{"ok":true,"data":{"subject":{"kind":"trial","nctId":"NCT05457556","title":"Mismatched Related Donor Versus Matched Unrelated Donor Stem Cell Transplantation for Children, Adolescents, and Young Adults With Acute Leukemia or Myelodysplastic Syndrome","sponsor":"Children's Oncology Group","phases":["PHASE3"],"status":"ACTIVE_NOT_RECRUITING","indication":{"slug":"pediatric-all","name":"Childhood acute lymphoblastic leukemia"},"disease":"childhood acute lymphoblastic leukemia"},"rows":[{"n":1,"question":"Is the biology right?","flags":[{"id":"somatic_driver","label":"Somatic driver evidence","value":"no","detail":"None of IMPDH1, IMPDH2 has somatic-mutation evidence in childhood acute lymphoblastic leukemia","rule":"Open Targets has somatic-mutation evidence for the target in this cancer","source":{"label":"Open Targets: IMPDH1 in childhood acute lymphoblastic leukemia","url":"https://platform.opentargets.org/evidence/ENSG00000106348/MONDO_0000870","date":"2026-11-11T19:33:53.834Z"},"context":[]},{"id":"human_genetic","label":"Human genetic evidence","value":"no","detail":"No germline or somatic evidence for IMPDH1, IMPDH2 in childhood acute lymphoblastic leukemia","rule":"Any germline or somatic human genetic evidence for the target in this cancer, counted apart from animal-model and literature evidence","source":{"label":"Open Targets: IMPDH1 in childhood acute lymphoblastic leukemia","url":"https://platform.opentargets.org/evidence/ENSG00000106348/MONDO_0000870","date":"2026-11-11T19:33:53.834Z"},"context":[]},{"id":"pediatric_target","label":"Pediatric target","value":"no","detail":"Not on the FDA list","rule":"Target is on FDA's Pediatric Molecular Target List (relevant targets); membership alone neither requires nor waives a study","source":{"label":"FDA Pediatric Molecular Target List (Listed as February 2026 on the FDA Pediatric Oncology page; the file served is 9.7.22_the_relevant_molecular_target_list.xlsx, whose Summary of Changes sheet is headed 'SEPTEMBER 2022 UPDATE' (footnote date 2022-09-01))","url":"https://www.fda.gov/media/191157/download?attachment","date":"2026-11-11T07:05:03Z"},"context":[]},{"id":"haematologic","label":"Haematologic cancer","value":"yes","detail":"Haematologic","rule":"From the indication, or the registry conditions when no indication matches","source":{"label":"ClinicalTrials.gov NCT05457556","url":"https://clinicaltrials.gov/study/NCT05457556","date":"2026-11-11T19:33:53.834Z"},"context":[{"figure":"Likelihood of approval from phase 1: 7.5% haematologic vs 4.6% solid","dataset":"BIO / Informa / QLS 2021","years":"2011–2020","caveat":"Population-level, not a prediction."}]}],"facts":[{"label":"Background therapy","text":"Cyclophosphamide, Fludarabine, Methotrexate, Rituximab: standard agents, not counted in these flags."},{"label":"IMPDH1 (via Mycophenolate Mofetil)","text":"Open Targets has no association between IMPDH1 and childhood acute lymphoblastic leukemia.","source":{"label":"Open Targets: IMPDH1 in childhood acute lymphoblastic leukemia","url":"https://platform.opentargets.org/evidence/ENSG00000106348/MONDO_0000870","date":"2026-11-11T19:33:53.834Z"}},{"label":"IMPDH2 (via Mycophenolate Mofetil)","text":"Open Targets has no association between IMPDH2 and childhood acute lymphoblastic leukemia.","source":{"label":"Open Targets: IMPDH2 in childhood acute lymphoblastic leukemia","url":"https://platform.opentargets.org/evidence/ENSG00000178035/MONDO_0000870","date":"2026-11-11T19:33:53.834Z"}}],"pending":[{"what":"Normal-tissue expression in vital organs","source":"Human Protein Atlas (ticket 36)"},{"what":"Pan-essential in cell lines","source":"DepMap (ticket 36)"},{"what":"Approved drug on this target","source":"Drugs@FDA (ticket 30)"}]},{"n":2,"question":"Can the result be trusted?","flags":[{"id":"randomised","label":"Randomised","value":"yes","detail":"Randomised allocation","rule":"Registry allocation field","source":{"label":"ClinicalTrials.gov NCT05457556","url":"https://clinicaltrials.gov/study/NCT05457556","date":"2026-11-11T19:33:53.834Z"},"context":[]},{"id":"small_denominator","label":"Small denominator","value":"no","detail":"66 enrolled; each patient moves a rate by 100 ÷ 66 = 1.5 points","rule":"Enrolment under 30; the arithmetic is shown, not a benchmark","source":{"label":"ClinicalTrials.gov NCT05457556","url":"https://clinicaltrials.gov/study/NCT05457556","date":"2026-11-11T19:33:53.834Z"},"context":[]},{"id":"primary_os","label":"Primary endpoint is overall