- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06954987
Venetoclax or Placebo in Combination With Reduced-Intensity Conditioning Hematopoietic Cell (Bone Marrow/Blood Stem Cell) Transplant and as Maintenance Therapy After Transplant in Patients With Acute Myeloid Leukemia (A MyeloMATCH Treatment Trial)
A Two Cohort, Randomized, Double-Blind, Placebo-Controlled, Phase II Multi-Center Signal-Finding Study of Venetoclax Combined With Reduced-Intensity Conditioning Followed by Allogeneic Hematopoietic Cell Transplantation Then Venetoclax Maintenance in Adult Patients With Acute Myeloid Leukemia in First Complete Remission: A MyeloMATCH Sub-Study
Study Overview
Status
Conditions
Intervention / Treatment
- Drug: Venetoclax
- Drug: Fludarabine
- Procedure: Positron Emission Tomography
- Procedure: Computed Tomography
- Drug: Melphalan
- Drug: Placebo Administration
- Procedure: Multigated Acquisition Scan
- Drug: Busulfan
- Procedure: Chest Radiography
- Procedure: Bone Marrow Biopsy
- Radiation: Total-Body Irradiation
- Procedure: Echocardiography Test
- Procedure: Allogeneic Hematopoietic Stem Cell Transplantation
- Procedure: Biospecimen Collection
Detailed Description
PRIMARY OBJECTIVE:
I. To determine if venetoclax combined with reduced-intensity conditioned allogeneic hematopoietic cell transplantation improves 100-day event-free survival relative to placebo in adults with AML in first complete remission (complete remission [CR] or complete remission with incomplete hematologic recovery [CRi]).
SECONDARY OBJECTIVES:
I. To determine the post-transplant 30-day and 12-month event-free survival (EFS) rates in venetoclax and placebo arms.
II. To determine the post-transplant 12-month EFS in patients with minimal/measurable residual disease (MRD)-positive status first complete remission at transplant in venetoclax and placebo arms.
III. To determine the post-transplant 100-day and 12-month overall survival (OS) rate in venetoclax and placebo arms.
IV. To determine the post-transplant 100-day and 12-month cumulative incidence rates (CIR) of morphologic relapse in venetoclax and placebo arms.
V. To determine the post-transplant 100-day and 12-month non-relapse mortality (NRM) rates in venetoclax and placebo arms.
VI. To determine the post-transplant 12-month relapse-free survival rate (RFS), OS, cumulative incidence of relapse (CIR), and cumulative incidence of NRM from start of maintenance in venetoclax and placebo arms.
VII. To determine the post-transplant 100-day and 12-month cumulative incidence of grade 2-4 acute graft versus host disease (GVHD) and 12-month cumulative incidence of chronic GVHD.
VIII. To determine neutrophil engraftment at day 30 and platelet engraftment at days 30 and 60 post-transplant.
IX. To determine the incidence of primary and secondary graft failure within 12 months of hematopoietic stem cell transplant (HCT).
X. To assess toxicity and tolerability of the combination of reduced intensity conditioned allogeneic hematopoietic cell transplantation and venetoclax.
EXPLORATORY OBJECTIVES:
I. To determine the post-transplant 30-day MRD clearance rates in venetoclax and placebo arms.
II. To assess patterns of immune reconstitution per standard of care (SOC) site testing for venetoclax and placebo arms.
III. To assess patterns of marrow and peripheral blood chimerism per SOC site testing for venetoclax and placebo arms.
IV. To assess graft-versus-host relapse-free survival for venetoclax and placebo arms.
V. To assess clinical flow and genetic MRD concordance rate (using Myelomatch available MRD tools) and to associate MRD negativity with clinical outcomes for venetoclax and placebo arms.
VI. Compare rate of cytokine release syndrome after hematopoietic cell infusion. (Cohort 2 only)
OUTLINE: Patients with matched donors are randomized to conditioning 1A or 1B. Patients with haploidentical or mismatched unrelated donors are randomized to conditioning 2A or 2B.
CONDITIONING 1A: Patients receive venetoclax orally (PO) once daily (QD) on days -10 to -2, fludarabine intravenously (IV) on days -6 or -5 to -2 and busulfan IV on days -3 to -2 or twice daily (BID) on days -5 to -2 or melphalan IV on day -2. Patients then receive hematopoietic cell transplant IV on day 0. Treatment is given in the absence of disease progression or unacceptable toxicity.
