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Clonal Cytopenia of Undetermined SignificancePhase 2NCT05641831

Canakinumab for the Prevention of Progression to Cancer in Patients With Clonal Cytopenias of Unknown Significance, IMPACT Study

A Phase 2 study testing Biospecimen Collection, Bone Marrow Aspiration and Biopsy and Canakinumab in people with Clonal Cytopenia of Undetermined Significance, run by Uma Borate at 6 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

This phase II trial tests how well canakinumab works to prevent progression to cancer in patients with clonal cytopenias of unknown significance (CCUS). CCUS is a blood condition defined by a decrease in blood cells. Blood cells are composed of either red blood cells, white blood cells, or platelets. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Biospecimen Collection, Bone Marrow Aspiration and Biopsy and Canakinumab
Type of treatment
Surgery or procedure
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
110 participants
Where
6 sitesUnited States
Study dates
6 Feb 2023to 31 Dec 2028
Phase
Phase 2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients with age >= 18 with high-risk CCUS
  • Must meet ALL the following criteria:
  • Unexplained, clinically meaningful cytopenias (greater than 4 months) in one or more of the following lineages: erythroid cells, neutrophils, platelets. Clinically meaningful cytopenia is institution specific and threshold may vary on age, sex, and race. Decision-making should depend upon lab values specific to the institution and supersede public works. Based upon published work, significant cytopenias are defined as the following (must meet criteria in at least one lineage):
  • Erythroid Cells:
  • Hemoglobin < 11 g/dL
  • White Blood Cells:
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  • Absolute Neutrophil Count < 1800/microL and > 500/microL
  • Platelets:
  • Platelet Count < 150,000/microL and > 50,000/microL
  • MDS criteria not fulfilled
  • No other evidence of hematological malignancy
  • No or only mild (< 10%) bone marrow dysplasia
  • Blast cells < 5% detected via morphologic examination of blood and/or bone marrow smears which can also be supported by flow cytometry and/or immunohistochemical studies
  • Any of the following:
  • Isolated somatic spliceosome mutation at any VAF (SRSF2, SF3B1, U2AF1, or ZRSR2)
  • Isolated TP53 mutation greater than 5% VAF
  • At least 1 mutation in TET2, DMNT3A, or ASXL1 at any VAF coupled with at least 1 other known myeloid pathogenic somatic mutation or known pathogenic germline mutation that predisposes to myeloid malignancy as determined by next generation sequencing and bone marrow biopsy
  • A TET2, DMNT3A, or ASXL1 greater than 10% VAF coupled with another TET2, DMNT3A, or ASXL1 greater than 10% VAF
  • The presence of two or more known myeloid pathogenic somatic or germline mutations (other than TET2, ASXL1, DMNT3A, TP53, or spliceosome mutations) greater than 10% VAF
  • Ability to understand and willingness to sign the written informed consent document
  • Eastern Cooperative Oncology Group (ECOG) performance status 0, 1, or 2
  • Patients with a history of hypertension or active hypertension are strongly encouraged to optimize blood pressure control
  • Creatinine clearance greater than 45 ml/min using Cockcroft-Gault
  • Total bilirubin =< 1.5 x ULN
  • Aspartate transaminase (AST) < 3 x ULN
  • Alanine transaminase (ALT) < 3 x ULN

