Using genetic information to guide maintenance therapy after stem cell transplantation for blood cancers

A Prospective, Multicenter Umbrella Study Based on Molecular Genetics to Guide the Efficacy and Safety of Maintenance Therapy After Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia/Myelodysplastic Syndrome

This study is testing whether personalized treatment based on genetic information can help people with blood cancers like acute myeloid leukemia and myelodysplastic syndromes stay healthy after a stem cell transplant.

Quick facts

• Phase: PHASE2; PHASE3
• Study type: Interventional
• Enrollment: 126 (estimated)
• Ages: 14 Years to 75 Years
• Sex: All
• Sponsor: Ruijin Hospital (other)
• Drugs / interventions: avastinib
• Locations: 1 site (Shanghai, Shanghai Municipality)
• Trial ID: NCT06972641 on ClinicalTrials.gov

What this trial studies

This study is a multicenter, open-label clinical trial aimed at evaluating the efficacy and safety of mutation-based maintenance therapy in patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) following allogeneic hematopoietic stem cell transplantation. Participants will be grouped based on their myeloid genomic sequencing results and assigned to different treatment regimens tailored to their specific genetic mutations. Maintenance therapy will begin 60-90 days post-transplant and will continue for up to two years, with follow-up monitoring for safety and survival. The study aims to determine the best therapeutic approach based on individual genetic profiles to improve patient outcomes.

Who should consider this trial

Good fit: Ideal candidates for this study are patients aged 14-75 years with AML or MDS who have undergone allogeneic hematopoietic stem cell transplantation and have specific genetic mutations identified through second-generation sequencing.

Not a fit: Patients without the specified genetic mutations or those who do not meet the eligibility criteria for the treatment arms may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could lead to more effective and personalized maintenance therapies for patients after stem cell transplantation.

How similar studies have performed: Other studies have shown promise in using genetic profiling to guide treatment decisions in hematologic malignancies, suggesting that this approach may be effective.

Eligibility criteria

Inclusion Criteria:

* 1\) Age 14-75 years and gender; (2) Initial diagnosis, pre-transplant myelogenetic second-generation sequencing data refinement; 3)ARM1: TP53 mutation (VAF ≥ 2%, excluding germline mutations), and/or AML-MR (SRSF2, SF3B1, U2AF1, ZRSR2, ASXL1, EZH2, BCOR, STAG2) by second-generation sequencing of the initial bone marrow gene; ARM2 Initial bone marrow gene II sequencing showed FLT3-ITD mutation with or without NPM1 mutation, no TP53 mutation, and no AML/MR. ARM3 Initial bone marrow gene II sequencing showed KIT mutations (loci: D816, N822, exon 8, VAF ≥2%, excluding germline mutations); no TP53 mutations, AML/MR, FLT3-ITD; ARM4 MDS in the intermediate/high/very high risk group as assessed by IPSS-M or AML in the intermediate/high risk group as assessed by ELN2022 without ARM1, 2, or 3 related mutations/fusions; 4) Subjects receive their first allogeneic hematopoietic stem cell transplantation within 30-60 days and STR-PCR shows complete donor chimerism; 5) Evaluation of the primary disease prior to maintenance therapy as complete remission and negative bone marrow flow MRD; 6) No active infection and no acute graft-versus-host disease requiring systemic treatment 7) Have appropriate organ function and laboratory results within 7 days prior to the start of treatment need to meet the following criteria:
* Aspartate aminotransferase (AST) ≤ 3 times ULN (upper limit of normal, ULN);
* Alanine aminotransferase (ALT) ≤ 3x ULN;
* Total serum bilirubin ≤ 1.5 times the upper limit of normal ULN unless the patient has documented Gilbert's syndrome; patients with Gilbert's syndrome with bilirubin ≤ 3.0 times the upper limit of normal and direct bilirubin ≤ 1.5 times the upper limit of normal may be included;
* Hemoglobin ≥ 70 g/L (had not received a red blood cell transfusion within 1 week prior to administration); Absolute neutrophil count (ANC) ≥ 0.8 x 10\^9/L (had not received long-acting colony-stimulating factor (LACSF) within 1 week prior to administration and short-acting colony-stimulating factor (SACSF) within 3 days prior to administration); and Platelet count ≥ 20 x 10\^9/L (1 week prior to administration) have not received a platelet transfusion);
* Serum creatinine ≤ 1.5 times ULN or creatinine clearance ≥ 60 mL/min;
* Coagulation function: International Normalized Ratio (INR) ≤1.5×ULN, Activated Partial Thromboplastin Time (APTT) ≤1.5×ULN;
* Left ventricular ejection fraction (LVEF) ≥45%; 8) Women of childbearing potential must have a negative serum pregnancy study within 7 days prior to the first dose. Female subjects of childbearing potential and male subjects whose partner is a woman of childbearing potential must agree to use a highly effective method of contraception from the time of signing the informed consent form until 180 days after the last dose of study drug is given (9) Voluntarily signing the informed consent, understanding and complying with the requirements of the study, good compliance, and cooperating with the follow-up visits.

Exclusion Criteria:

Patients were not enrolled if they met any of the following criteria:

1. Bone marrow or peripheral blood MRD changes from negative to positive;
2. Presence of acute or chronic GVHD, active infection requiring systemic immunosuppressive therapy prior to maintenance therapy;
3. Have clinically significant active cardiovascular disease such as uncontrolled arrhythmias, uncontrolled hypertension, congestive heart failure, any grade 3 or 4 heart disease as determined by the New York Heart Association (NYHA) functional class, or a history of myocardial infarction within the 6 months prior to screening;
4. Other serious medical conditions that may limit the patient's participation in this trial (e.g., uncontrolled diabetes, active autoimmune disease, etc.);
5. Known human immunodeficiency virus (HIV) infection, or chronic infection with hepatitis B virus (HBsAg-positive) or hepatitis C virus (anti-HCV-positive) that is uncontrolled by drugs;
6. Patients with neurological or psychiatric disorders;
7. Those who are unable to understand or comply with the study protocol or are unable to sign the informed consent form;
8. The researcher does not consider it appropriate to participate in this study.

Where this trial is running

Shanghai, Shanghai Municipality

• Ruijin Hospital — Shanghai, Shanghai Municipality, China (RECRUITING)

Study contacts

• Study coordinator: Xiaoxia Hu

Conditions: AML, MDS