CONDITIONING 1B: Patients receive placebo PO QD on days -10 to -2, fludarabine IV on days -6 or -5 to -2 and busulfan IV on days -3 to -2 or BID on days -5 to -2 or melphalan IV on day -2. Patients then receive hematopoietic cell transplant IV on day 0. Treatment is given in the absence of disease progression or unacceptable toxicity.
CONDITIONING 2A: Patients receive venetoclax PO QD on days -10 to -2, melphalan IV on day -6, fludarabine IV on days -5 to -2 and undergo total body irradiation once on day -1. Patients then receive hematopoietic cell transplant IV on day 0. Treatment is given in the absence of disease progression or unacceptable toxicity.
CONDITIONING 2B: Patients receive placebo PO QD on days -10 to -2, melphalan IV on day -6, fludarabine IV on days -5 to -2 and undergo total body irradiation once on day -1. Patients then receive hematopoietic cell transplant IV on day 0. Treatment is given in the absence of disease progression or unacceptable toxicity.
MAINTENANCE: All patients without evidence of relapse at day +100 are re-randomized to maintenance I or II.
MAINTENANCE I: Patients receive venetoclax PO QD on days 1-28 of each cycle. Cycles repeat every 28 days for up to 1 year post transplant (9 cycles) in the absence of disease progression or unacceptable toxicity.
MAINTENANCE II: Patients receive placebo PO QD on days 1-28 of each cycle. Cycles repeat every 28 days for up to 1 year post transplant (9 cycles) in the absence of disease progression or unacceptable toxicity.
Patients undergo chest x-ray, echocardiography or multigated acquisition scan (MUGA) during screening, and bone marrow biopsy and blood, urine and buccal swab collection throughout the study. Patients may also undergo positron emission tomography (PET) scan and/or computed tomography (CT) scan throughout the study.
After completion of study treatment, patients are followed up at 30 days, every 3 months for up to 1 year and then every 6 months for up to 10 years.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients must be registered to the Master Screening and Reassessment Protocol (MSRP) and assigned to this protocol by the MATCHBox Treatment Verification Team
- STEP 1: History of acute myeloid leukemia (AML) by World Health Organization (WHO) criteria in first complete remission with morphologic complete remission (CR) or CR with incomplete hematologic recovery (CRi) defined as less than 5% bone marrow blasts by morphology with no circulating leukemic myeloblasts and no known extramedullary disease
- STEP 1: MRD status by MDNet must have been performed
STEP 1 COHORT 1: Human leukocyte antigen (HLA)-matched donor defined as one of the following:
- Sibling donor must be a 6/6 match at HLA-A and -B (intermediate or higher resolution) and -DRB1 (at high resolution using deoxyribonucleic acid [DNA]-based typing)
- Related donor other than sibling must be an 8/8 match for HLA-A, -B, -C and -DRB1 at high resolution using DNA-based typing
- Unrelated donor must be an 8/8 match at HLA-A, -B, -C and -DRB1 at high resolution using DNA-based typing
- Age 40-75 years
- STEP 1 COHORT 1: Not recommended for a myeloablative regimen by treating investigator
STEP 1 COHORT 2: Haploidentical or HLA-mismatched unrelated donor defined as one of the following:
- Haploidentical donors: Related donor must be a haploidentical 3/6, 4/6, or 5/6 match at HLA-A and -B (intermediate or higher resolution) and -DRB1 (at high resolution using DNA-based typing)
- HLA-mismatched unrelated donors: Unrelated donor must be a 6/8 or 7/8 match at HLA-A, -B, -C and -DRB1 at high resolution using DNA-based typing, ideally age < 35
- Age 18-75 years
- STEP 1 COHORT 2: Not recommended for a myeloablative regimen by treating investigator
- STEP 1: Prior venetoclax therapy is allowed unless there is evidence of progression or no response (failure to achieve remission) to venetoclax-based regimen < 2 months prior to registration
- STEP 1: No prior allogeneic or autologous hematopoietic cell transplantation
- STEP 1: Anti-leukemic therapy must be completed more than 14 days prior to registration with the exception of venetoclax
- STEP 1: Karnofsky performance status ≥ 60
- STEP 1: Total bilirubin < 2 x upper limit of normal (ULN)
- STEP 1: Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) < 3 x upper limit of normal (ULN)
- STEP 1: Alkaline phosphatase ≤ 2.5 x upper limit of normal (ULN)
- STEP 1: Pulmonary function diffusion capacity of the lung for carbon monoxide (DLCO) (corrected for hemoglobin) ≥ 40% and forced expiratory volume (FEV1) ≥ 50%
