.
    Cang S, Iragavarapu C, Savooji J, Song Y, et al · · 2015 · cited 216× · PMID 26589495 · DOI 10.1186/s13045-015-0224-3
  3. Venetoclax Plus Rituximab in Relapsed Chronic Lymphocytic Leukemia: 4-Year Results and Evaluation of Impact of Genomic Complexity and Gene Mutations From the MURANO Phase III Study.
    Kater AP, Wu JQ, Kipps T, Eichhorst B, et al · · 2020 · cited 175× · PMID 32986498 · DOI 10.1200/jco.20.00948
  4. BCL-2 as therapeutic target for hematological malignancies.
    Perini GF, Ribeiro GN, Pinto Neto JV, Campos LT, et al · · 2018 · cited 153× · PMID 29747654 · DOI 10.1186/s13045-018-0608-2
  5. Enduring undetectable MRD and updated outcomes in relapsed/refractory CLL after fixed-duration venetoclax-rituximab.
    Seymour JF, Kipps TJ, Eichhorst BF, D'Rozario J, et al · · 2022 · cited 119× · PMID 35605176 · DOI 10.1182/blood.2021015014
  6. Targeting the Bcl-2 Family in B Cell Lymphoma.
    Adams CM, Clark-Garvey S, Porcu P, Eischen CM. · · 2018 · cited 112× · PMID 30671383 · DOI 10.3389/fonc.2018.00636
  7. Targeting BCL2 With BH3 Mimetics: Basic Science and Clinical Application of Venetoclax in Chronic Lymphocytic Leukemia and Related B Cell Malignancies.
    Roberts AW, Huang D. · · 2017 · cited 104× · PMID 27806433 · DOI 10.1002/cpt.553
  8. Venetoclax: evidence to date and clinical potential.
    Juárez-Salcedo LM, Desai V, Dalia S. · · 2019 · cited 83× · PMID 31645879 · DOI 10.7573/dic.212574

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