To learn if the combination of cladribine, cytarabine, venetoclax, and azacitidine can help to control higher-risk myelodysplastic syndrome (MDS) with excess blasts and/or higher-risk chronic myelomonocytic leukemia (CMML).
Primary Objectives: * To determine the efficacy, safety and tolerability of the combination of cladribine, cytarabine and venetoclax in higher-risk MDS with excess blasts and higher-risk CMML. * MDS relapsed cohort (Cohort A, N=20): MDS with Int-2 or High risk IPSS and \>5% blasts with no response after 6 cycles of azacitidine, decitabine, guadecitabine, CC-486 or ASTX727 (decitabine/cedazuridine) or relapse or progression after any number of cycles * CMML relapsed cohort (Cohort B, N=10): CMML 1 or 2 with no response after 6 cycles of azacitidine, decitabine, guadecitabine, CC-486 or ASTX727 (decitabine/cedazuridine) or relapse or progression after any number of cycles * MDS HMA-naïve cohort (Cohort C, N=20): MDS with Int-2 or High risk by IPSS and \>10% blasts OR diagnosis * CMML HMA-naïve cohort (Cohort D, N=10): CMML-2; OR CMML-1 with at least one of the following high-risk features: extramedullary disease, splenomegaly of \>5cm below costal margin, platelets \<100x109/L, Hgb level \<10g/dL, WBC \>13x109/L, clonal cytogenetic abnormality (other than monosomy Y). Secondary Objectives: * To evaluate responses by 2015 IWG MDS/MPN response criteria in patients with MDS/MPN and by 2023 IWG response criteria in all patients (Appendix). * To assess overall survival (OS), duration of response, leukemia-free survival (LFS), and relapse-free survival (RFS). * To evaluate proportion of transplant-candidate patients bridged to allogeneic stem-cell transplant. * Correlative studies including correlation of response with disease subtype and genomic profile. * To evaluate changes in clonal composition and VAF of identified mutations with therapy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Given by Vein (IV)
Given under the skin; subcutaneous injection (SQ)
Given by PO
Given by IV or subcutaneous injection (SQ)
M D Anderson Cancer Center
Houston, Texas, United States
RECRUITINGTo establish the overall survival (OS).
Time frame: through study completion, an average of 1 year
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