- STEP 1: Calculated (Calc.) creatinine clearance ≥ 40 mL/min/based on the Cockcroft-Gault formula
- STEP 1: Not pregnant and not nursing, because this study involves an agent that has known genotoxic, mutagenic and teratogenic effects. Therefore, for women of childbearing potential only, a negative pregnancy test done ≤ 7 days prior to registration is required
- STEP 1: Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
- STEP 1: Patients with known HIV infection on effective anti-retroviral therapy with undetectable viral load within 6 months prior to registration are eligible for this trial
- STEP 1: For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated
- STEP 1: Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load
- STEP 1: Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association (NYHA) Functional Classification. To be eligible for this trial, patients should have ejection fraction ≥ 40% and NYHA functional status class II or better
- STEP 1: No history of liver cirrhosis
- STEP 1: No history of sinusoidal occlusion syndrome of the liver
- STEP 1: No known intolerance or allergy to any protocol-defined agents
- STEP 1: No known medical condition causing an inability to swallow oral formulations of agents
- STEP 2: Patient has completed the conditioning and transplantation regimens
- STEP 2: Patient has no evidence of AML morphologic relapse
- STEP 2: Patient does not have flow measurable/minimal residual disease by myeloMATCH central labs (MDNet) testing defined as ≥ 0.1% on day 100+ (between day 80+ and 110+) marrow
- STEP 2: Absolute neutrophil count > 1,000/mcL (confirmed by a lab draw performed on two separate occasions [> 2 days apart])
- STEP 2: Platelet count > 50,000/mcL
- STEP 2: AST (SGOT)/ALT (SGPT) < 3 x upper limit of normal (ULN)
- STEP 2: Total bilirubin < 2 mg/dL x upper limit of normal (ULN)
- STEP 2: Calc. creatinine clearance ≥ 40 mL/min/based on the Cockcroft-Gault formula
- STEP 2: Patient does not have active/current grade 3-4 acute GVHD
- STEP 2: Patient does not have evidence of grade 3 or higher sinusoidal occlusion syndrome/veno-occlusive disease of the liver as defined by European Society for Blood and Marrow Transplantation (EBMT) criteria
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Sequential Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Conditioning 1A (matched donors with venetoclax)
Patients receive venetoclax PO QD on days -10 to -2, fludarabine IV on days -6 or -5 to -2 and busulfan IV on days -3 to -2 or BID on days -5 to -2 or melphalan IV on day -2.
Patients then receive hematopoietic cell transplant IV on day 0. Treatment is given in the absence of disease progression or unacceptable toxicity.
Patients undergo chest x-ray, echocardiography or MUGA during screening, and bone marrow biopsy and blood, urine and buccal swab collection throughout the study.
Patients may also undergo PET scan and/or CT scan throughout the study.
|
Given PO
Other Names:
Given IV
Other Names:
Undergo PET scan
Other Names:
Undergo CT scan
Other Names:
Given IV
Other Names:
Undergo MUGA
Other Names:
Given IV
Other Names:
Undergo chest x-ray
Other Names:
Undergo bone marrow biopsy
Other Names:
Undergo echocardiography
Other Names:
Given IV
Other Names:
Undergo blood, urine and buccal swab collection
Other Names:
|
|
Placebo Comparator: Conditioning 1B (matched donor with placebo)
Patients receive placebo PO QD on days -10 to -2, fludarabine IV on days -6 or -5 to -2 and busulfan IV on days -3 to -2 or BID on days -5 to -2 or melphalan IV on day -2.
Patients then receive hematopoietic cell transplant IV on day 0. Treatment is given in the absence of disease progression or unacceptable toxicity.
Patients undergo chest x-ray, echocardiography or MUGA during screening, and bone marrow biopsy and blood, urine and buccal swab collection throughout the study.
Patients may also undergo PET scan and/or CT scan throughout the study.
|
Undergo PET scan
Other Names:
Undergo CT scan
Other Names:
Given IV
Other Names:
Given PO
Undergo MUGA
Other Names:
Given IV
Other Names:
Undergo chest x-ray
Other Names:
Undergo bone marrow biopsy
Other Names:
Undergo echocardiography
Other Names:
Given IV
Other Names:
Undergo blood, urine and buccal swab collection
Other Names:
|
|
Experimental: Conditioning 2A (haplo/mismatched donor with venetoclax)
Patients receive venetoclax PO QD on days -10 to -2, melphalan IV on day -6, fludarabine IV on days -5 to -2 and undergo total body irradiation once on day -1.
