Newly Diagnosed Mixed Phenotype Acute Leukemia
Conditions
Keywords
Newly diagnosed Mixed Phenotype Acute Leukemia, Bcl-2 inhibitor (Sonrotoclax)
Brief summary
This is a prospective, open-label, single-arm, two-cohort Phase 2 clinical study designed to evaluate the efficacy and safety of Bcl-2 Inhibitor combined with azacitidine (with blinatumomab added in B/myeloid subtype) in patients with newly diagnosed mixed phenotype acute leukemia (MPAL). Eligible subjects are divided into two cohorts based on immunophenotype: Cohort A (T/Myeloid MPAL) receives Bcl-2 Inhibitor + azacitidine, and Cohort B (B/Myeloid MPAL) receives Bcl-2 Inhibitor + azacitidine + blinatumomab. The treatment cycle is 28 days, with the primary efficacy endpoint assessed after 2 cycles of induction therapy. Patients who achieve CRc will undergo allogeneic hematopoietic stem cell transplantation (allo-HSCT) following 2 to 3 cycles of consolidation therapy.The total enrollment period is 24 months, and all subjects will be followed up for at least 24 months from the first day of the first cycle (C1D1). The primary objective is to evaluate the composite complete response (CRc) rate after 2 cycles of induction therapy , and the secondary objectives include evaluating measurable residual disease (MRD) negativity rate, bridge-to-allogeneic hematopoietic stem cell transplantation (allo-HSCT) rate in first complete response (CR1), overall survival(OS),Event-Free Survival(EFS),Relapse-Free Survival(RFS) and Safety.
Interventions
DRUGBCL-2 indibitor
Sonrotoclax:40mg qd (D1), 80mg qd (D2), 160mg qd (D3), 320mg qd (D4-D21), oral; * 2 cycles.
DRUGAzacitidine (AZA)
75mg/m² qd (D1-D7), subcutaneous injection; 28-day cycle, ≥2 cycles
DRUGBlinatumomab
9μg/day (D8-D14), 28μg/day (D15-D21), continuous intravenous infusion
Sponsors
The First Affiliated Hospital of Soochow University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Two independent cohorts based on immunophenotype： Cohort A (T/Myeloid MPAL) Cohort B (B/Myeloid MPAL)
Eligibility
Sex/Gender
ALL
Age
16 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
1. Aged 16 to 70 years old 2. Newly diagnosed MPAL confirmed by the 2022 WHO/ICC classification criteria for hematopoietic and lymphoid neoplasms 3. Previously untreated; use of glucocorticoids or hydroxyurea for ≤7 days to control tumor burden before enrollment is allowed, no other systemic anti-leukemia therapy 4. ECOG performance status score 0-3 5. No severe combined heart, brain, lung, liver or kidney disease, judged by the investigator to tolerate the study regimen 6. Able to understand and voluntarily sign a written informed consent form
Exclusion criteria
1. BCR::ABL-positive MPAL patients 2. Presence of active, uncontrolled infection 3. Known uncontrolled active central nervous system leukemia (CNSL) 4. Life-threatening extramedullary disease requiring urgent radiotherapy or surgical debulking 5. Severe cardiac insufficiency with left ventricular ejection fraction (LVEF) \<40% 6. Previous receipt of systemic anti-leukemia therapy 7. Pregnant or lactating female subjects 8. Judged by the investigator to be ineligible for the study for other reasons
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Composite Complete Response (CRc) rate after 2 cycles of induction therapy | From randomization to 2 cycles of induction before consolidation therapy（100 days） | CRc = CR + CRi; CR: bone marrow blasts \<5%, no extramedullary disease, no peripheral blasts, ANC ≥1.0×10⁹/L, PLT ≥100×10⁹/L; CRi: bone marrow blasts \<5%, no extramedullary disease, no peripheral blasts, incomplete hematologic recovery (ANC \<1.0×10⁹/L or PLT \<100×10⁹/L) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| MRD negativity rate | From randomization to 2 cycles of induction before consolidation therapy（100 days） | Bone marrow MRD \<0.01% detected by MFC |
| NGS-MRD negativity rate | From randomization to 2 cycles of induction before consolidation therapy（100 days）, and test Every 3 months during follow-up | NGS-MRD can not detected by IgH/TCR NGS (NGS-based MRD will be incorporated as an exploratory complementary assay in patients with trackable clonotypic rearrangements at diagnosis) |
| CR1 bridge-to-allo-HSCT rate | Up to 6 months after enrollment | Proportion of subjects who achieve CR/CRi and successfully receive allo-HSCT within 2-3 cycles |
| Overall Survival (OS) | From the time from randomization to time for up to 2 years | Time from C1D1 to death from any cause; data censored at last follow-up for surviving subjects |
| Event-Free Survival (EFS) | From the time from randomization to time for up to 2 years | Time from C1D1 to first event (no CRc after 2 cycles, morphological/extramedullary relapse, disease progression, off-protocol anti-leukemia therapy, death from any cause); data censored at last follow-up for event-free subjects |
| Relapse-Free Survival (RFS) | From the time from randomization to time for up to 2 years | Time from first CR/CRi to relapse or death from any cause; relapse defined as bone marrow blasts ≥5%, extramedullary disease, peripheral blasts, or molecular MRD ≥10-⁴ in previously MRD-negative patients;data censored at last follow-up for relapse-free subjects |
| 100-day Non-Relapse Mortality (100-day NRM) | Up to 100 days after initial MPAL diagnosis | Proportion of deaths from non-relapse causes within 100 days of diagnosis |
| Incidence of grade ≥3 adverse events (AEs) | From treatment initiation to the end of Induction | Type, frequency and severity of grade ≥3 AEs graded by CTCAE v5.0 |
Countries
China
Contacts
CONTACTJing Lu Doctor
PRINCIPAL_INVESTIGATORSuning Chen
The First Affiliated Hospital of Soochow University Principal Investigator
Outcome results
None listed