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Testing the Addition of the Anti-cancer Drug Venetoclax and/or the Anti-cancer Immunotherapy Blinatumomab to the Usual Chemotherapy Treatment for Infants With Newly Diagnosed KMT2A-rearranged or KMT2A-non-rearranged Leukemia

  • PhasePhase 2
  • StatusRecruiting
  • Planned enrollment153 people
  • Recruiting US sites116
  • SponsorNational Cancer Institute (NCI)
  • RegistryNCT06317662

Recruitment re-checked on ClinicalTrials.gov Oct 30, 2026. Public record; not medical advice.

Testing the Addition of the Anti-cancer Drug Venetoclax and/or the Anti-cancer Immunotherapy Blinatumomab to the Usual Chemotherapy Treatment for Infants With Newly Diagnosed KMT2A-rearranged or KMT2A-non-rearranged Leukemia: a one-minute explainerNCT063176621 min

Eligibility

Who can join

The film gives the main points. The full list below is copied from the registry; the study team makes the final decision.

  • AgeNo minimum to 365 Days
  • SexAll
  • Healthy volunteersNo

You may be able to join if

  • All patients must be enrolled on APEC14B1 and consented to eligibility screening (part A) prior to treatment and enrollment on AALL2321
  • Infants (aged 365 days or less) on the date of diagnosis are eligible; infants must be > 36 weeks gestational age (cumulative prenatal and postnatal age must be > 36 weeks) at the time of enrollment
  • Patients must have newly diagnosed B-acute lymphoblastic leukemia (B-ALL, 2017 World Health Organization [WHO] classification), also termed B-precursor ALL, or acute leukemia of ambiguous lineage (ALAL), which includes mixed phenotype acute leukemia. For patients with ALAL, the immunophenotype of the leukemia must comprise at least 50% B lineage
  • Diagnostic immunophenotype: Leukemia cells must express CD19

You cannot join if

  • Patients with Down Syndrome
  • Patients with secondary B-ALL that developed after treatment of a prior malignancy with cytotoxic chemotherapy
  • Patients must not have received any cytotoxic chemotherapy for either the current diagnosis of infant ALL or for any cancer diagnosis prior to the initiation of protocol therapy, with the exception of:
  • Steroid pretreatment:
  • PredniSONE, prednisoLONE, or methylPREDNISolone for ≤ 72 hours (3 days) in the 7 days prior to enrollment. The dose of predniSONE, prednisoLONE or methylPREDNISolone does not affect eligibility
  • Inhaled and topical steroids are not considered pretreatment
  • Note: Pretreatment with dexamethasone in the 28 days prior to initiation of protocol therapy is not allowed with the exception of a single dose of dexamethasone used during or within 6 hours prior to or after sedation to prevent or treat airway edema. However, prior exposure to ANY steroids that occurred > 28 days before enrollment does not affect eligibility
  • Intrathecal cytarabine or methotrexate:
  • An intrathecal dose of cytarabine or methotrexate in the 7 days prior to enrollment does not affect eligibility
  • Note: The preference is to defer the diagnostic lumbar puncture with intrathecal chemotherapy to day 1 of induction to allow for cytoreduction of circulating blasts and decrease the potential for central nervous system (CNS) contamination due to a traumatic tap. If done prior to day 1 of induction, these results will be used to determine CNS status
  • Hydroxyurea:
  • Pretreatment with ≤ 72 hours (3 days) of hydroxyurea in the 7 days prior to enrollment does not affect eligibility
  • All patients and/or their parents or legal guardians must sign a written informed consent
  • All institutional, Food and Drug Administration (FDA) and National Cancer Institute (NCI) requirements for human studies must be met

The treatment

How it is intended to work

This is how the treatment is meant to work. Whether it helps, and how safe it is, is what this trial is testing.