Patients then receive hematopoietic cell transplant IV on day 0. Treatment is given in the absence of disease progression or unacceptable toxicity.
Patients undergo chest x-ray, echocardiography or MUGA during screening, and bone marrow biopsy and blood, urine and buccal swab collection throughout the study.
Patients may also undergo PET scan and/or CT scan throughout the study.
|
Given PO
Other Names:
Given IV
Other Names:
Undergo PET scan
Other Names:
Undergo CT scan
Other Names:
Given IV
Other Names:
Undergo MUGA
Other Names:
Undergo chest x-ray
Other Names:
Undergo bone marrow biopsy
Other Names:
Undergo total body irradiation
Other Names:
Undergo echocardiography
Other Names:
Given IV
Other Names:
Undergo blood, urine and buccal swab collection
Other Names:
|
|
Placebo Comparator: Conditioning 2B (haplo/mismatched unrelated and placebo)
Patients receive placebo PO QD on days -10 to -2, melphalan IV on day -6, fludarabine IV on days -5 to -2 and undergo total body irradiation once on day -1.
Patients then receive hematopoietic cell transplant IV on day 0. Treatment is given in the absence of disease progression or unacceptable toxicity.
Patients undergo chest x-ray, echocardiography or MUGA during screening, and bone marrow biopsy and blood, urine and buccal swab collection throughout the study.
Patients may also undergo PET scan and/or CT scan throughout the study.
|
Given IV
Other Names:
Undergo PET scan
Other Names:
Undergo CT scan
Other Names:
Given IV
Other Names:
Given PO
Undergo MUGA
Other Names:
Undergo chest x-ray
Other Names:
Undergo bone marrow biopsy
Other Names:
Undergo total body irradiation
Other Names:
Undergo echocardiography
Other Names:
Given IV
Other Names:
Undergo blood, urine and buccal swab collection
Other Names:
|
|
Experimental: Maintenance I (venetoclax)
Patients receive venetoclax PO QD on days 1-28 of each cycle.
Cycles repeat every 28 days for up to 1 year post transplant (9 cycles) in the absence of disease progression or unacceptable toxicity.
Patients undergo bone marrow biopsy and blood, urine and buccal swab collection throughout the study.
Patients may also undergo PET scan and/or CT scan throughout the study.
|
Given PO
Other Names:
Undergo PET scan
Other Names:
Undergo CT scan
Other Names:
Undergo bone marrow biopsy
Other Names:
Undergo blood, urine and buccal swab collection
Other Names:
|
|
Placebo Comparator: Maintenance II (placebo)
Patients receive placebo PO QD on days 1-28 of each cycle.
Cycles repeat every 28 days for up to 1 year post transplant (9 cycles) in the absence of disease progression or unacceptable toxicity.
Patients undergo bone marrow biopsy and blood, urine and buccal swab collection throughout the study.
Patients may also undergo PET scan and/or CT scan throughout the study.
|
Undergo PET scan
Other Names:
Undergo CT scan
Other Names:
Given PO
Undergo bone marrow biopsy
Other Names:
Undergo blood, urine and buccal swab collection
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Event free survival (EFS)
Time Frame: From randomization to minimal residual disease (MRD) persistence, MRD relapse, morphologic relapse, or death from any cause, assessed up to day +100
|
MRD positivity is defined as >= 0.1% leukemic blasts by MyeloMatch flow cytometry.
Day 100 is defined as 100 days (day +100 +/- 10 days) after hematopoietic cell infusion (day 0).
The day 100 EFS rates will be compared between venetoclax versus placebo arms using a using a two-sided log-rank test.
|
From randomization to minimal residual disease (MRD) persistence, MRD relapse, morphologic relapse, or death from any cause, assessed up to day +100
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
MRD conversion rate
Time Frame: At day +30
|
Corresponding 95% binomial confidence intervals will be estimated at 30 days.
Proportions will be compared using Fisher's test or Chi-square test.
The analysis will be done within each cohort.
|
At day +30
|
|
EFS
Time Frame: From the time of randomization to relapse or death, assessed at 12 months
|
Kaplan-Meier estimates and their corresponding 95% binomial confidence intervals will be estimated at 12 months.