survival","value":"no","detail":"Severe GVHD (Grade III-IV acute GVHD or chronic GVHD requiring systemic immunosuppressive therapy); Disease free survival (DFS) (where an event is the occurrence of death from any cause or relapse)","rule":"A registered primary outcome measure names overall survival","source":{"label":"ClinicalTrials.gov NCT05457556","url":"https://clinicaltrials.gov/study/NCT05457556","date":"2026-11-11T19:33:53.834Z"},"context":[{"figure":"Non-OS primary endpoint: odds ratio 2.79 for a positive phase 3","dataset":"Otsuka 2021, 400 phase 3 oncology trials","years":"to 2020","caveat":"Shown with the next figure: a surrogate is easier to hit, and often a weak guide to survival."},{"figure":"52% of surrogate-to-OS correlations are low","dataset":"Prasad 2015","years":"published to 2014","caveat":"Shown with the figure above."}]},{"id":"results_overdue","label":"Results overdue","value":"no","detail":"Primary completion 2026-06-30, 4 months ago; within 12 months","rule":"Primary completion (actual) more than 12 months ago and no results posted to the registry","source":{"label":"ClinicalTrials.gov NCT05457556","url":"https://clinicaltrials.gov/study/NCT05457556","date":"2026-11-11T19:33:53.834Z"},"context":[]}],"facts":[],"pending":[{"what":"Treated and evaluable counts, assessor, confirmed response, follow-up and data cutoff","source":"Readout extraction (ticket 32)"},{"what":"Primary endpoint changed between registry versions","source":"Registry versions in the store (ticket 32)"}]},{"n":3,"question":"What must it beat?","flags":[],"facts":[],"pending":[{"what":"Control-arm result and approved therapies for the same segment, with label links","source":"Drugs@FDA, FDA labels and readouts (tickets 30, 32)"}]},{"n":4,"question":"Too crowded, or too late?","flags":[],"facts":[{"label":"Stopped on this target","text":"241 terminated, withdrawn or suspended trials of drugs against IMPDH1; 15 of the 200 most recent give no reason. Reasons are quoted as the registry gives them on the target page.","source":{"label":"IMPDH1: what already stopped","url":"/target/ENSG00000106348#stopped","date":"2026-11-11T19:33:53.884Z"}}],"pending":[{"what":"Programs on the target by phase and months behind the leader","source":"Programs and Drugs@FDA (ticket 33)"}]},{"n":5,"question":"Can it be approved, and stay approved?","flags":[{"id":"single_country","label":"Single-country","value":"no","detail":"63 sites in 3 countries; 57 in the United States (90%)","rule":"All listed sites are in one country; the share of US sites is shown","source":{"label":"ClinicalTrials.gov NCT05457556","url":"https://clinicaltrials.gov/study/NCT05457556?tab=locations","date":"2026-11-11T19:33:53.834Z"},"context":[]},{"id":"eu_pip","label":"EU paediatric investigation plan","value":"no","detail":"No EMA paediatric investigation plan decision names Busulfan, Lapine T-Lymphocyte Immune Globulin, Melphalan, Mycophenolate Mofetil","rule":"An EMA PIP decision (agreement, modification or waiver) lists the drug as its active substance, exact name","source":{"label":"EMA data download (dated snapshot)","url":"https://www.ema.europa.eu/en/documents/report/medicines-output-paediatric_investigation_plans-output-json-report_en.json","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"eu_orphan","label":"EU orphan designation","value":"yes","detail":"EU/3/00/011 expired 30 Dec 2000: Conditioning treatment prior to haematopoietic-progenitor-cell transplantation","rule":"An EU orphan designation lists the drug as its active substance (exact name) or belongs to a medicine that does; withdrawn and expired designations are listed with their status","source":{"label":"EMA EU/3/00/011","url":"https://www.ema.europa.eu/en/medicines/human/orphan-designations/eu-3-00-011","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"eu_authorised","label":"Authorised in the EU","value":"yes","detail":"CellCept: authorised since 14 Feb 1996; Mycophenolate mofetil Teva: authorised since 21 Feb 2008; Myfenax: authorised since 21 Feb 2008; Myclausen: authorised since 7 Oct 2010; +3 more","rule":"An EMA medicine record lists the drug as its active substance or INN, exact name; national-only authorisations are not in this file","source":{"label":"EMA data download (dated snapshot)","url":"https://www.ema.europa.eu/en/documents/report/medicines-output-medicines_json-report_en.json","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"fda_orphan","label":"FDA orphan designation","value":"not published","detail":"FDA's