Immuno-Targeted Therapy Plus Low-Dose Chemotherapy for Newly Diagnosed Adult Ph-Negative B-ALL: A Prospective Umbrella Trial

Официальное название

A Prospective Umbrella Clinical Trial of Immuno-Targeted Agents Combined With Low-Dose Chemotherapy for Newly Diagnosed Adult Philadelphia Chromosome-Negative B-Cell Acute Lymphoblastic Leukemia

Обзор

This is a prospective, open-label, single-arm, umbrella phase 2 clinical trial enrolling 32 adult patients with newly diagnosed Philadelphia chromosome-negative (Ph-) B-cell acute lymphoblastic leukemia (B-ALL). All patients receive a frontline treatment backbone consisting of low-dose chemotherapy combined with immuno-targeted agents and a BCL2 inhibitor. Subsequent treatment pathways are guided by MRD response, disease characteristics, and clinical decision-making, including antibody-based immunotherapy, CAR-T cell therapy, or hematopoietic stem cell transplantation. All patients continue protocol-defined maintenance therapy after consolidation. The primary endpoint is the complete remission rate with negative flow cytometric MRD after induction therapy. MRD is monitored longitudinally by flow cytometry, quantitative PCR, and immune repertoire sequencing. Safety is evaluated according to NCI CTCAE version 5.0.

Вмешательства

• Препарат Inotuzumab Ozogamicin (IO)
  Anti-CD22 antibody-drug conjugate (ADC) administered intravenously during induction and consolidation therapy.
• Препарат Venetoclax
  BCL-2 inhibitor administered orally daily during induction and consolidation cycles to enhance leukemic cell apoptosis.
• Препарат Blinatumomab
  CD19/CD3 bispecific T-cell engager (BiTE) administered as continuous intravenous infusion during consolidation therapy.
• Биопрепарат CD19-directed chimeric antigen receptor (CAR-T) T cells
  Autologous CD19 CAR-T cell therapy administered as a single intravenous infusion as optional consolidation therapy for eligible patients.
• Препарат Vincristine
  A vinca alkaloid that inhibits microtubule formation by binding to tubulin, resulting in mitotic arrest and inhibition of proliferation of rapidly dividing leukemic cells.
• Препарат Cyclophosphamide
  An alkylating agent that forms DNA cross-links, leading to inhibition of DNA replication and transcription and subsequent apoptosis of rapidly proliferating hematopoietic cells.
• Препарат Dexamethasone
  A synthetic glucocorticoid that induces lymphoid cell apoptosis and exerts anti-inflammatory and immunosuppressive effects, contributing to reduction of leukemic burden.
• Препарат Methotrexate
  A folate antimetabolite that inhibits dihydrofolate reductase, resulting in impaired DNA synthesis and cell replication, particularly in rapidly dividing lymphoid cells.
• Препарат Cytarabine (Ara-C)
  A pyrimidine nucleoside analog that inhibits DNA polymerase, leading to termination of DNA chain elongation and inhibition of leukemic cell proliferation.
• Препарат Prednisone
  A glucocorticoid that induces apoptosis in lymphoid cells and provides anti-inflammatory and immunosuppressive effects as part of multi-agent leukemia therapy.

Первичные конечные точки

• Flow Cytometric MRD-Negative Complete Remission Rate [Срок оценки: At the end of induction therapy (approximately 1 month after treatment initiation)]

Вторичные конечные точки (8)

• Next-Generation Sequencing (NGS)-MRD Negative Remission Rate [Срок оценки: Within 3 months after treatment initiation]
• Best MRD Clearance Rate [Срок оценки: Within 3 months after treatment initiation]
• Overall Survival (OS) [Срок оценки: Up to 5 years]
• Disease-Free Survival (DFS) [Срок оценки: Up to 5 years]
• Relapse-Free Survival (RFS) [Срок оценки: Up to 5 years]
• 30-Day Mortality [Срок оценки: 30 days]
• 60-Day Mortality [Срок оценки: 60 days]
• Incidence of Adverse Events [Срок оценки: From treatment initiation through completion of study treatment, up to 5 years]

Критерии участия

Критерии включения

• Newly diagnosed adult (≥18 years) patients with Ph-negative B-cell acute lymphoblastic leukemia according to WHO 2022 criteria.
• CD22-positive expression on tumor cells (CD22 ≥20%).
• Expected survival ≥3 months.
• Sexually active men and women of childbearing potential must agree to use effective contraception.
• Ability to understand and voluntarily sign informed consent, and willingness to comply with study requirements. Informed consent must be signed by the patient or a legal next of kin prior to initiation of any study-specific procedures.

Критерии исключения

• Burkitt lymphoma/leukemia.
• Acute leukemia of ambiguous lineage.
• Pregnant women.
• Severe, uncontrolled active infections.
• History of chronic liver disease (e.g., liver cirrhosis) or prior veno-occlusive disease (VOD) / sinusoidal obstruction syndrome (SOS).
• History of clinically significant ventricular arrhythmias, unexplained syncope (not vasovagal), or sinus node dysfunction or high-grade atrioventricular (AV) block with chronic bradycardia, unless a permanent pacemaker has been implanted.
• Uncontrolled active hepatitis B or hepatitis C infection, or known HIV seropositivity. HIV testing may be required according to local regulations or standards.
• Psychiatric disorders that may impair the subject's ability to complete treatment or provide informed consent.
• Any other conditions deemed by the investigator to render the subject unsuitable for participation in the study.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Не применимо

Модель

Последовательный дизайн

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Список центров уточняется — проверьте первичный протокол.

Идентификаторы

NCT: NCT07643103 · IIT2026063 · IIT2026063-EC-1

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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