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300 patients will be randomly distributed into the control group (n=150) and the experimental group(n=150). Patients will receive two cycles of induction chemotherapy. The control group receives standard 3+7 induction regimen containing cytarabine (100mg/m2 d1-7) and daunorubicin (60mg/m2 d1-3). The experimental group receives venetoclax combined with intensive chemotherapy (3+7 induction regimen same as the control group). For each group, patients who fail to achieve CR/CRi after two courses of induction therapy may receive alternative therapy decided by their physicians. After CR/CRi achieved, subjects proceed allo-transplantation or consolidation therapy according to their ELN risks: subjects in favorable risk group should continue with chemotherapy; subjects in poor risk group should go through transplantation; for subjects in intermediate risk group, those with suitable donors can receive transplantation while others can continue with consolidation therapy. Subjects receive 3 courses of intermediate-dose cytarabine (1.5g/m2 q12h d1, 3, 5) for age>55 years or high dose cytarabine (3g/m2 q12h d1, 3, 5) for age≤ 55 years as consolidation therapy with venetoclax in experimental group and without venetoclax in control group. After consolidation, patients will be observed.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Venetoclax combined with intensive chemotherapy | Experimental | The experimental group receives two cycles of inducation chemotherapy consisting of venetoclax combined with standard DA 3+7 regimen. After CR/CRi achieved, subjects proceed allo-transplantation or consolidation therapy according to their ELN risks. The consolidation chemotherapy regimen consists of three cycles of intermediate (for age>55 years)or high(for age≤ 55 years) dose cytarabine combined with venetoclax. |
|
| Intensive chemotherapy only | Active Comparator | The control group receives two cycles of inducation chemotherapy consisting of standard DA 3+7 regimen without venetoclax. After CR/CRi achieved, subjects proceed allo-transplantation or consolidation therapy according to their ELN risks. The consolidation chemotherapy regimen consists of three cycles of intermediate (for age>55 years)or high(for age≤ 55 years) dose cytarabine without venetoclax. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| with or without venetoclax | Drug | Bcl-2 inhibitor |
|
| Measure | Description | Time Frame |
|---|---|---|
| Event-free survival | The time from randomization to treatment failure, death from any cause or relapse after achieving CR or CRi, whichever occurs first. | up to 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Overall survival Overall survival | The time from randomization to death resulting from any cause | up to 36 months |
| CR rate | The proportion of patients achieving CR after two cycles of induction chemotherapy. |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Institute of Hematology & Blood Diseases Hospital | Tianjin | Tianjin Municipality | China |
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| ID | Term |
|---|---|
| D015470 | Leukemia, Myeloid, Acute |
| ID | Term |
|---|---|
| D007951 | Leukemia, Myeloid |
| D007938 | Leukemia |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
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| ID | Term |
|---|---|
| C579720 | venetoclax |
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| up to 2 months |
| Rates of remission (CR/CRi) without measurable residual disease (CRMRD-) | The proportion of AML patients achieving CR/CRi with negativity for a genetic marker by real-time quantitative polymerase chain reaction and/or with negativity by multi-color flow cytometry. | up to 2 months |
| Relapse free survival | From the date of complete remission(CR) until the date of documented relapse or death due to any cause or the last follow-up day. | up to 36 months |
| Cumulative incidence of relapse | Calculated from tdate of first CR to the date of relapse, considering nonrelapse mortality (NRM) as a competing event | up to 36 months |
| Frequency and severity of AEs | Adverse clinical events in the course of drug treatment according to CTCAE v5.0. | up to 8 months |
| D006402 |
| Hematologic Diseases |
| D006425 | Hemic and Lymphatic Diseases |