Randomized Trial in Adult de Novo Ph Positive ALL With Chemotherapy, Imatinib or Ponatinib, Blinatumomab and SCT

NCT ID: NCT06061094

Last Updated: 2025-04-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE2

Total Enrollment

220 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-07-14

Study Completion Date

2029-07-01

Brief Summary

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The current Standard of Care (SoC) in younger patients with Ph+ ALL is Imatinib in combination with low-dose chemotherapy, change of TKI in case of persistent MRD above 10-3 after consolidation I and indication for stem cell transplantation.

The EVOLVE trial aims to answer three questions challenging the current SoC:

Use of Ponatinib compared to Imatinib both in combination with low-dose chemotherapy and consolidation I (randomization I).

In MRD good responders: Omit end of therapy in primary care and indication for SCT but continue therapy with TKI, chemotherapy and Blinatumomab as additional antileukemic compound (randomization II).

In MRD poor responders: Omit indication for TKI change but give instead Blinatumomab followed by end of therapy in primary care and indication for SCT (non-randomized).

Detailed Description

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Conditions

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Philadelphia Chromosome Positive Acute Lymphoblastic Leukemia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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A: Imatinib + low dose chemotherapy

Imatinib 600mg QD + low dose chemotherapy induction and consolidation I (Standard Arm of Randomization I)

Group Type ACTIVE_COMPARATOR

Imatinib

Intervention Type DRUG

Imatinib 600mg QD plus Chemotherapy

B: Ponatinib + low dose chemotherapy

Ponatinib 45mg QD (reduction to 30mg QD after Induction) + low dose chemotherapy induction and consolidation I (Experimental Arm of Randomization I)

Group Type EXPERIMENTAL

Ponatinib

Intervention Type DRUG

Ponatinib 45 mg QD plus chemotherapy

C: Molecular CR: End of therapy with indication for SCT

Molecular CR: End of therapy with indication for SCT (Standard Arm of Randomization II)

Group Type ACTIVE_COMPARATOR

Indication for stem cell transplantation

Intervention Type OTHER

Patients with molecular CR randomized to the standard arm have an indication for SCT; patients with molecular failure or intermediate response have an indication for SCT. SCT is not part of the trial.

D: Molecular CR: continuation with Imatinib/Ponatinib (per Rando I), chemotherapy and Blinatumomab

Molecular CR: No end of therapy with indication for SCT but and continuation with Imatinib/Ponatinib (per Randomization I), chemotherapy and Blinatumomab (Experimental Arm of Randomization II)

Group Type EXPERIMENTAL

Imatinib

Intervention Type DRUG

Imatinib 600mg QD plus Chemotherapy

Ponatinib

Intervention Type DRUG

Ponatinib 45 mg QD plus chemotherapy

Blinatumomab

Intervention Type DRUG

Patients with molecular failure or intermediate response receive one cycle Blinatumomab before SCT; Patients with molecular CR randomized to the experimental arm receive 3 cycles Blinatumomab + chemotherapy

E: Mol Fail / Mol NE: Continuation with Imatinib/Ponatinib (per Rando I) and addition of Blina

Molecular Failure / Molecular Not Evaluable: Continuation with Imatinib/Ponatinib (per Randomization I) and addition of Blinatumomab (Experimental Arm)

Group Type EXPERIMENTAL

Imatinib

Intervention Type DRUG

Imatinib 600mg QD plus Chemotherapy

Ponatinib

Intervention Type DRUG

Ponatinib 45 mg QD plus chemotherapy

Blinatumomab

Intervention Type DRUG

Patients with molecular failure or intermediate response receive one cycle Blinatumomab before SCT; Patients with molecular CR randomized to the experimental arm receive 3 cycles Blinatumomab + chemotherapy

Indication for stem cell transplantation

Intervention Type OTHER

Patients with molecular CR randomized to the standard arm have an indication for SCT; patients with molecular failure or intermediate response have an indication for SCT. SCT is not part of the trial.

