B-Cell Acute Lymphoblastic Leukemia, Adult
Conditions
Keywords
Philadelphia chromosome-negative;, B-cell Acute Lymphoblastic Leukemia, Blinatumomab, Venetoclax, Allogeneic Hematopoietic Stem Cell Transplantation, maintenance therapy
Brief summary
This study is a single-center, single-arm, prospective clinical trial evaluating the efficacy and safety of blinatumomab combined with venetoclax as maintenance therapy for high-risk Philadelphia chromosome-negative acute B-cell lymphoblastic leukemia (B-ALL) after allogeneic hematopoietic stem cell transplantation .
Detailed description
This study focuses on high-risk Philadelphia chromosome-negative (Ph-) acute B-cell lymphoblastic leukemia (B-ALL) patients. The primary objective is to evaluate the efficacy of blinatumomab combined with venetoclax as maintenance therapy following allogeneic hematopoietic stem cell transplantation (allo-HSCT) in these patients, while the secondary objective is to assess its safety. The primary endpoint is the 2-year progression-free survival (PFS) rate post-transplantation. Secondary endpoints include the 2-year cumulative relapse rate, 2-year overall survival (OS), incidence of acute graft-versus-host disease (GVHD) within 180 days post-transplant, cumulative incidence of chronic GVHD, graft-versus-host disease-free and relapse-free survival (GRFS), non-relapse mortality (NRM), and the incidence of treatment-emergent adverse events (TEAEs) (defined as occurring from the start of maintenance therapy to 3 months after completion). Safety assessments include the incidence of adverse events and serious adverse events during treatment.
Interventions
DRUGblinatumomab combined with venetoclax as maintenance therapy
blinatumomab combined with venetoclax as maintenance therapy for high-risk Philadelphia chromosome-negative acute B-cell lymphoblastic leukemia (B-ALL) after allogeneic hematopoietic stem cell transplantation
Sponsors
Zhejiang University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
14 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Demographics : Patients aged 14-65 years, regardless of gender or race. * Diagnosis : Confirmed Ph-negative acute B-cell lymphoblastic leukemia (Ph- B-ALL) through bone marrow cytomorphology, cytochemistry, immunophenotyping, chromosomal analysis, and genetic mutation testing, with CD19 surface antigen expression. * Risk Stratification : High-risk B-ALL (per NCCN 2024.V2 guidelines) or Standard-risk B-ALL with no pre-transplant remission or Standard-risk B-ALL in first complete remission (CR1) with measurable residual disease (MRD) positivity or Standard-risk B-ALL with ≥CR2 or B-ALL patients receiving reduced-intensity or non-myeloablative conditioning. * Transplant Eligibility : Scheduled for allogeneic hematopoietic stem cell transplantation (allo-HSCT) with a suitable donor meeting: HLA-identical sibling donor or Unrelated donor (HLA 9-10/10 high-resolution matched) or Haploidentical related donor. * HCT-CI Score : ≤2 (Hematopoietic Cell Transplantation-Specific Comorbidity Index). * ECOG Performance Status : ≤2. * Organ Function : Serum creatinine ≤1.5×ULN Cardiac ejection fraction ≥50% Baseline SpO₂ \>92% Total bilirubin ≤1.5×ULN; ALT/AST ≤2.0×ULN Pulmonary DLCO (hemoglobin-adjusted) ≥40% and FEV1 ≥50% * Post-Transplant Recovery : Full donor chimerism Platelet count \>50×10⁹/L Absolute neutrophil count \>1.0×10⁹/L Hemoglobin \>80g/L - Informed Consent : Patient and legal guardian must provide written informed consent, comply with treatment protocols, follow-up visits, and laboratory assessments.
Exclusion criteria
* Prior Malignancy : History of malignancy other than acute lymphoblastic leukemia within 5 years, except for adequately treated cervical carcinoma in situ, basal or squamous cell skin cancer, localized prostate cancer post-radical resection, or ductal carcinoma in situ post-resection. * MRD-Negative B-ALL : Standard-risk B-ALL with MRD-negative status pre-transplant (per NCCN 2024.V2). * Disease Activity : Relapse of primary disease or CR/MRD positivity (≥0.01%) confirmed by bone marrow re-evaluation within 1 week before maintenance therapy. * T-Cell Deficiency : Absolute CD3+ T-cell count ≤0.5×10⁹/L prior to maintenance therapy. * Active GVHD : Concurrent acute/chronic GVHD requiring systemic immunosuppressive treatment. * Unstable Systemic Diseases : Including but not limited to: * Unstable angina or cerebrovascular accident/transient ischemic attack (within 3 months) * Myocardial infarction (within 3 months) * Congestive heart failure (NYHA Class ≥ III) * Post-pacemaker implantation with severe arrhythmia requiring medication * Uncontrolled hepatic/renal/metabolic diseases * Pulmonary hypertension * Active Infection : Uncontrolled infections requiring intravenous antibiotics. HIV : Positive human immunodeficiency virus status. Hepatitis : Active HBV/HCV requiring antiviral therapy. * Psychiatric Conditions : Mental disorders or inability to provide informed consent. * Substance Abuse : Drug addiction or chronic alcoholism affecting trial evaluation. * Reproductive Status : Pregnant/breastfeeding females Fertile patients unwilling to use contraception during treatment and 12 months post-treatment \- Other : Conditions deemed inappropriate by investigators.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the 2-year progression-free survival (PFS) rate post-transplantation | the 2-year progression-free survival (PFS) rate post-transplantation | evaluate the 2-year progression-free survival (PFS) rate post-transplantation of blinatumomab combined with venetoclax as maintenance therapy following allogeneic hematopoietic stem cell transplantation (allo-HSCT) in these patients |
Secondary
| Measure | Time frame |
|---|---|
| the 2-year cumulative relapse rate | 2 year after allogeneic hematopoietic stem cell transplantation (allo-HSCT) |
| 2-year overall survival (OS) | 2 year after allogeneic hematopoietic stem cell transplantation (allo-HSCT) |
Countries
China
Outcome results
None listed