Tranexamic Acid Use to Reduce Blood Transfusion in Pediatric Cancer Patients Undergoing Limb Salvage Procedure

NCT ID: NCT04410042

Last Updated: 2024-12-20

Basic Information

• Recruitment Status: TERMINATED
• Clinical Phase: PHASE3
• Total Enrollment: 15 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-01-29
• Study Completion Date: 2024-01-16

Brief Summary

This is a randomized double-blind control trial evaluating the use Tranexamic acid (TXA) to decrease blood loss and transfusion requirements in pediatric and young adult cancer patients undergoing a limb salvage procedure that frequently requires perioperative or post-operative transfusions of blood products.

Primary Objective

• To evaluate the difference in intra-or post-operatively transfused blood volume (mL/kg) for patients undergoing limb salvage procedures of the distal femur or proximal tibia who are randomized to receive perioperative tranexamic acid (TXA) versus placebo.

Secondary Objectives

• To evaluate changes in platelets and in hemoglobin from pre-op to post-op level for patients randomized to receive perioperative TXA versus placebo.
• To evaluate differences in post-operative daily surgical drain output for patients randomized to receive perioperative TXA versus placebo.
• To evaluate changes in estimated blood loss (EBL) for patients randomized to receive perioperative TXA versus placebo.
• To evaluate the association between the intra-or post-operatively transfused blood volume and estimated blood loss (EBL) for patients randomized to receive perioperative TXA and placebo, respectively.

Exploratory Objectives

• To evaluate differences in functional outcomes post-operatively for patients randomized to receive perioperative TXA versus placebo.
• To explore if significant correlations are observed between parameters reported with rotational thromboelastometry (ROTEM®) and EBL and transfusion requirements in pediatric and young adult patients undergoing limb salvage procedure who are randomized to perioperative TXA versus placebo.
• To evaluate differences in the prevalence and management of wound complications such as superficial or periprosthetic infections, wound dehiscence, contact dermatitis, post- operative hematomas, or any other clinically significant wound complication between patients randomized to receive perioperative TXA versus placebo.

Detailed Description

Eligible participants undergoing limb salvage procedures will be randomized to receive either tranexamic acid (TXA) or placebo peri-operatively.

The initial dose of tranexamic acid/placebo will be given at the initiation of surgical preparation. The second dose will be given 6 hours after the first dose (either intraoperatively or post-operatively). All doses will be given intravenously. Doses will be double blinded and randomized for each surgical procedure.

Conditions

Cancer of the Bone; Limb Salvage

Keywords

Blood Transfusion; Cancer of the bone; Distal femur; Limb Salvage; Malignant Bone Tumor; Placebo; Proximal tibia; Randomized; Tranexamic acid; TXA

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: SUPPORTIVE_CARE
• Blinding Strategy: TRIPLE

Study Groups

Tranexamic Acid

At initiation of surgical preparation, participants randomized to the active treatment arm will receive tranexamic acid 10 mg/kg (max 1 g), given via syringe pump programmed to infuse over 15 minutes. If no unacceptable toxicities occur, a second dose of tranexamic acid IV push over 5 to 15 minutes will be given 6 hours (with a window of +/- 30 minutes) after the first dose (either intra- or post-operatively).

Group Type: EXPERIMENTAL

Tranexamic Acid

Intervention Type: DRUG

Given IV

Placebo

At initiation of surgical preparation, participants randomized to the placebo treatment arm will receive 0.9% sodium chloride (salt water). It will be matched in appearance, volume, and administration to the active treatment arm with tranexamic acid. If no unacceptable toxicities occur, a second dose of placebo IV push over 5 to 15 minutes will be given 6 hours (with a window of +/- 30 minutes) after the first dose (either intra- or post-operatively).