Interventions

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Imatinib

Imatinib 600mg QD plus Chemotherapy

Intervention Type DRUG

Ponatinib

Ponatinib 45 mg QD plus chemotherapy

Intervention Type DRUG

Blinatumomab

Patients with molecular failure or intermediate response receive one cycle Blinatumomab before SCT; Patients with molecular CR randomized to the experimental arm receive 3 cycles Blinatumomab + chemotherapy

Intervention Type DRUG

Indication for stem cell transplantation

Patients with molecular CR randomized to the standard arm have an indication for SCT; patients with molecular failure or intermediate response have an indication for SCT. SCT is not part of the trial.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Male or female patients \>= 18 years, \<=65 years
* Philadelphia chromosome or BCR-ABL1 positive ALL
* Not previously treated except with corticosteroids ≤ 7 days, standard GMALL prephase with dexamethasone and cyclophosphamide including intrathecal therapy, hydroxyurea, a single dose vincristine or other cytostatic drugs and start of standard induction for Ph-positive ALL (1 dose vincristine, 1 dose of Rituximab, 2 doses dexamethasone and up to 5 days Imatinib)
* ECOG performance status ≤2
* Signed written inform consent
* Molecular evaluation for BCR-ABL1 performed
* Negative pregnancy test in women of childbearing potential
* Woman of childbearing potential willing to use 2 highly effective methods of contraception while receiving study treatment and for an additional 3 months after the last dose of study treatment (Pearl-Index \<1%). Male who has a female partner of childbearing potential willing to use 2 highly effective forms of contraception while receiving study treatment and for at least an additional 3 months after the last dose of study treatment (Pearl-Index \<1%).
* Normal serum levels \> LLN (lower limit of normal) of potassium and magnesium, or corrected to within normal limits with supplements, prior to the first dose of study medication
* Serum lipase ≤ 1.5 x ULN. For serum lipase \> ULN - ≤ 1.5 x ULN, value must be considered not clinically significant and not associated with risk factors for acute pancreatitis
* Normal QTcF interval ≤450 ms for males and ≤470 ms for females
* Signed and dated written informed consent is available
* Participation in the registry of the German Multicenter Study Group for Adult ALL (GMALL)

Exclusion Criteria

* History of malignancy other than ALL diagnosed within 5 years (yrs) prior to start of protocol-specified therapy with defined exceptions
* Contraindications against the use of Imatinib, Ponatinib, chemotherapy or Blinatumomab
* Patient previously treated with tyrosine kinase inhibitors
* Nursing women
* Known impaired cardiac function, including any of the following: as detailed in protocol
* Symptomatic peripheral vascular disease
* Any history of ischemic stroke or transient ischemic attacks (TIAs)
* Uncontrolled hypertriglyceridaemia
* History or presence of clinically relevant CNS pathology as detailed in protocol
* History or active relevant autoimmune disease
* Known hypersensitivity to immunoglobulins or to any other component of the study drug formulation
* Known diagnosis of human immunodeficiency virus (HIV) infection (HIV testing is not mandatory) or active infection with Hepatitis B or C
* History of pancreatitis within 6 months previous to start of treatment within the trial
* Treatment with any other investigational agent or participating in another trial within 30 days prior to entering this study
* Inadequate hepatic functions defined as ASAT or ALAT \> 2,5 times the institutional upper limit of normal or \> 5 times ULN if considered due to leukemia
* Total bilirubin \> 1.5-fold the institutional upper limit unless considered to be due to organ involvement by the leukemia or to M. Gilbert / M. Meulengracht
* Concurrent severe diseases which exclude the administration of therapy e.g. severe, uncontrolled acute or chronic infections
* Inability to understand and/or unwillingness to sign a written informed consent
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Deutsche Leukämie- & Lymphom-Hilfe

UNKNOWN

Sponsor Role collaborator

German Federal Ministry of Education and Research

OTHER_GOV

Sponsor Role collaborator

Goethe University

OTHER

Sponsor Role lead

Responsible Party

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Nicola Goekbuget

Dr. Nicola Gökbuget

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nicola Goekbuget, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Medicine, Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany

Fabian Lang, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Medicine, Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany

Heike Pfeifer, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Medicine, Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany

Locations

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Uniklinik RWTH Aachen

Aachen, , Germany

Site Status RECRUITING

Klinikum Aschaffenburg

Aschaffenburg, , Germany

Site Status RECRUITING

Klinikum Augsburg

Augsburg, , Germany

Site Status RECRUITING

Helios Klinikum Bad Saarow

Bad Saarow, , Germany

Site Status RECRUITING

Klinikum Bayreuth

Bayreuth, , Germany

Site Status RECRUITING

Vivantes Klinikum am Urban

Berlin, , Germany

Site Status RECRUITING

Charité Universitätsmedizin Berlin

Berlin, , Germany

Site Status RECRUITING

Vivantes Klinikum Neukölln

Berlin, , Germany

Site Status RECRUITING

Helios Klinikum Berlin-Buch

Berlin, , Germany

Site Status RECRUITING

Charite Berlin Virchow Klinikum

Berlin, , Germany

Site Status RECRUITING

Evangelisches Krankenhaus Bielefeld

Bielefeld, , Germany

Site Status RECRUITING

UK Knappschaftskrankenhaus Bochum

Bochum, , Germany

Site Status RECRUITING

Evangelische Kliniken Bonn

Bonn, , Germany

Site Status RECRUITING

Universitätsklinikum Bonn

Bonn, , Germany

Site Status RECRUITING

Städtisches Klinikum Braunschweig

Braunschweig, , Germany

Site Status RECRUITING

Klinikum Bremen-Mitte

Bremen, , Germany

Site Status RECRUITING

Klinikum Chemnitz

Chemnitz, , Germany

Site Status RECRUITING

Universitätsklinikum Köln

Cologne, , Germany

Site Status RECRUITING

Klinikum Darmstadt

Darmstadt, , Germany

Site Status RECRUITING

Städtisches Klinikum Dessau

Dessau, , Germany

Site Status RECRUITING

Klinikum Dortmund

Dortmund, , Germany

Site Status RECRUITING

St. Johannes Hospital Dortmund

Dortmund, , Germany

Site Status RECRUITING

Universitätsklinikum Carl Gustav Carus Dresden

Dresden, , Germany

Site Status RECRUITING

Helios Klinikum Duisburg

Duisburg, , Germany

Site Status RECRUITING

Universitätsklinikum Düsseldorf

Düsseldorf, , Germany

Site Status RECRUITING

Marien Hospital Düsseldorf

Düsseldorf, , Germany

Site Status RECRUITING

Universitätsklinikum Erlangen

Erlangen, , Germany

Site Status RECRUITING

St.-Antonius-Hospital

Eschweiler, , Germany

Site Status RECRUITING

Universitätsklinikum Essen

Essen, , Germany

Site Status RECRUITING

Evangelisches Krankenhaus Essen-Werden

Essen, , Germany

Site Status RECRUITING

Department of Medicine, Hematology and Oncology, Goethe University Hospital Frankfurt