orphan designation database turns away automated requests, so this app does not read it; search it by hand at the link","rule":"Would be: an FDA orphan designation names the drug","source":{"label":"FDA orphan designations search","url":"https://www.accessdata.fda.gov/scripts/opdlisting/oopd/","date":""},"context":[]},{"id":"fda_ped_approval","label":"FDA pediatric oncology approval","value":"yes","detail":"Busulfan [Busulfex], 13 Jan 2003: For use in combination with cyclophosphamide as a conditioning regimen prior to allogeneic hematopoietic progenitor cell transplantation for chronic myelogenous leukemia","rule":"FDA's Pediatric Oncology Drug Approvals table names the drug","source":{"label":"FDA Pediatric Oncology Drug Approvals (content current as of 2026-03-03)","url":"https://www.fda.gov/about-fda/oncology-center-excellence/pediatric-oncology-drug-approvals","date":"2026-11-11T19:33:53.926Z"},"context":[]},{"id":"studies_under_18","label":"Registered studies open to children","value":"yes","detail":"1038 interventional studies of Busulfan, Lapine T-Lymphocyte Immune Globulin, Melphalan, Mycophenolate Mofetil include patients under 18; 177 are recruiting, not yet recruiting or active","rule":"The registry's age group includes Child (birth to 17 years), which also counts studies that set no minimum age","source":{"label":"ClinicalTrials.gov search","url":"https://clinicaltrials.gov/search?intr=%22Busulfan%22+OR+%22Lapine+T-Lymphocyte+Immune+Globulin%22+OR+%22Melphalan%22+OR+%22Mycophenolate+Mofetil%22&aggFilters=ages%3Achild%2CstudyType%3Aint","date":"2026-11-11T19:33:53.937Z"},"context":[]}],"facts":[{"label":"Caveat","text":"Site counts are not patients per country, and trials registered only outside ClinicalTrials.gov are not covered. Where the sites are is a fact about the record, not a judgement of its quality."},{"label":"Rare pediatric disease voucher","text":"FDA, content current as of 29 Apr 2026: “As of February 3, 2026, enactment of the Consolidated Appropriations Act, 2026, the rare pediatric disease PRV program will sunset after September 30, 2029. FDA may not award any PRVs under this program after September 30, 2029.” Voucher sale prices are not shown here; they appear only as company-reported news.","source":{"label":"FDA: Rare Pediatric Disease Designation and Priority Review Voucher Programs","url":"https://www.fda.gov/industry/medical-products-rare-diseases-and-conditions/rare-pediatric-disease-designation-and-priority-review-voucher-programs","date":"2026-11-11"}}],"pending":[{"what":"Precedent approvals for target, modality and endpoint; accelerated-approval status","source":"Drugs@FDA and FDA accelerated-approval tables (ticket 30)"}]},{"n":6,"question":"Can the sponsor finish?","flags":[],"facts":[{"label":"Sponsor","text":"Children's Oncology Group (academic or other)","source":{"label":"ClinicalTrials.gov NCT05457556","url":"https://clinicaltrials.gov/study/NCT05457556","date":"2026-11-11T19:33:53.834Z"}},{"label":"principal investigator","text":"Heather J Symons, Children's Oncology Group","source":{"label":"Person page","url":"/person/Heather%20J%20Symons?ind=pediatric-all","date":"2026-11-11T19:33:53.834Z"}}],"pending":[{"what":"Filed cash, quarterly spend and the runway arithmetic","source":"SEC XBRL company facts (ticket 37)"},{"what":"Sponsor's completed vs stopped oncology trials and results-reporting record","source":"Registry, by company (ticket 37)"}]}],"limits":"Public records cannot show: sales forecasts; a probability of success for this asset; full deal terms and net prices; FDA designations and action dates before approval (shown only as company-reported); clinical holds unless the company disclosed them; manufacturing; patents on unapproved drugs; whether preclinical findings have been replicated.","sources":[{"label":"ClinicalTrials.gov NCT05457556","url":"https://clinicaltrials.gov/study/NCT05457556","date":"2026-11-11T19:33:53.834Z"},{"label":"Open Targets Platform","url":"https://platform.opentargets.org","date":"2026-11-11T19:33:53.834Z"},{"label":"FDA Pediatric Molecular Target List (Listed as February 2026 on the FDA Pediatric Oncology page; the file served is 9.7.22_the_relevant_molecular_target_list.xlsx, whose Summary of Changes sheet is headed 'SEPTEMBER 2022 UPDATE' (footnote date 2022-09-01))","url":"https://www.fda.gov/media/191157/download?attachment","date":"2026-11-11T07:05:03Z"}]},"source":"ClinicalTrials.gov + Open Targets","fetchedAt":"2026-11-11T19:33:53.826Z"}