Venetoclax and a Pediatric-Inspired Regimen for the Treatment of Newly Diagnosed B Cell Acute Lymphoblastic Leukemia

Inclusion Criteria

• Documented informed consent of the participant and/or legally authorized representative
• Age between 18 and 54 years
• Eastern Cooperative Oncology Group (ECOG) =< 2
• Histologically confirmed B-cell ALL according to World Health Organization criteria * Note: Lymphoblastic leukemia is included as long as there is bone marrow involvement
• Newly diagnosed disease with >= 5% blasts in the marrow
• For the Ph-like expansion cohort, documentation of CRLF2-rearrangement by fluorescent in situ hybridization (FISH)
• White blood cell count less than 25 x 10^9/L prior to initiation of venetoclax. Cytoreduction with hydroxyurea or steroid or a single dose of intrathecal chemotherapy prior to treatment may be required (performed within 14 days prior to day 1 of protocol therapy unless otherwise stated)
• Total bilirubin =< 1.5 X upper limit of normal (ULN) (unless has Gilbert’s disease or underlying leukemia, =< 3 X ULN) (performed within 14 days prior to day 1 of protocol therapy unless otherwise stated)
• Aspartate aminotransferase (AST) =< 2.5 x ULN (performed within 14 days prior to day 1 of protocol therapy unless otherwise stated) * Unless it is related to underlying leukemia
• Alanine aminotransferase (ALT) =< 2.5 x ULN (performed within 14 days prior to day 1 of protocol therapy unless otherwise stated) * Unless it is related to underlying leukemia
• Creatinine clearance of >= 60 mL/min per 24 hour urine test or the Cockcroft-Gault formula (performed within 14 days prior to day 1 of protocol therapy unless otherwise stated)
• Left ventricular ejection fraction (LVEF) >= 50% * Note: Echocardiogram to be performed within 42 days prior to day 1 of protocol therapy
• Seronegative for active hepatitis B virus (HBV) (surface antigen negative and anti-HB core antibody [c] negative) for CD20+ patients only * Note Infectious disease testing to be performed within 28 days prior to day 1 of protocol therapy
• Women of childbearing potential (WOCBP): Negative urine or serum pregnancy test. (performed within 14 days prior to Day 1 of protocol therapy unless otherwise stated) * If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
• Agreement by females and males of childbearing potential* to use an effective method of birth control (non-hormonal) or abstain from heterosexual activity for the course of the study through at least 3 months after the last dose of protocol therapy. For CD20+ participants taking rituximab, effective birth control or abstinence to be used for at least 12 months after last dose * Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for > 1 year (women only

Exclusion Criteria

• Leukemia-based therapy with chemotherapy with the exception of: * Cytoreduction with steroid or hydroxyurea or a single dose of intrathecal chemotherapy is allowed before initiating the study * Prior treatment with all-trans-retinoic acid (ATRA) for suspected acute promyelocytic leukemia (APL) is allowed
• Strong or moderate CYP3A4 inducers within 14 days prior to day 1 of protocol therapy
• Subjects who have consumed grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges) or Star fruit within 3 days prior to the first dose of study drug
• Live vaccines
• Known presence of philadelphia chromosome positive (Ph+; t(9;22)), MLL-rearrangement, t(12;21), and t(1;19). Cases with documented CRLF2-rearrangement in the absence Ph+ disease are allowed regardless of MLL-rearrangement, t(12;21) or t(1;19); Note: For the Ph-like expansion cohort, only known presence of Ph + and absence of CRLF2r by FISH will be an exclusion
• T cell ALL
• Class III/IV cardiovascular disability according to the New York Heart Association Classification. Subjects with controlled, asymptomatic atrial fibrillation can enroll
• Parenchymal central nervous system (CNS) involvement requiring cranial radiation
• Participants with clinically significant arrhythmia or arrhythmias not stable on medical management within two weeks of enrollment
• History of acute cardiovascular ischemic event, i.e., myocardial infarction or unstable angina within 6 months of enrollment
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to study agent
• Clinically significant uncontrolled illness
• Uncontrolled active infection
• Other active malignancy
• Females only: Pregnant or breastfeeding
• Any other condition that would, in the Investigator’s judgment, contraindicate the patient’s participation in the clinical study due to safety concerns with clinical study procedures
• Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)