ALL, Adult, Philadelphia-Positive Acute Lymphoblastic Leukemia, Precursor Cell Lymphoblastic Leukemia-Lymphoma
Conditions
Keywords
Philadelphia-Positive, Adult Acute Lymphoblastic Leukemia, Allogeneic Hematopoietic Stem Cell Transplantation, Tyrosine Kinase Inhibitors
Brief summary
This project is a key clinical research project approved by the Clinical Research Center of the First Affiliated Hospital of Xi 'an Jiaotong University.Tyrosine kinase inhibitors (TKI) combined with chemotherapy and subsequent allogeneic hematopoietic stem cell transplantation (allo-HSCT) are routinely used in patients with philadelpha-positive lymphoblastic leukemia (Ph+ALL). However, TKI maintenance therapy post-HSCT remains controversial. In this study, Ph+ALL patients are enrolled and given dasatinib combined with chemotherapy followed by allo-HSCT. Then patients in the group A continuing to use dasatinib for 1 year is compared with those in the group B receiving dasatinib for 6 months after HSCT. The measurable residual disease (MRD), complete remission (CR), overall survival (OS), disease free survival (DFS), non-relapse mortality (NRM) and the incidence of graft versus host disease (GVHD) will be observed to determine the optimal duration of TKI maintenance therapy post-HSCT.
Detailed description
About 25% of adult patients with acute lymphoblastic leukemia (ALL) are associated with t (9; 22), positive philadelphia chromosome (Ph+ ALL), in whom BCR/ABL fusion gene can be detected in the bone marrow and peripheral blood. Although current treatment strategies using tyrosine kinase inhibitors (TKIs) such as dasatinib combined with chemotherapy have achieved high complete remission (CR) rates, the duration of remission is short, and most Ph+ ALL patients relapse within 2 years. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) bridging to CR remains the only strategy to cure Ph+ ALL. However, TKI maintenance therapy post-HSCT remains controversial. In this study, Ph+ALL patients are enrolled. The participants will receive dasatinib combined with induction and consolidation chemotherapy to obtain molecular remission and then undergo allo-HSCT. After the above treatments, the patients will be randomly divided into two groups. The subjects in the group A will continue to use dasatinib for 1 year, while the patients in the group B receive dasatinib for 6 months post-HSCT. The measurable residual disease (MRD), CR, overall survival (OS), disease free survival (DFS), non-relapse mortality (NRM) and the incidence of graft versus host disease (GVHD) will be observed to determine the optimal duration of TKI maintenance therapy post-HSCT.
Interventions
DRUGDasatinib
Take Dasatinib orally for 1 year or 6 months post-HSCT.
Sponsors
First Affiliated Hospital Xi'an Jiaotong University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* 18-65 years old, newly diagnosed as Ph+ALL. * Sign the informed consent. * Have appropriate allo-HSCT donors. * Accept allo-HSCT. * Accept follow-up.
Exclusion criteria
* Liver and kidney function impairment: serum transaminase \> 2 times of the upper limit of normal value, total bilirubin \> 1.5 times of the upper limit of normal value, serum inosine \> the upper limit of normal value (97 umol/L). * Active hepatitis B, hepatitis C or tuberculosis infection. * Can not tolerate the adverse effects of dasatinib. * Pregnancy. * Diagnosis of mental disorders. * Failed to reach molecular complete remission (MCR) after the early treatment. * Do not accept follow-up.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Patients with Measurable Residual Disease (MRD) Positivity | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 36 months. | MRD means the subclinical levels of residual leukemia. |
| Percentage of Patients with Complete Remission (CR) | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 36 months. | CR means that the blood counts have returned to normal, the leukemia cannot be seen when a bone marrow sample is examined under the microscope, and the signs and symptoms of the ALL are gone. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Non-relapse Mortality (NRM), rate or percentage | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 36 months. | NRM means death without recurrent or progressive disease after allo-HSCT. |
| Disease-free Survival (DFS), months | From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 36 months. | The measure of time after allo-HSCT during which no sign of ALL is found. |
| Adverse Effects (AE) | From date of randomization until the date of death from any cause, whichever came first, assessed up to 36 months. | An adverse effect is any untoward medical occurrence in clinical investigation subject administered dasatinib and which does not necessarily have a causal relationship with this treatment. |
| Incidence of graft versus host disease (GVHD), rate or percentage | From date of randomization until the date of GVHD occurrence or date of death from any cause, whichever came first, assessed up to 36 months. | GVHD is a condition that might occur after allo-HSCT. In GVHD, the donated bone marrow or peripheral blood stem cells view the recipient's body as foreign, and the donated cells/bone marrow attack the body. |
| Overall Survival (OS), months | From date of randomization until the date of death from any cause, whichever came first, assessed up to 36 months. | The length of time from the date of allo-HSCT that Ph+ ALL patients are still alive. |
Countries
China
Contacts
Primary ContactPengcheng He
Backup ContactXiaoyan Zheng
Outcome results
None listed