Sorafenib Relapase Prophylaxis After HCT With PTBCy Regimen

Summary

This is a single-center randomized open-label phase II clinical trial to compare relapse prophylaxis with sorafenib and observation after graft-versus-host disease prophylaxis with post-transplantation bendamustine and cyclophosphamide in high-risk myeloid malignancies. This is an intention to treat study, where randomization is performed at first documentation of CR after engraftment.

Eligibility

Inclusion Criteria:

* Patients must undergo allogeneic hematopoietic stem cell transplantation with post-transplantation bendamustine AND cyclophosphamide from any donor.
* Patients must have high-risk myeloid malignancy as an indication for transplantation defined as:

  * acute myeloid leukemia not in hematological remission prior to transplantation,
  * ≥ 3 remission of acute myeloid leukemia,
  * any myeloid malignancy with bi-allelic tp53 mutation,
  * any myeloid malignancy with complex karyotype,
  * therapy-related myeloid malignancy not in MRD-negative response
  * myelodysplastic syndrome with very high IPSS-R risk
  * any myeloid malignancy with monosomal or t(3;3) karyotype,
  * any myeloid malignancy with ASXL1, bi-allelic tp53 or RUNX1 mutation, EVI1 overexpression
  * MDS/NPM unclassified not in hematologic remission.
* Documented hematological remission in the bone marrow at the time of inclusion post-engraftment, measurable residual disease is allowed
* First 100 days after allogeneic hematopoietic stem cell transplantation

Exclusion Criteria:

* successfully treated relapse between transplantation and enrollment
* use of any other planned method for prophylaxis of relapse besides sorafenib
* donor lymphocyte infusion prior to randomization
* Second malignancy not in complete remission within 6 months prior to randomization
* Moderate or severe cardiac disease: ejection fraction \<50%, unstable angina, stable angina NYHA class III or IV, chronic heart failure NYHA class III or IV, Lawn grade V arrhythmia, myocardial infarction within 3 months before inclusion
* Stroke within 3 months of inclusion, unless related to the underlying malignancy
* Severe decrease in pulmonary function: FEV1 \<50% or DLCO\<50% of predicted or respiratory distress or need for oxygen support;
* Severe organ dysfunction: AST or ALT \>10 upper normal limits, bilirubin \>2 upper normal limits, creatinine \>2 upper normal limits
* Creatinine clearance \< 30 mL/min
* Uncontrolled bacterial or fungal infection at the time of enrollment defined by CRP\> 70 mg/L
* Requirement for vasopressor support at the time of enrollment
* Requirement for positive-pressure oxygen at the time of enrollment
* Karnofsky index \<30%
* Pregnancy
* Somatic or psychiatric disorder making the patient unable to sign informed consent

Conditions5

Interventions1

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