This phase II MyeloMATCH treatment trial compares the usual treatment of azacitidine and venetoclax to the combination treatment of azacitidine, venetoclax and gilteritinib in treating older and unfit patients with acute myeloid leukemia and FLT3 mutations. Azacitidine is a drug that is absorbed into DNA and leads to the activation of cancer suppressor genes, which are genes that help control cell growth. Venetoclax is in a class of medications called B-cell lymphoma-2 (BCL-2) inhibitors. It may stop the growth of cancer cells by blocking Bcl-2, a protein needed for cancer cell survival. Gilteritinib is in a class of medications called kinase inhibitors. It works by blocking the action of a certain naturally occurring substance that may be needed to help cancer cells multiply. This study may help doctors find out if these different approaches are better than the usual approaches. To decide if they are better, the study doctors are looking to see if the study drugs lead to a higher percentage of patients achieving a deeper remission compared to the usual approach.
Patient must be ≥ 60 years of age or adults ˂ 60 who in the opinion of the treating physician are better served by azanucleoside-based therapy rather than intensive, cytarabine-based induction based on clinical status (i.e., performance status), organ dysfunction, or disease biology
Patient must have a morphologically confirmed diagnosis of AML as determined by the site and confirmed by the treatment verification team, excluding acute promyelocytic leukemia (APL) with PML-RARA, AML with RUNX1-RUNX1T1, or AML with CBFB-MYH11
Patient must have no prior therapy for AML with the exception of hydroxyurea, all-trans retinoic acid (ATRA), cytarabine-based emergency therapy or leukapheresis to ensure white blood cells (WBC) < 25,000/mm^3 prior to starting venetoclax treatment
Patient must have no prior therapy with hypomethylating agents or FLT3 inhibitors
None
Parallel
Azacitidine
DrugGiven IV or SC
Biospecimen Collection
Procedure/SurgeryUndergo blood sample collection
Bone Marrow Aspiration
Procedure/SurgeryUndergo bone marrow biopsy and aspiration
Bone Marrow Biopsy
Procedure/SurgeryUndergo bone marrow biopsy and aspiration
Gilteritinib
DrugGiven PO
Venetoclax
DrugGiven PO
Rate of measured residual disease (MRD) negative complete remission (CR)
Will be assessed by multiparameter flow cytometry at a level of ≤ 1 residual blast / 1,000 leukocytes (≤ 10\^-3). Patients achieved MRD negative CR at any time up to 4 cycles will count as a responder. The MRD negative CR frequencies will be compared between each triplet regimen and the control regimen using Fisher's exact test with one-sided alpha of 0.05 for each comparison. Test results with one-sided p-value \< 0.05 will be considered statistically significant.
Rate of MRD negative CR/CR with incomplete count recovery (CRi)/CR with partial hematologic recovery (CRh)
Patients who achieved MRD negative CR at any time up to 4 cycles will count as a responder. The MRD negative CR frequencies will be compared between each triplet regimen and the control regimen using Fisher's exact test with one-sided alpha of 0.05 for each comparison. Test results with one-sided p-value \< 0.05 will be considered statistically significant.
Rate of CR
The CR rates will be compared using Fisher's exact test. Only nominal p-values will be provided.
Rate of CRi
The CR rates will be compared using Fisher's exact test. Only nominal p-values will be provided.
Rate of CRh
The CR rates will be compared using Fisher's exact test. Only nominal p-values will be provided.
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