A Study of Azacitidine and Venetoclax Versus a Stem Cell Transplant in People 65 Years and Older With Acute Myeloid Leukemia

Memorial Sloan Kettering Cancer Center (MSK)

Status and phase

Enrolling

Phase 2

Conditions

Acute Myeloid Leukemia

Treatments

Drug: Venetoclax

Drug: Azacitidine (AZA)

Procedure: Allogeneic hematopoietic stem cell transplantation

Study type

Interventional

Funder types

Other

Industry

Identifiers

NCT06903702

25-063

Details and patient eligibility

About

The researchers are doing this study to find out if an allogeneic hematopoietic stem cell transplant (HSCT) or maintenance therapy with azacitidine and venetoclax is more effective at keeping AML from coming back (relapsing).

Enrollment

100 estimated patients

Sex

All

Ages

65+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Adult patients ≥65 years of age at the time of signing the informed consent form.
Confirmed diagnosis of acute myeloid leukemia according to the ELN 2017 criteria
Treatment with azacitidine and venetoclax for the diagnosis of AML

o The first cycle of study treatment will start 28-42 days after the start of the second cycle of SOC AZA/VEN. In the event that patients can't be admitted for allo-HCT until after Day 42 due to donor related issues, an additional cycle of AZA/VEN will be allowed as a bridge to the transplant, and then initiation of conditioning will start no later than day 42 after the start of the third cycle.
Patients with adequate organ function to be considered as candidates for allo-HCT:
- Cardiac: asymptomatic or if symptomatic, then LVEF at rest must be >40% and must improve with exercise.
- Renal: CrCl ≥50 ml/min (measured or calculated/estimated).
- Pulmonary: asymptomatic or if symptomatic, DLCO > 50% of predicted (corrected for hemoglobin)
- Hepatic: < 5x ULN liver function tests and < 2x ULN total serum bilirubin, unless there is congenital benign hyperbilirubinemia.
- KPS of ≥ 70
Patients with suitable donor for allo-HCT
Patients must achieve a morphologic remission <5% blast with MRD negative status by flow cytometry (defined as one or less residual leukemic blasts per 1000 leukocytes (or 10^3)) meeting one of the below:
- Complete remission (CR) defined as: <5% blasts with ANC> 1000 AND Plt >100K
- CRh defined as <5% blasts with ANC > 500 AND Plt >50K
- CRi defined as <5% blasts with ANC< 1000 OR Plt < 100K
Subject is willing and able to adhere to the study visit schedule and other protocol requirements.

Exclusion criteria

Patients who are not considered to be transplant eligible (either due to lack of suitable donor or due to comorbidities/performance status). The reason the patient is not considered transplant eligible will be documented in the eCRF.
History of prior allo-HCT
Patients who underwent prior leukemia directed treatment (other than aza/ven)
Patients with CNS involvement at any time point prior to enrollment.
Patients with previous exposure to venetoclax or an HMA for the treatment of a myeloid malignancy
Patients who are planned for treatment other than AZA/VEN
Patients who are planned for treatment with HMA/VEN with another agent (e.g. a "triplet")
Presence of any other condition that may increase the risk associated with study participation, and in the opinion of the investigator, would make the patient inappropriate for entry into the study.

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

100 participants in 2 patient groups

maintenance arm Azacitidine and Venetoclax (AZA/VEN)

Experimental group

Description:

Patients randomized to the maintenance arm (AZA/VEN) will be treated with azacitidine given daily for 7 days starting on Day 1 of each Cycle (7 consecutive days or a total of 7 days with a 2 day break due to weekends or holidays is permissible). Venetoclax will be taken orally daily for 28 days. A cycle will be considered 28 days.

Treatment: