Safety and Efficacy of FT14 Conditioning for Allogeneic HSCT in Acute Myeloid Leukemia

NCT ID: NCT07232953

Last Updated: 2025-11-18

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: PHASE2
• Total Enrollment: 82 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-11-10
• Study Completion Date: 2027-06-30

Brief Summary

This is a prospective, multicenter, phase II, open-label, non-randomized clinical trial designed to evaluate the safety and efficacy of the Fludarabine plus Treosulfan 14 g/m² (FT14) conditioning regimen for allogeneic stem cell transplantation (allo-SCT) in patients with Acute Myeloid Leukemia (AML) aged 40-65 years who are in complete remission.

Detailed Description

This is a prospective, multicenter, phase II, open-label, non-randomized clinical trial designed to evaluate the safety, tolerability, and antileukemic activity of the FT14 conditioning regimen (Fludarabine plus Treosulfan 14 g/m²/day for three consecutive days) in adult patients with Acute Myeloid Leukemia (AML) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Eligible patients are 40 to 65 years old, in complete remission (CR), and candidates for allogeneic transplantation according to institutional criteria.

Treosulfan-based conditioning represents an effective alternative to conventional myeloablative regimens, with reduced organ toxicity and favorable immunosuppressive properties. Increasing the treosulfan dose to 14 g/m²/day aims to enhance antileukemic potency while maintaining an acceptable safety profile. Fludarabine provides additional immunosuppression and cytotoxic synergism, facilitating engraftment and disease control.

Enrolled patients will receive the FT14 conditioning regimen followed by allo-HSCT from either a matched related donor (MRD) or a matched unrelated donor (MUD). Haploidentical donors are not included in this study. Graft-versus-host disease (GVHD) prophylaxis, antimicrobial prophylaxis, and supportive care will follow each center's standard procedures.

The primary endpoint is the 1-year leukemia-free survival (LFS). Secondary endpoints include time to engraftment, cumulative incidence of graft failure, transplant-related mortality (TRM) and non-relapse mortality (NRM), relapse incidence, acute and chronic GVHD incidence and severity, overall survival (OS), and graft-versus-host disease-free, relapse-free survival (GRFS). Safety will be assessed through regimen-related toxicities, early and late post-transplant complications, and hematologic recovery kinetics.

The study is designed to provide prospective clinical evidence on the performance, tolerability, and efficacy of the FT14 regimen in adults with AML undergoing allo-HSCT, with the aim of defining its potential role as a conditioning option for this patient population.

Conditions

Acute Myeloid Leukaemia (AML); Hematopoietic Stem Cell Transplant (HSCT)

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Fludarabine + Treosulfan conditioning regimen in AML patients

Fludarabine (30 mg/m²/d × 5 days) IV infusion days -6 to -2 and Treosulfan (14 g/m²/d × 3 days) IV infusion days -4 to -2.

Group Type: EXPERIMENTAL

Fludarabine + Treosulfan

Intervention Type: DRUG

Fludarabine (30 mg/m²/d × 5 days) IV infusion days -6 to -2 and Treosulfan (14 g/m²/d × 3 days) IV infusion days -4 to -2

Interventions

Fludarabine + Treosulfan

Fludarabine (30 mg/m²/d × 5 days) IV infusion days -6 to -2 and Treosulfan (14 g/m²/d × 3 days) IV infusion days -4 to -2

Intervention Type: DRUG

Other Intervention Names

Treosulfan; Fludarabine

Eligibility Criteria

Inclusion Criteria

• Patients >40 <65 years of age
• Diagnosis of AML in first complete remission (CR)/complete remission with incomplete recovery (CRi)/multiflow leukemia free state (MLFS)
• Eligible for allo-SCT from HLA-identical matched related or unrelated donor as defined by molecular high-resolution typing (4 digits) at the following four HLA gene loci (HLA-A, B, C, and DRB1)
• Adequate hepatic function (bilirubin ≤2 UNL; ALT/AST ≤2,5 UNL)
• Adequate renal function (creatinine clearance ≥50 mL/min)
• ECOG Performance Status < 2
• Willing and able to comply with all of the requirements and visits in the protocol.
• Written and signed informed consent

Exclusion Criteria

• AML patients with t(15;17); t(8;21); inv(16)
• Subject has known active CNS involvement with AML.
• Grade >2 NCI-CTCAE (v. 5) adverse events at the time of enrollment
• Serious organ dysfunction: left ventricular ejection fraction < 40%, FEV1, FVC, DLCO (diffusion capacity) <40% of predicted, LFT > 5 times the upper limit of normal, or creatinine clearance < 40 ml/min.
• The evidence of HBV or HCV active infection (HBV DNA, HCV RNA positive test).
• Patients with HIV infection
• Current uncontrolled infections
• Patients with other life-threatening concurrent diseases
• Subjects with known hypersensitivity to any of the component medications
• Participation in another clinical trial within 1 month before the start of this trial
• Participant, both female and male, in childbearing age who do not agree to maintain an active contraceptive practice
• Pregnant or breastfeeding patients during screening

