The Role of Allo-HSCT in MRD-negative Patients With AML Under the Age of 60 Years in the First Complete Remission

  • STATUS
    Recruiting
  • End date
    Feb 1, 2026
  • participants needed
    75
  • sponsor
    National Research Center for Hematology, Russia
Updated on 28 April 2022

Summary

Depending on the variant of the disease, patients are divided into 3 groups: A, B and C. Group A include patients with acute myeloid leukemia (AML) inv(16)(p13.1q22) or t(16;16)(p13.1;q22); CBFB-MYH11, group B - AML with t(8;21)(q22;q22.1); RUNX1-RUNX1T1, AML with normal karyotype with or without gene mutations (FLT3, NPM1, CEBPa) regardless of the allele ratio, and also AML with cytogenetic abnormalities not classified as those within groups A/C, group C - AML with myelodysplasia-related changes. Patients from group A receive treatment according to the scheme: 2 courses "7+3", 2 courses "FLAG", then - 6 courses of maintenance therapy according to the scheme "5+5". Patients from group B are given one course of "7+3". After that, their minimal residual disease (MRD) status is assessed. In case MRD negativity is achieved after the 1st course of "7 +3", randomization is carried out: branch 1

  • therapy is similar to therapy for patients from group A (4 courses of induction and consolidation + 6 courses of maintenance chemotherapy (CT), allogeneic hematopoietic stem cell transplantation (allo-HSCT) is not planned), branch 2 - performing allo-HSCT should be done as soon as possible (before the start of maintenance CT is most desirable). If MRD negativity is not achieved after the 1st course of "7+3", the patient is given CT according to the standard program, followed by mandatory allo-HSCT. Patients from group C are treated either according to the "Aza-Ida-Ara-C" scheme, or according to the "Ven-DAC /AZA" scheme, followed by mandatory allo-HSCT.

Description

"7+3" regimen:

  1. Cytarabine 200 mg/m2 (IV continuous infusion over 24 hours), days 1-7
  2. Daunorubicin 60 mg/m2 (IV bolus), days 1-3

"FLAG" regimen:

  1. Fludarabine 25 mg/m2 (IV in 30 minutes), days 1-5
  2. Cytarabine 1500 mg/m2 (IV in 3 hours), days 1-5
  3. Granulocyte colony-stimulating factor 5 mcg/kg (subcutaneous injection), from day 6 until regression of cytopenia

"Aza-Ida-Ara-C" regimen:

  1. Azacitidine 75 mg/m2 (subcutaneous injection), days 1-3
  2. Idarubicin 3 mg/m2 (IV bolus), days 4-10
  3. Cytarabine 15 mg/m2 twice a day (subcutaneous injection), days 4-17

"Ven-DAC/AZA"

  1. Venetoclax 400 mg once daily (PO), days 1-28
  2. Either Azacitidine or Decitabine Azacitidine 75 mg/m2 (subcutaneous injection), days 1-7 Decitabine 20 mg/m2 (IV in 60 minutes). days 1-5

"5+5" regimen

  1. Cytarabine 50 mg/m2 twice a day (subcutaneous injection), days 1-5
  2. Mercaptopurine 30 mg/m2 twice a day (PO), days 1-5

Details
Condition AML
Treatment Allo-HSCT
Clinical Study IdentifierNCT05339204
SponsorNational Research Center for Hematology, Russia
Last Modified on28 April 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Newly diagnosed, previously untreated AML
Age from 18 to 59 years
Somatic status - ECOG < 3

Exclusion Criteria

previous chemotherapy for AML
pregnancy
relapses and refractory forms of AML
acute promyelocytic leukemia
blast crisis of chronic myeloid leukemia
de novo AML with t(9;22)
AML transformed from MDS or MPN after treatment, for which a different protocol is provided
Blastoid plasmacytoid dendritic cell neoplasia (with the exception of cases when a small population of plasmacytoid dendritic progenitors is detected in the leukemic neoplasia)
Undifferentiated acute leukemia
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