Frankfurt, , Germany

Site Status RECRUITING

Universitätsklinikum Freiburg

Freiburg im Breisgau, , Germany

Site Status RECRUITING

Niels-Stensen-Kliniken Georgsmarienhütte

Georgsmarienhütte, , Germany

Site Status RECRUITING

Wilhelm-Anton-Hospital

Goch, , Germany

Site Status RECRUITING

Universitätsmedizin Göttingen

Göttingen, , Germany

Site Status RECRUITING

Universitätsmedizin Greifswald

Greifswald, , Germany

Site Status RECRUITING

Klinikum Gütersloh

Gütersloh, , Germany

Site Status RECRUITING

Katholisches Krankenhaus Hagen

Hagen, , Germany

Site Status RECRUITING

Universitätsklinikum Halle

Halle, , Germany

Site Status RECRUITING

Asklepios Klinik St. Georg Hamburg

Hamburg, , Germany

Site Status NOT_YET_RECRUITING

Universitätsklinikum Hamburg-Eppendorf

Hamburg, , Germany

Site Status RECRUITING

Medizinische Hochschule Hannover

Hanover, , Germany

Site Status RECRUITING

Universitätsklinikum Heidelberg

Heidelberg, , Germany

Site Status RECRUITING

Marien Hospital Herne

Herne, , Germany

Site Status RECRUITING

Universitätsklinikum des Saarlandes

Homburg, , Germany

Site Status RECRUITING

Klinikum Idar-Oberstein

Idar-Oberstein, , Germany

Site Status RECRUITING

Universitätsklinikum Jena

Jena, , Germany

Site Status RECRUITING

Städtisches Klinikum Karlsruhe

Karlsruhe, , Germany

Site Status RECRUITING

St. Vincentius-Kliniken Karlsruhe

Karlsruhe, , Germany

Site Status RECRUITING

Klinikum Kassel

Kassel, , Germany

Site Status RECRUITING

Universitätsklinikum Kiel

Kiel, , Germany

Site Status RECRUITING

Gemeinschaftsklinikum Mittelrhein

Koblenz, , Germany

Site Status RECRUITING

Universitätsklinikum Leipzig

Leipzig, , Germany

Site Status RECRUITING

Märkische Kliniken Lüdenscheid

Lüdenscheid, , Germany

Site Status RECRUITING

Universitätsklinikum Magdeburg

Magdeburg, , Germany

Site Status RECRUITING

UNIVERSITÄTSMEDIZIN der Johannes Gutenberg-Universität Mainz

Mainz, , Germany

Site Status NOT_YET_RECRUITING

Universitätsklinikum Mannheim

Mannheim, , Germany

Site Status RECRUITING

Philipps-Universität Marburg

Marburg, , Germany

Site Status RECRUITING

Kliniken Maria Hilf Möchengladbach

Möchengladbach, , Germany

Site Status RECRUITING

LMU Klinikum München

München, , Germany

Site Status RECRUITING

Klinikum Rechts der Isar TU München

München, , Germany

Site Status RECRUITING

Universitätsklinikum Münster

Münster, , Germany

Site Status RECRUITING

Klinikum Nürnberg

Nuremberg, , Germany

Site Status RECRUITING

Ortenau Klinikum Offenburg

Offenburg, , Germany

Site Status RECRUITING

Klinikum Oldenburg

Oldenburg, , Germany

Site Status RECRUITING

Brüderkrankenhaus St. Josef Paderborn

Paderborn, , Germany

Site Status RECRUITING

Klinikum Passau

Passau, , Germany

Site Status RECRUITING

Klinikum Ernst von Bergmann

Potsdam, , Germany

Site Status NOT_YET_RECRUITING

Krankenhaus Barmherzige Brüder Regensburg

Regensburg, , Germany

Site Status RECRUITING

Universitätsklinikum Regensburg

Regensburg, , Germany

Site Status RECRUITING

Universitätsklinikum Rostock

Rostock, , Germany

Site Status RECRUITING

Agaplesion Diakonieklinikum Rotenburg

Rotenburg (Wümme), , Germany

Site Status RECRUITING

Diakonie-Krankenhaus Schwäbisch-Hall

Schwäbisch Hall, , Germany

Site Status RECRUITING

Katharinenhospital Stuttgart

Stuttgart, , Germany

Site Status RECRUITING

Diakonissenkrankenhaus Stuttgart

Stuttgart, , Germany

Site Status RECRUITING

Robert-Bosch-Krankenhaus Stuttgart

Stuttgart, , Germany

Site Status RECRUITING

Klinikum Traunstein

Traunstein, , Germany

Site Status RECRUITING

Mutterhaus der Borromäerinnen Trier

Trier, , Germany

Site Status RECRUITING

Krankenhaus d. Barmherzigen Brüder

Trier, , Germany

Site Status NOT_YET_RECRUITING

Universitätsklinikum Tübingen

Tübingen, , Germany

Site Status RECRUITING

Universitätsklinikum Ulm

Ulm, , Germany

Site Status RECRUITING

Klinikum Schwarzwald-Baar

Villingen-Schwenningen, , Germany

Site Status RECRUITING

Helios Klinikum Wuppertal

Wuppertal, , Germany

Site Status RECRUITING

Universitätsklinikum Würzburg

Würzburg, , Germany

Site Status RECRUITING

Heinrich-Braun Klinikum

Zwickau, , Germany

Site Status RECRUITING

Countries

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Germany

Central Contacts

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Nicola Goekbuget, MD

Role: CONTACT

0049-6963016365

Fabian Lang, MD

Role: CONTACT

0049-69630183044

Facility Contacts

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Nicola Goekbuget, MD

Role: primary

0049-6963016365

Fabian Lang, MD

Role: backup

0049-69630183044

Related Links

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https://pubmed.ncbi.nlm.nih.gov/38754400/

Lang et al, Oncol Res Treat 2024;47:430-433

Other Identifiers

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2022-000760-21

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

GMALL-EVOLVE

Identifier Type: -

Identifier Source: org_study_id

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