autologous blinatumomab-expanded T cells. A preparation of autologous, peripheral blood-derived polyclonal activated T cells that have been expanded and activated ex-vivo using blinatumomab and recombinant human IL2 (rhIL-2) and depleted of contaminating CD19+ tumor cells, with potential immunomodulating activity. Upon administration, these blinatumomab-expanded T cells (BET), composed of functional polyclonal CD4+ and CD8+ T cells and mostly effector and central memory cells, may induce immunological recovery. BET cell expansion leads to the lysis and elimination of contaminating CD19+ tumor cells. The elimination of contaminating tumor cells is important in the treatment of non-Hodgkin CD20 + indolent lymphoma (iNHL) and chronic lymphatic leukemia (CLL). NCI Drug Dictionary

Treatments listed in the registry

  • Asparaginase Erwinia chrysanthemi (Drug): Given recombinant crisantaspase IM or crisantaspase IM or IV
  • Biospecimen Collection (Procedure): Undergo collection of blood samples
  • Blinatumomab (Biological): Given IV
  • Bone Marrow Aspiration (Procedure): Undergo bone marrow aspiration
  • Calaspargase Pegol (Drug): Given IV
  • Computed Tomography (Procedure): Undergo CT
  • Cyclophosphamide (Drug): Given IV
  • Cytarabine (Drug): Given IT or IV
  • Daunorubicin (Drug): Given IV
  • Dexamethasone (Drug): Given PO or NG or IV
  • Doxorubicin (Drug): Given IV
  • Echocardiography Test (Procedure): Undergo ECHO
  • FDG-Positron Emission Tomography (Procedure): Undergo FDG-PET
  • Leucovorin (Drug): Given PO or NG or IV
  • Levoleucovorin (Drug): Given IV
  • Lumbar Puncture (Procedure): Undergo lumbar puncture
  • Magnetic Resonance Imaging (Procedure): Undergo MRI
  • Mercaptopurine (Drug): Given PO or NG
  • Methotrexate (Drug): Given IT or IV or PO or NG
  • Methylprednisolone (Drug): Given IV
  • Multigated Acquisition Scan (Procedure): Undergo MUGA
  • Prednisolone (Drug): Given PO or NG
  • Prednisone (Drug): Given PO or NG
  • Therapeutic Hydrocortisone (Drug): Given IT
  • Thioguanine (Drug): Given PO or NG
  • Venetoclax (Drug): Given PO or NG
  • Vincristine (Drug): Given IV

The study

Treatment groups

Randomized · Sequential · masking: None

Arm A (Experimental)

See Detailed Description for Arm A.

Arm B, Cohort 1 (Experimental)

See Detailed Description for Arm B, Cohort 1.

Arm B, Cohort 2 (Experimental)

See Detailed Description for Arm B, Cohort 2.

Arm B, Cohort 3 (Experimental)

See Detailed Description for Arm B, Cohort 3.

Arm B, Cohort 4 (Experimental)

See Detailed Description for Arm B, Cohort 4.

Arm C (Experimental)

See Detailed Description for Arm C.

Safety Phase Cohort (Experimental)

See Detailed Description for Safety Phase Cohort. (CLOSED TO ACCRUAL 06/03/2026)

Steroid Prephase(prednisone, prednisolone, methylprednisolone) (Experimental)

All patients receive prednisone or prednisolone PO or NG TID or methylprednisolone IV TID for 7 days prior to the start of induction therapy (on days 1-7).

What it involves

Procedures

As the registry describes them. Requirements to join, such as a tissue sample, are in the eligibility list above even when on-study procedures are optional. Ask the study team which steps apply to you.

  • bone marrow: Part of the study plan
  • blood samples: Part of the study plan
  • CT scans: Part of the study plan; some time points described as optional
  • MRI: Part of the study plan; some time points described as optional
  • PET scans: Part of the study plan; some time points described as optional
  • echocardiogram: Part of the study plan
  • lumbar puncture: Part of the study plan; some time points described as optional

Goals

What the study measures

Main goals

  • Incidence of dose-limiting toxicities (DLTs) (safety phase) (For the duration of the induction + venetoclax cycle)
  • Incidence of DLTs (expansion phase) (During the induction, consolidation, and MARMA cycles of Arm B)
  • Minimal residual disease (MRD)-negative remission rate (At the end of induction)

Other goals

  • MRD-negative remission rate
  • Event free survival (EFS) rates of infants with KMT2A-R ALL
  • 3-year EFS of infants with KMT2A-R ALL
  • Proportion of KMT2A-germline (G) patients in Arm C who are able to receive all treatment cycles before maintenance
  • 3-year EFS of infants with KMT2A-G ALL treated on Arm C
  • Pharmacokinetics (PK) of venetoclax in infants

Planned enrollment: 153 (estimated).