The analysis will be done within each cohort.
|
From the time of randomization to relapse or death, assessed at 12 months
|
|
Overall survival
Time Frame: From randomization to death from any cause, assessed up to 10 years
|
Will be estimated using the Kaplan-Meier method for each treatment.
|
From randomization to death from any cause, assessed up to 10 years
|
|
Relapse free survival
Time Frame: From randomization or re-randomization to morphologic relapse or death from any cause, assessed up to 10 years
|
Will be estimated using the Kaplan-Meier method for each treatment.
|
From randomization or re-randomization to morphologic relapse or death from any cause, assessed up to 10 years
|
|
Non relapse mortality
Time Frame: From randomization to death from any cause other than morphologic relapse, assessed up to 10 years
|
Will be estimated using the Kaplan-Meier method for each treatment.
|
From randomization to death from any cause other than morphologic relapse, assessed up to 10 years
|
|
Cumulative incidence of morphologic relapse
Time Frame: From the date of achievement of a remission until the date morphologic relapse, assessed up to 10 years
|
From the date of achievement of a remission until the date morphologic relapse, assessed up to 10 years
|
|
|
Incidence of acute graft versus host disease (GVHD)
Time Frame: From date of randomization until date of death with acute GVHD
|
Gray's test was used to assess the difference between venetoclax and placebo arms.
|
From date of randomization until date of death with acute GVHD
|
|
Incidence of chronic GVHD
Time Frame: From date of randomization until date of death with chronic GVHD
|
Gray's test was used to assess the difference between venetoclax and placebo arms.
|
From date of randomization until date of death with chronic GVHD
|
|
Time of neutrophil engraftment
Time Frame: Up to 10 years
|
Defined as the first of three successive days with absolute neutrophil count ≥ 0.5 × 10^9/L after post-transplantation nadir.
|
Up to 10 years
|
|
Time of platelet engraftment
Time Frame: Up to 10 years
|
Defined as the first of seven consecutive days with platelet count 20 × 10^9/L or higher, in the absence of platelet transfusion for preceding seven days.
|
Up to 10 years
|
|
Incidence of adverse events
Time Frame: Up to 10 years
|
Frequency and severity of adverse events and tolerability for each treatment strategy group will be summarized using descriptive statistics.
As per National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0, the term toxicity is defined as adverse events that are classified as either possibly, probably, or definitely related to study treatment.
The maximum grade for each type of toxicity will be recorded for each patient, and frequency tables will be reviewed to determine toxicity patterns.
Will also assess tolerability through assessing the number of patients who require dose modifications and/or dose delays, and the proportion of patients who go off treatment due to adverse events.
Further, toxicity and tolerability measures will be assessed by treatment course.
|
Up to 10 years
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Matthew J Wieduwilt, Alliance for Clinical Trials in Oncology
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Neoplasms
- Neoplasms by Histologic Type
- Hematologic Diseases
- Leukemia, Myeloid
- Leukemia
- Hemic and Lymphatic Diseases
- Leukemia, Myeloid, Acute
- Amino Acids, Peptides, and Proteins
- Sulfur Compounds
- Organic Chemicals
- Investigative Techniques
- Therapeutics
- Clinical Laboratory Techniques
- Diagnostic Techniques and Procedures
- Diagnosis
- Surgical Procedures, Operative
- Cytological Techniques
- Cytodiagnosis
- Hydrocarbons, Acyclic
- Hydrocarbons
- Physical Phenomena
- Transplantation
- Amino Acids
- Alkanes
- Diagnostic Techniques, Surgical
- Alcohols
- Chemistry Techniques, Analytical
- Butylene Glycols
- Glycols
- Mesylates
- Alkanesulfonates
- Alkanesulfonic Acids
- Sulfonic Acids
- Sulfur Acids
- Spectrum Analysis
- Nitrogen Mustard Compounds
- Mustard Compounds
- Hydrocarbons, Halogenated
- Electromagnetic Phenomena
- Magnetic Phenomena
- Radiotherapy
- Cell Transplantation
- Cell- and Tissue-Based Therapy
- Biological Therapy
- Phenylalanine
- Amino Acids, Aromatic
- Amino Acids, Cyclic
- Electromagnetic Radiation
- Radiation
- Radiation, Ionizing
- Melphalan
- Busulfan
- Biopsy
- Specimen Handling
- Magnetic Resonance Spectroscopy
- fludarabine
- venetoclax
- Stem Cell Transplantation
- X-Rays
- Whole-Body Irradiation
Other Study ID Numbers
- NCI-2025-03015 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
- U10CA180821 (U.S. NIH Grant/Contract)
- MM3TCT-A03 (Other Identifier: CTEP)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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