This phase I/II trial finds the best dose, side effects and how well giving venetoclax in combination with cladribine, cytarabine, granulocyte colony-stimulating factor, and mitoxantrone (CLAG-M) in treating patients with acute myeloid leukemia and high-grade myeloid neoplasms. Venetoclax may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cancer cell survival. Chemotherapy drugs, such as cladribine, cytarabine, and mitoxantrone, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving venetoclax with CLAG-M may kill more cancer cells.
OUTLINE: This is a dose-escalation study of venetoclax. Patients will receive induction with granulocyte colony-stimulating factor subcutaneously (SC) on days 0-5 (if peripheral white blood cell count is less than 20,000/uL), cladribine intravenously (IV) on days 1-5, cytarabine IV on days 1-5, and mitoxantrone IV on days 1-3. Patients also receive venetoclax orally (PO) on days 1-14. Treatment repeats every 28-35 days for up to 2 induction cycles including mitoxantrone, and up to 4 consolidation cycles without mitoxantrone in the absence of disease progression or unacceptable toxicity. Patients undergo bone marrow biopsy and/or aspiration, and blood sample collection throughout the study. After completion of study treatment, patients are followed up every 3 months for 12 months.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
62
Given IV
Given IV
Given IV
Given subcutaneously
Given PO
Undergo bone marrow aspiration
Undergo bone marrow biopsy
Undergo blood sample collection
Fred Hutch/University of Washington Cancer Consortium
Seattle, Washington, United States
RECRUITINGIncidence of adverse events (Phase I)
Time frame: Up to 12 months
Maximum tolerated dose of venetoclax in combination with CLAG-M (Phase I)
Time frame: Up to 12 months
Event free survival (Phase II)
Time frame: At 6 months
Complete remission rate
Time frame: After 2 cycles (each cycle is approximately 35 days)
Rate of minimal residual disease negativity
Time frame: Up to 1 year
Rate of allogeneic hematopoietic cell transplant
Time frame: At 1 year
Overall survival
Time frame: At 1 year
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