A Phase 2 interventional study of Venetoclax low dose with itraconazole in Acute Lymphobkastic Leukemia, Acute Lymphoblastic Leukaemia Recurrent and Philadelphia Chromosome Negative ALL, sponsored by Hospital Universitario Dr. Jose E. Gonzalez. Recruiting at 1 site in Mexico. Open to participants aged 16 Years to 45 Years. Per ClinicalTrials.gov, last updated 2025-10-02.
Sponsored by Hospital Universitario Dr. Jose E. Gonzalez · Phase 2, Interventional, and Treatment
Relapsed/refractory acute lymphoblastic leukemia remains a challenge in the context of limited access to immunotherapy in developing countries. With such poor 5-year overall survival rates of 10%, the investigators need strategies that surpass the complete response rate achieved in this setting, which does not exceed 60% effectiveness with different regimens, and to eventually transfer patients to hematopoietic stem cell transplantation.
In this context, the investigators are studyng if the use of venetoclax, a BCL2 inhibitor, with the use of a cytochrome p450 inhibitor such as itraconazole, alongside the TACL chemotherapy regimen, which is based on the combination of asparaginase, dexamethasone, bortezomib, vincristine, and mitoxantrone.
Response rates for salvage regimens vary depending on the patient's performance status (suitable or unsuitable for high-intensity chemotherapy), whether the patient is refractory (40%), in early or late first relapse (up to 60%), and in second or later relapse, where complete response rates decrease dramatically (as low as 10% with high-intensity regimens). Post-refractory OS has been reported at 5 months, with an EFS of 4.7 months. For patients in first relapse, the reported studies range from 5.8 months for those receiving salvage chemotherapy alone, increasing to 10 months if they undergo hematopoietic progenitor cell transplantation. For second relapses or relapses after transplantation, OS does not exceed 5 months. For patients who do not receive any treatment, the prognosis is grim, with high mortality within the following months following refractoriness or relapse without any support. 30,31,32
Therefore, it is proposed to increase the complete response rate with a pediatric-inspired chemotherapy regimen in conjunction with a BCL-2 inhibitor, so that patients can be transitioned to allogeneic bone marrow transplantation (the only curative therapy in this context), either after the treatment received or with short-term immunotherapy bridging to transplantation.
The risks associated with conventional salvage chemotherapy for patients with good performance status will not differ significantly from those typically observed in daily clinical practice (see below for the expected description of adverse events), since the basis of therapy remains the TACL regimen. A higher degree of cytopenias, especially neutropenia and thrombocytopenia, can be expected with the addition of a BCL-2 inhibitor.
Salvage chemotherapy will be assigned as follows:
The proposed chemotherapy regimen will be administered orally, intravenously, intramuscularly, and subcutaneously in an outpatient setting on the previously specified days, with appointments scheduled on days 1, 8, 15, and 22 for drug administration on the fifth floor of the University Cancer Center in the Hematology Service area. General patient assessment will be conducted in the ground floor offices of the University Cancer Center's Hematology Service. Any adverse events will be reported by system and grade according to CTCAE.
After completing the salvage chemotherapy regimen, bone marrow aspiration and measurable residual disease will be assessed on day 29 of the cycle, and not beyond day 35.
51 studies on the registry are indexed under Philadelphia Chromosome; 12 are open to participants now.
This study's planned enrollment of 12 is below the median of 61 across 46 interventional studies indexed under Philadelphia Chromosome.
Browse Philadelphia Chromosome studies →Hospital Universitario Dr. Jose E. Gonzalez is the lead sponsor of 83 studies on the registry; 12 are open to participants now.
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Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Relapsed: the illness came back after treatment had worked. Refractory: it did not respond to treatment, or stopped responding while still on it.
A line of therapy is one course of treatment, which may combine several drugs. First-line is the first course given; second-line follows when that stops working or is not tolerated.
“Two prior lines” means two courses that count separately under the study’s rules — not simply two drugs. Ask the study team if you are unsure how yours are counted.
A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.
Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.
The US National Cancer Institute’s scale of how severe an adverse event is — any unwanted medical event during a study, such as a symptom, an illness or an abnormal test result, whether or not a treatment caused it. Whether it did is judged separately.
“Side effects of earlier treatment resolved to grade 1 or less” means they have settled to mild or gone.
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
Relapsed and refractory
Relapsed: the illness came back after treatment had worked. Refractory: it did not respond to treatment, or stopped responding while still on it.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Line of therapy
A line of therapy is one course of treatment, which may combine several drugs. First-line is the first course given; second-line follows when that stops working or is not tolerated.
“Two prior lines” means two courses that count separately under the study’s rules — not simply two drugs. Ask the study team if you are unsure how yours are counted.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
ECOG performance status
A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.
Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
CTCAE grade
The US National Cancer Institute’s scale of how severe an adverse event is — any unwanted medical event during a study, such as a symptom, an illness or an abnormal test result, whether or not a treatment caused it. Whether it did is judged separately.
“Side effects of earlier treatment resolved to grade 1 or less” means they have settled to mild or gone.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Hypersensitivity
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Salvage chemotherapy will be assigned as follows: * Venetoclax 100 mg orally every day for 7 days * Itraconazole 100 mg orally every 12 hours for 7 days * Vincristine 1.4 mg/m2 intravenously on days 1, 8, 15, and 22 * Mitoxantrone 6 mg/m2 intravenously on day 1 * L-Asparaginase 6,000 IU/m2 intramuscularly on days 5, 7, 9, 11, 13, 16, 18, 20, and 23 * Dexamethasone 16 mg orally from days 1 to 15 * Bortezomib 2 mg subcutaneously on days 1, 4, 8, and 11 * Rituximab 375 mg/m2 intravenously on day 8 for patients with CD20+, more than 20% expression * Intrathecal Chemotherapy or CNS (-): Days 8 and 15 or CNS (+): Days 1, 8, 15, and 22
Drug: Venetoclax low dose with itraconazole
The investigators will add venetoclax in low dose (100 mg) with itraconazole to the pediatric inspired regimen TACL to enchance the complete response rate
Overall response rata after low dose venetoclax with itraconazole plus TACL
To evaluate the overall response after reinduction to remission with low dose venetoclax plus TACL in patients with relapsed/refractory acute lymphoblastic leukemia
Time frame: 16 months
Percentage of measurable residual disease in complete response
Describe the percentage of residual measurable disease in patients with complete response or complete response with incomplete hematologic recovery
Time frame: 16 months
Adverse events evaluatio
Identify the most frequent adverse events following the administration of venetoclax + TACL according to the CTCAE version 5 criteria
Time frame: 16 months
Patients recieving HSCT after chemotherapy
Determinate the percentage of patients who receive hematopoietic stem cell transplant after treatment with low dose venetoclax with itraconazole plus TACL
Time frame: 24 months
Event-free survival
Evaluate event-free survival following low dose venetoclax with itraconazole plus TACL regimen
Time frame: 24 months
Overall survival
Evaluate overall survival following low dose venetoclax with itraconazole plus TACL regimen
Time frame: 24 months
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Hospital Universitario Dr. Jose E. Gonzalez