Where

Recruiting US sites

  • Children's Hospital of Alabama, Birmingham, Alabama
  • Providence Alaska Medical Center, Anchorage, Alaska
  • Banner Children's at Desert, Mesa, Arizona
  • Arkansas Children's Hospital, Little Rock, Arkansas
  • Loma Linda University Medical Center, Loma Linda, California
  • Miller Children's and Women's Hospital Long Beach, Long Beach, California
  • UCSF Benioff Children's Hospital Oakland, Oakland, California
  • Kaiser Permanente-Oakland, Oakland, California
  • Children's Hospital of Orange County, Orange, California
  • University of California Davis Comprehensive Cancer Center, Sacramento, California
  • UCSF Medical Center-Mission Bay, San Francisco, California
  • Children's Hospital Colorado, Aurora, Colorado
  • Connecticut Children's Medical Center, Hartford, Connecticut
  • Yale University, New Haven, Connecticut
  • Alfred I duPont Hospital for Children, Wilmington, Delaware
  • Children's National Medical Center, Washington D.C., District of Columbia
  • UF Health Cancer Institute - Gainesville, Gainesville, Florida
  • Memorial Regional Hospital/Joe DiMaggio Children's Hospital, Hollywood, Florida
  • Nemours Children's Clinic-Jacksonville, Jacksonville, Florida
  • University of Miami Miller School of Medicine-Sylvester Cancer Center, Miami, Florida
  • AdventHealth Orlando, Orlando, Florida
  • Arnold Palmer Hospital for Children, Orlando, Florida
  • Nemours Children's Hospital, Orlando, Florida
  • Nemours Children's Clinic - Pensacola, Pensacola, Florida
  • Johns Hopkins All Children's Hospital, St. Petersburg, Florida
  • Saint Joseph's Hospital/Children's Hospital-Tampa, Tampa, Florida
  • Saint Mary's Medical Center, West Palm Beach, Florida
  • Children's Healthcare of Atlanta - Arthur M Blank Hospital, Atlanta, Georgia
  • Kapiolani Medical Center for Women and Children, Honolulu, Hawaii
  • Saint Luke's Cancer Institute - Boise, Boise, Idaho
  • Lurie Children's Hospital-Chicago, Chicago, Illinois
  • University of Chicago Comprehensive Cancer Center, Chicago, Illinois
  • Advocate Children's Hospital-Oak Lawn, Oak Lawn, Illinois
  • Advocate Children's Hospital-Park Ridge, Park Ridge, Illinois
  • OSF Children's Hospital of Illinois, Peoria, Illinois
  • Southern Illinois University School of Medicine, Springfield, Illinois
  • Riley Hospital for Children, Indianapolis, Indiana
  • Ascension Saint Vincent Indianapolis Hospital, Indianapolis, Indiana
  • Blank Children's Hospital, Des Moines, Iowa
  • University of Kentucky/Markey Cancer Center, Lexington, Kentucky
  • Norton Children's Hospital, Louisville, Kentucky
  • Children's Hospital New Orleans, New Orleans, Louisiana
  • Ochsner Medical Center Jefferson, New Orleans, Louisiana
  • Maine Children's Cancer Program, Scarborough, Maine
  • Sinai Hospital of Baltimore, Baltimore, Maryland
  • Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, Maryland
  • Dana-Farber Cancer Institute, Boston, Massachusetts
  • UMass Memorial Medical Center - University Campus, Worcester, Massachusetts
  • C S Mott Children's Hospital, Ann Arbor, Michigan
  • Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital, Grand Rapids, Michigan
  • Bronson Methodist Hospital, Kalamazoo, Michigan
  • University of Minnesota/Masonic Cancer Center, Minneapolis, Minnesota
  • University of Mississippi Medical Center, Jackson, Mississippi
  • Children's Mercy Hospitals and Clinics, Kansas City, Missouri
  • Washington University School of Medicine, St Louis, Missouri
  • Mercy Hospital Saint Louis, St Louis, Missouri
  • Children's Hospital and Medical Center of Omaha, Omaha, Nebraska
  • Alliance for Childhood Diseases/Cure 4 the Kids Foundation, Las Vegas, Nevada
  • Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center, Lebanon, New Hampshire
