This randomized, open label, multi arm phase II trial will evaluate the efficacy and safety of venetoclax based induction regimens of varying intensity (VA, VAM, or 2+5+V) versus standard 3+7 in fit patients aged ≥14 years with newly diagnosed AML. The trial is designed to select the optimal regimen as the experimental arm for a subsequent phase III randomized controlled trial. A total of 320 patients will be enrolled in this study,and segregated into four groups with 80 in each group. Patients who achieve CR/CRi/CRh after using different induction regimens will receive the same consolidation. Allogeneic hematopoietic stem cell transplantation is recommended for patients in the high-risk group or those with persist MRD positivity. After completion of the treatment phase, patients entered the follow-up period.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
320
daunorubicin: 60 mg/m2, administered by intravenous drip (ivgtt) on days 1-3,
Cytarabine: 100 mg/m2, administered by intravenous drip (ivgtt) on days 1-7,
Liposome Mitoxantrone: 24 mg/m², administered by intravenous drip (ivgtt) on day 1,
Venetoclax: 100 mg on day 1, 200 mg on day 2, and 400 mg on days 3-14, administered orally (po),
Azacitidine: 75 mg/m², administered subcutaneously (sc) on days 1-7,
Venetoclax: 100 mg on day 1, 200 mg on day 2, and 400 mg on days 3-21, administered orally (po). Bone marrow examination is performed on day 21. If blasts \>5%, then venetoclax 400 mg is continued on days 21-28.
daunorubicin: 60 mg/m2, administered by intravenous drip (ivgtt) on days 1-2,
Cytarabine: 100 mg/m2, administered by intravenous drip (ivgtt) on days 1-5,
Venetoclax: 100 mg on day 3, 200 mg on day 4, and 400 mg on days 5-11, administered orally (po),
Event-free survival (EFS)
It is defined as the time from the start of randomization to the occurrence of induction failure or disease progression or death from any cause (whichever occurs first).
Time frame: up to 3 years
30-day postinduction mortality
It is defined as death from any cause within 30 days after the start of induction.
Time frame: up to 30 days
60-day postinduction mortality
It is defined as death from any cause within 60 days after the start of induction.
Time frame: Up to 60 days
Composite complete remission (CRc) rate
Proportion of patients with complete remission (CR), complete remission with partial hematologic recovery (CRh) or complete remission with incomplete hematologic recovery (CRi).
Time frame: Up to eight weeks
Measurable Residual Disease (MRD) negative rate by flow cytometry
Among those who have achieved CR/CRh/CRi after induction, proportion of patients who is MRD-negative by flow cytometry.
Time frame: Up to eight weeks
Measurable Residual Disease (MRD) negative rate by molecular testing
Among those who have achieved CR/CRh/CRi after induction, proportion of patients who is MRD-negative by molecular testing.
Time frame: Up to approximately eight weeks
Relapse-free Survival (RFS)
It is defined as the time from the start of achieving remission to disease progression, death from any cause or the last follow-up.
Time frame: Up to 3 years
Overall survival (OS)
It is defined as the time from the start of randomization to the death from any cause.
Time frame: Up to 3 years
Cumulative incidence of relapse (CIR)
It is defined as the time from the start of achieving remission to hematologic relapse.
Time frame: Up to 3 years
Incidence of treatment related adverse events
The safety of the drug was evaluated by NCI-CTC AE 5.0 standard which including hematologic and non-hematologic toxicity.
Time frame: From day 1 of treatment to 28 days after the last dose
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