Group Type: PLACEBO_COMPARATOR

0.9% sodium chloride

Intervention Type: OTHER

Given IV

Interventions

Tranexamic Acid

Given IV

Intervention Type: DRUG

0.9% sodium chloride

Given IV

Intervention Type: OTHER

Other Intervention Names

Cyklokapron®; Salt water

Eligibility Criteria

Inclusion Criteria

• Participant undergoing limb salvage procedure of malignant bone tumor of the distal femur or proximal tibia, which typically requires blood transfusions.
• Patient under the age of 25
• Adequate bone marrow function defined as:

• Upward trending peripheral absolute neutrophil count (ANC)
• Platelet count ≥ 100,000/mm^3 (transfusion independent defined as no platelets required for 4 days)
• Hemoglobin ≥ 8.0 g/dL
• No RBC transfusion within 24 hours
• Adequate renal function defined as:

• Creatinine clearance or radioisotope GFR ≥ 70 mL/min/1.73m^2 OR
• Maximum serum creatinine based on age/gender as follows: Age 1 day to < 1 years: maximum serum creatinine (mg/dL) 0.6 for males and 0.5 for females; Age 1 to < 2 years: maximum serum creatinine (mg/dL) 0.6 for males and 0.6 for females; Age 2 to < 6 years: maximum serum creatinine (mg/dL) 0.8 for males and 0.8 for females; Age 6 to < 10 years: maximum serum creatinine (mg/dL) 1.0 for males and 1.0 for females; Age 10 to < 13 years: maximum serum creatinine (mg/dL) 1.2 for males and 1.2 for females; Age 13 to < 16 years: maximum serum creatinine (mg/dL) 1.5 for males and 1.4 for females; Age ≥ 16 years: maximum serum creatinine (mg/dL) 1.7 for males and 1.4 for females
• Adequate liver function defined as:

• Total bilirubin ≤ 1.5x the institutional upper limit of normal (IULN) for age
• ALT (SGPT) and AST (SGOT) ≤ 2.5x IULN for age (or <5x IULN for patients with documented disease involving the liver or 10x IULN for patients receiving HDMTX)
• Serum albumin > 2 g/dL
• Adequate coagulation function as defined by International Normalized Ratio (INR) ≤ 1.5
• Female participants of child-bearing potential (>10 years old) must have a negative serum or urine pregnancy test within 72 hours of sedation

Exclusion Criteria

• Participants whose limb salvage procedure may require significant manipulation of major blood vessels.
• Participants with known bone marrow deficiency resulting in red blood cell deficiency (e.g. Diamond-Blackfan anemia)
• Participants receiving erythropoietin-stimulating agents (e.g. epoetin alfa)
• Participants with active hemorrhagic cystitis (e.g. alkylator-induced) with gross hematuria or >50 RBCs per high powered field on urinalysis
• Participants actively receiving all-trans retinoic acid (ATRA) or isotretinoin (Accutane)
• Participants with known allergies to antifibrinolytics
• Participants with known hypercoagulopathies
• Personal history of a thrombosis or active thrombus
• Participants currently on anticoagulation medications (e.g. warfarin, enoxaparin)
• Participants with a history of seizures. Patients with a history of febrile seizure are eligible.
• Persisting toxicity related to other systemic therapies (e.g. chemotherapy) which constitutes an unacceptable safety risk based on the judgment of the PI and/or the primary treating physician.
• Female participants who are currently pregnant or actively breastfeeding.
• Female participants who are currently receiving estrogen-based contraception therapy.
• Inability or unwillingness of research participant or legal guardian/representative to give written informed consent.
• Participants enrolled in another clinical trial utilizing an IND/IDE experimental therapy.
• Participants with a history of CNS disease.
• Participants with known bleeding disorder.
• Participants with known platelet dysfunction.

• Maximum Eligible Age: 24 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

St. Jude Children's Research Hospital

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Michael D. Neel, MD

Role: PRINCIPAL_INVESTIGATOR

St. Jude Children's Research Hospital

Locations

St. Jude Children's Research Hospital

Memphis, Tennessee, United States

Countries

United States

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Related Links

http://www.stjude.org

St. Jude Children's Research Hospital

http://www.stjude.org/protocols

ClinicalTrials Open at St. Jude

Other Identifiers

NCI-2020-02984

Identifier Type: REGISTRY

Identifier Source: secondary_id

TXAKIDS

Identifier Type: -

Identifier Source: org_study_id