  • Hackensack University Medical Center, Hackensack, New Jersey
  • Morristown Medical Center, Morristown, New Jersey
  • Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital, New Brunswick, New Jersey
  • Saint Joseph's Regional Medical Center, Paterson, New Jersey
  • Albany Medical Center, Albany, New York
  • Roswell Park Cancer Institute, Buffalo, New York
  • The Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York
  • Laura and Isaac Perlmutter Cancer Center at NYU Langone, New York, New York
  • Memorial Sloan Kettering Cancer Center, New York, New York
  • NYP/Weill Cornell Medical Center, New York, New York
  • University of Rochester, Rochester, New York
  • State University of New York Upstate Medical University, Syracuse, New York
  • Montefiore Medical Center - Moses Campus, The Bronx, New York
  • New York Medical College, Valhalla, New York
  • UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
  • Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina
  • Duke University Medical Center, Durham, North Carolina
  • East Carolina University, Greenville, North Carolina
  • Wake Forest University Health Sciences, Winston-Salem, North Carolina
  • Sanford Broadway Medical Center, Fargo, North Dakota
  • Children's Hospital Medical Center of Akron, Akron, Ohio
  • Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
  • Rainbow Babies and Childrens Hospital, Cleveland, Ohio
  • Dayton Children's Hospital, Dayton, Ohio
  • ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital, Toledo, Ohio
  • University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
  • Lehigh Valley Hospital-Cedar Crest, Allentown, Pennsylvania
  • Geisinger Medical Center, Danville, Pennsylvania
  • Penn State Children's Hospital, Hershey, Pennsylvania
  • Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
  • Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
  • Rhode Island Hospital, Providence, Rhode Island
  • Prisma Health Richland Hospital, Columbia, South Carolina
  • BI-LO Charities Children's Cancer Center, Greenville, South Carolina
  • Sanford USD Medical Center - Sioux Falls, Sioux Falls, South Dakota
  • East Tennessee Childrens Hospital, Knoxville, Tennessee
  • Saint Jude Children's Research Hospital, Memphis, Tennessee
  • The Children's Hospital at TriStar Centennial, Nashville, Tennessee
  • Vanderbilt University/Ingram Cancer Center, Nashville, Tennessee
  • Dell Children's Medical Center of Central Texas, Austin, Texas
  • Driscoll Children's Hospital, Corpus Christi, Texas
  • Medical City Dallas Hospital, Dallas, Texas
  • UT Southwestern/Simmons Cancer Center-Dallas, Dallas, Texas
  • El Paso Children's Hospital, El Paso, Texas
  • Cook Children's Medical Center, Fort Worth, Texas
  • Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center, Houston, Texas
  • Children's Hospital of San Antonio, San Antonio, Texas
  • Methodist Children's Hospital of South Texas, San Antonio, Texas
  • Scott and White Memorial Hospital, Temple, Texas
  • University of Virginia Cancer Center, Charlottesville, Virginia
  • Children's Hospital of The King's Daughters, Norfolk, Virginia
  • VCU Massey Comprehensive Cancer Center, Richmond, Virginia
  • Carilion Children's, Roanoke, Virginia
  • Seattle Children's Hospital, Seattle, Washington
  • Providence Sacred Heart Medical Center and Children's Hospital, Spokane, Washington
  • Saint Vincent Hospital Cancer Center Green Bay, Green Bay, Wisconsin
  • Children's Hospital of Wisconsin, Milwaukee, Wisconsin

1 recruiting sites outside the US. Site status as of Oct 30, 2026. Check the live record before contacting a site.

Sources

Where this comes from

Registry record reviewed as fetched Oct 30, 2026, last updated by the sponsor Oct 26, 2026. Public record; not medical advice.

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