• Minimum Eligible Age: 40 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia

OTHER

Sponsor Role: lead

Responsible Party

Prof Domenico Russo

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Domenico Russo, MD

Role: PRINCIPAL_INVESTIGATOR

ASST Spedali Civili di Brescia

Locations

Grande Ospedale Metropolitano "Bianco Melacrino Morelli"

Reggio Calabria, Calabria, Italy

Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli

Napoli, Campania, Italy

Azienda Ospedaliera Universitaria di Modena

Modena, Emilia-Romagna, Italy

Azienda Sanitaria Universitaria Friuli Centrale

Udine, Friuli Venezia Giulia, Italy

ASST degli Spedali Civili di Brescia

Brescia, Lombardy, Italy

Fondazione IRCCS Ca&#39; Granda Ospedale Maggiore Policlinico,

Milan, Lombardy, Italy

IRCCS Ospedale San Raffaele

Milan, Lombardy, Italy

Azienda Ospedaliera S. Croce e Carle

Cuneo, Piedmont, Italy

Ospedali Riuniti di Ancona

Ancona, The Marches, Italy

Ospedale C e G Mazzoni

Ascoli Piceno, The Marches, Italy

Azienda Ospedaliero Universitaria Careggi

Florence, Tuscany, Italy

Ospedale dell'Angelo

Mestre, Veneto, Italy

Azienda Ospedaliera Universitaria Integrata Verona

Verona, Veneto, Italy

Countries

Italy

References

Shimoni A, Labopin M, Savani B, Hamladji RM, Beelen D, Mufti G, Socie G, Delage J, Blaise D, Chevallier P, Forcade E, Deconinck E, Mohty M, Nagler A. Intravenous Busulfan Compared with Treosulfan-Based Conditioning for Allogeneic Stem Cell Transplantation in Acute Myeloid Leukemia: A Study on Behalf of the Acute Leukemia Working Party of European Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant. 2018 Apr;24(4):751-757. doi: 10.1016/j.bbmt.2017.12.776. Epub 2017 Dec 13.

Reference Type: RESULT

PMID: 29247780 (View on PubMed)

Ruutu T, Volin L, Beelen DW, Trenschel R, Finke J, Schnitzler M, Holowiecki J, Giebel S, Markiewicz M, Uharek L, Blau IW, Kienast J, Stelljes M, Larsson K, Zander AR, Gramatzki M, Repp R, Einsele H, Stuhler G, Baumgart J, Mylius HA, Pichlmeier U, Freund M, Casper J. Reduced-toxicity conditioning with treosulfan and fludarabine in allogeneic hematopoietic stem cell transplantation for myelodysplastic syndromes: final results of an international prospective phase II trial. Haematologica. 2011 Sep;96(9):1344-50. doi: 10.3324/haematol.2011.043810. Epub 2011 Jun 9.

Reference Type: RESULT

PMID: 21659356 (View on PubMed)

Casper J, Holowiecki J, Trenschel R, Wandt H, Schaefer-Eckart K, Ruutu T, Volin L, Einsele H, Stuhler G, Uharek L, Blau I, Bornhaeuser M, Zander AR, Larsson K, Markiewicz M, Giebel S, Kruzel T, Mylius HA, Baumgart J, Pichlmeier U, Freund M, Beelen DW. Allogeneic hematopoietic SCT in patients with AML following treosulfan/fludarabine conditioning. Bone Marrow Transplant. 2012 Sep;47(9):1171-7. doi: 10.1038/bmt.2011.242. Epub 2011 Dec 12.

Reference Type: RESULT

PMID: 22158386 (View on PubMed)

Westerhof GR, Ploemacher RE, Boudewijn A, Blokland I, Dillingh JH, McGown AT, Hadfield JA, Dawson MJ, Down JD. Comparison of different busulfan analogues for depletion of hematopoietic stem cells and promotion of donor-type chimerism in murine bone marrow transplant recipients. Cancer Res. 2000 Oct 1;60(19):5470-8.

Reference Type: RESULT

PMID: 11034090 (View on PubMed)

Fichtner I, Becker M, Baumgart J. Antileukaemic activity of treosulfan in xenografted human acute lymphoblastic leukaemias (ALL). Eur J Cancer. 2003 Apr;39(6):801-7. doi: 10.1016/s0959-8049(02)00767-0.

