Cladribine Plus Homoharringtonine and Cytarabine Regimen (CHA) for de Novo Acute Myeloid Leukemia

Last updated: May 5, 2025
Sponsor: First Affiliated Hospital of Zhejiang University
Overall Status: Active - Recruiting

Phase

2

Condition

Leukemia

Treatment

cladribine + homoharringtonine + cytarabine

Clinical Study ID

NCT05906914
IIT20220027C-R2
  • Ages 18-59
  • All Genders

Study Summary

The goal of this clinical trial is to evaluate the response and safety of Cladribine plus Homoharringtonine and Cytarabine regimen (CHA) protocol in de novo acute myeloid leukemia with age <60y. This is a prospective, single-armed mono-center based investigator-initiated trial. About 30 patients who meet the enrollment criteria with be treated with CHA as induction chemotherapy. The complete response rate, survival rate, recurrence rate, and treatment-related mortality with be observed.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  1. The age is 18 to 59 years old, gender is not limited, race is not limited.

  2. Diagnosed as acute myeloid leukemia (AML) according to the diagnostic criteria ofthe World Health Organization (WHO) in 2016.

  3. No previous anti-acute leukemia therapy (including demethylation drugs for leukemiaor myelodysplastic syndrome (MDS), except hydroxyurea and leukocytosis).

  4. Physical status <= 2 according to eastern tumor cooperation group (ECOG).

  5. Within 21 days before random grouping and at baseline, biochemical indicators mustbe within the following limits: Glutamic pyruvic transaminase (ALT) and glutamicoxaloacetic transaminase (AST) <= 3 × normal upper limit (ULN); total bilirubin <= 3 × ULN; serum creatinine <= 2 × ULN or serum creatinine clearance rate (CrCl)>= 40mL/min.

  6. The left ventricular ejection fraction| (LVEF) measured by echocardiography was inthe normal range (LVEF > 50%).

  7. Each patient (or his or her legal representative) must sign an informed consent form (ICF), indicating that he / she understands the purpose and procedures of the studyand is willing to participate in the study.

Exclusion

Exclusion Criteria:

  1. Diagnosed or receiving treatment for other malignant tumors other than AML that areor are in need of treatment in the near future.

  2. Acute promyelocytic leukemia, myeloid sarcomas, accelerated and acute transformationof chronic myeloid leukemia.

  3. Patients with severe liver and kidney function, cardiopulmonary insufficiency.

  4. Uncontrolled or severe infection.

  5. Mental illness that may prevent subjects from completing treatment or informedconsent.

Study Design

Total Participants: 30
Treatment Group(s): 1
Primary Treatment: cladribine + homoharringtonine + cytarabine
Phase: 2
Study Start date:
October 26, 2022
Estimated Completion Date:
December 31, 2025

Study Description

In this study, a new chemotherapy regimen named CHA which composed of cladribine, homoharringtonine and cytarabine, was proposed for the induced remission treatment of adult acute myeloid leukemia, and the efficacy and safety of this regimen were evaluated. Enrolled patients will receive cladribine (5mg/m2, d1-3) + homoharringtonine (2mg/m2, d1-5) + cytarabine (100mg/m2, d1-7). If more than partial remission is achieved in the first course, a course of CHA regimen is repeated. If the first course of treatment did not achieve a partial response, or the second course of treatment did not achieve a complete response, the patient was withdrawn from the clinical study. Transplantation was stratification according to the prognostic risk stratification. Patients with favourable risk received 3 cycles of high-dose intravenous cytarabine (1-3g/m2, Q12H d1-3). Or 3 cycles of medium dose cytarabine (1.0g/m2, Q12H d1-3) combined with idarubicin (10mg/m2, d1-3) or etoposide (100mg, d1-3). Patients with intermediate risk who achieve minimal residual disease (MRD) negative in the first or second cycle can receive high-dose or intermediate-dose cytarabine chemotherapy, otherwise allogeneic hematopoietic stem cell transplantation (HSCT) is recommended. Patients with high risk are advised to receive allogeneic HSCT, or receive high-dose or intermediate-dose cytarabine.Bone marrow samples were collected at enrollment for bone marrow cytology, flow cytometry and next-generation sequencing. The probes for targeted sequencing covered exons and selected introns of 88 myeloid leukaemia-related genes for next-generation sequencing. Bone marrow was collected on day 28 after each treatment cycle, including bone marrow cytology and measurable residual disease (MRD) assessments, for response assessment.The response assessment was evaluated according to the Revised Recommendations of the International Working Group for Diagnosis, Standardization of Response Criteria, Treatment Outcomes, and Reporting Standards for Therapeutic Trials in Acute Myeloid Leukemia. The primary study endpoint was the composite complete remission (CR) rate (CR and CR with incomplete hematology recovery, CRi), assessed in all treated populations according to the Revised Recommendations of the International Working Group for Diagnosis, Standardization of Response Criteria, Treatment Outcomes, and Reporting Standards for Therapeutic Trials in Acute Myeloid Leukemia. The secondary endpoints were minimal residual disease in bone marrow measured by flow cytometry after one cycle of induction therapy, as well as overall survival (OS), event-free survival, and adverse events, assessed in all treated populations.

Connect with a study center

  • The First Affiliated Hospital, Zhejiang University School of Medicine

    Hangzhou, Zhejiang 310003
    China

    Active - Recruiting

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