Reference Type: RESULT

PMID: 12651206 (View on PubMed)

Munkelt D, Koehl U, Kloess S, Zimmermann SY, Kalaaoui RE, Wehner S, Schwabe D, Lehrnbecher T, Schubert R, Kreuter J, Klingebiel T, Esser R. Cytotoxic effects of treosulfan and busulfan against leukemic cells of pediatric patients. Cancer Chemother Pharmacol. 2008 Oct;62(5):821-30. doi: 10.1007/s00280-007-0669-3. Epub 2008 Feb 2.

Reference Type: RESULT

PMID: 18246351 (View on PubMed)

Beelen DW, Trenschel R, Stelljes M, Groth C, Masszi T, Remenyi P, Wagner-Drouet EM, Hauptrock B, Dreger P, Luft T, Bethge W, Vogel W, Ciceri F, Peccatori J, Stolzel F, Schetelig J, Junghanss C, Grosse-Thie C, Michallet M, Labussiere-Wallet H, Schaefer-Eckart K, Dressler S, Grigoleit GU, Mielke S, Scheid C, Holtick U, Patriarca F, Medeot M, Rambaldi A, Mico MC, Niederwieser D, Franke GN, Hilgendorf I, Winkelmann NR, Russo D, Socie G, Peffault de Latour R, Holler E, Wolff D, Glass B, Casper J, Wulf G, Menzel H, Basara N, Bieniaszewska M, Stuhler G, Verbeek M, Grass S, Iori AP, Finke J, Benedetti F, Pichlmeier U, Hemmelmann C, Tribanek M, Klein A, Mylius HA, Baumgart J, Dzierzak-Mietla M, Markiewicz M. Treosulfan or busulfan plus fludarabine as conditioning treatment before allogeneic haemopoietic stem cell transplantation for older patients with acute myeloid leukaemia or myelodysplastic syndrome (MC-FludT.14/L): a randomised, non-inferiority, phase 3 trial. Lancet Haematol. 2020 Jan;7(1):e28-e39. doi: 10.1016/S2352-3026(19)30157-7. Epub 2019 Oct 9.

Reference Type: RESULT

PMID: 31606445 (View on PubMed)

Romanski M, Wachowiak J, Glowka FK. Treosulfan Pharmacokinetics and its Variability in Pediatric and Adult Patients Undergoing Conditioning Prior to Hematopoietic Stem Cell Transplantation: Current State of the Art, In-Depth Analysis, and Perspectives. Clin Pharmacokinet. 2018 Oct;57(10):1255-1265. doi: 10.1007/s40262-018-0647-4.

Reference Type: RESULT

PMID: 29557088 (View on PubMed)

Danylesko I, Shimoni A, Nagler A. Treosulfan-based conditioning before hematopoietic SCT: more than a BU look-alike. Bone Marrow Transplant. 2012 Jan;47(1):5-14. doi: 10.1038/bmt.2011.88. Epub 2011 Apr 11.

Reference Type: RESULT

PMID: 21478921 (View on PubMed)

Rambaldi A, Grassi A, Masciulli A, Boschini C, Mico MC, Busca A, Bruno B, Cavattoni I, Santarone S, Raimondi R, Montanari M, Milone G, Chiusolo P, Pastore D, Guidi S, Patriarca F, Risitano AM, Saporiti G, Pini M, Terruzzi E, Arcese W, Marotta G, Carella AM, Nagler A, Russo D, Corradini P, Alessandrino EP, Torelli GF, Scime R, Mordini N, Oldani E, Marfisi RM, Bacigalupo A, Bosi A. Busulfan plus cyclophosphamide versus busulfan plus fludarabine as a preparative regimen for allogeneic haemopoietic stem-cell transplantation in patients with acute myeloid leukaemia: an open-label, multicentre, randomised, phase 3 trial. Lancet Oncol. 2015 Nov;16(15):1525-1536. doi: 10.1016/S1470-2045(15)00200-4. Epub 2015 Sep 28.

Reference Type: RESULT

PMID: 26429297 (View on PubMed)

Rashidi A, Weisdorf DJ, Bejanyan N. Treatment of relapsed/refractory acute myeloid leukaemia in adults. Br J Haematol. 2018 Apr;181(1):27-37. doi: 10.1111/bjh.15077. Epub 2018 Jan 9.

Reference Type: RESULT

PMID: 29318584 (View on PubMed)

Other Identifiers

FT14-Trial

Identifier Type: -

Identifier Source: org_study_id