Who cannot join

  • Concurrent malignancy requiring active systemic therapy
  • Diagnosis of MDS or any other myeloid malignancy in the patient's lifetime
  • History of Hypersensitivity to canakinumab or drug of a similar class
  • Active infection requiring prompt evaluation and treatment or history of recurrent infections
  • Known active or recurrent hepatic disorder including cirrhosis, hepatitis B and C (via positive or indeterminate central laboratory [lab] results)
  • Subjects with active tuberculosis. In subjects with a history of tuberculosis but without active tuberculosis, if the results of the evaluation require treatment per local guidelines, then the treatment should be initiated before randomization (unless otherwise required by Health Authorities or Institutional Review Board (IRB) in which case curative treatment must be completed prior to screening)
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  • Subjects with suspected or proven immunocompromised state or infections. If the results of this screening per local treatment guidelines or clinical practice require treatment for said infection then the patient is not eligible. Suspected or proven immunocompromised states or infections include:
  • Those with any other medical condition such as active infection, treated or untreated, which in the opinion of the investigator places the subject at an unacceptable risk for participation in immunomodulatory therapy. If in the opinion of the investigator, the patient's immunocompromised state does not pose an unacceptable risk for participation, in the absence of uncontrolled infection, and the patient does not have a history of serious infections (such as tuberculosis); then the patient may participate in this study.
  • Known history of testing positive for human immunodeficiency virus (HIV) infections. For countries where HIV status is mandatory: testing positive for HIV during screening using a local test.
  • Allogeneic bone marrow or solid organ transplant (history of any or within a certain period of time?)
  • Those requiring systemic or local treatment in doses with systemic effects e.g.:
  • Prednisone > 20 mg (or equivalent) oral or intravenous daily for > 14 days
  • Prednisone > 5 mg and =< 20 mg (or equivalent) daily for > 30 days
  • Equivalent dose of methotrexate > 15 mg weekly
  • Note: Azathioprine is allowed. Daily glucocorticoid-replacement for conditions such as adrenal or pituitary insufficiency is allowed. Topical, inhaled or local steroid use in doses that are not considered to cause systemic effects are permitted. Steroids for pre-medication related to chemotherapy as per local standard of care are permitted.
  • Live or attenuated vaccination within 3 months prior to first dose of study drug (e.g. Measles/Mumps/Rubella [MMR], Yellow Fever, Rotavirus, Smallpox, etc.) and after initiation of canakinumab treatment
  • Use of erythropoietin stimulating agents (ESA) or growth factors within four weeks prior to the start of the study
  • Pregnant or nursing women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive human chorionic gonadotropin (hCG) laboratory test. Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using basic methods of contraception during dosing of study treatment and for up to 130 days after last dose of study drug. Basic contraception methods include:
  • Total abstinence (when this is in line with the preferred and usual lifestyle of the subject. Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception
  • Female sterilization (have had surgical bilateral oophorectomy with or without hysterectomy), total hysterectomy or bilateral tubal ligation at least 6 weeks before taking study treatment. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment
  • Male sterilization (at least 6 months prior to screening). For female subjects on the study, the vasectomized male partner should be the sole partner for that subject
  • Barrier methods of contraception: Condom or Occlusive cap (diaphragm or cervical/vault caps). For UK: with spermicidal foam/gel/film/cream/ vaginal suppository
  • Use of oral, injected or implanted hormonal methods of contraception or other forms of hormonal contraception that have comparable efficacy (failure rate < 1%), for example hormone vaginal ring or transdermal hormone contraception or placement of an intrauterine device (IUD) or intrauterine system (IUS). In case of use of oral contraception women should have been stable on the same pill for a minimum of 3 months before taking study treatment. Prior to entry into this study, cisplatin-based chemotherapy, which may be toxic to the fetus, may be given. The time between the end of cisplatin-based chemotherapy and the start canakinumab/placebo treatment is variable, resulting in a variable need for continuation of highly effective contraception. Women are considered post-menopausal and not of child bearing potential if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (i.e. age appropriate, history of vasomotor symptoms) or have had surgical bilateral oophorectomy (with or without hysterectomy), total hysterectomy, or bilateral tubal ligation at least six weeks prior to first dose of study drug. In the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment is she considered not of child bearing potential. If local regulations deviate from the contraception methods listed above to prevent pregnancy, local regulations apply and will be described in the Informed Consent Form (ICF).

Trial locations and contacts

6 sites in 1 country. Contact the study team or a site near you to ask about taking part.

The Ohio State University Comprehensive Cancer Center contact

800-293-5066

OSUCCCClinicaltrials@osumc.edu

6 sites in 1 country

United States6 sites, 6 recruiting

  • Ohio State University Comprehensive Cancer Center

    Columbus, Ohio, 43210

    Uma M. Borate, MD, MS, 614-293-3316, borate.2@osu.edu

    Uma M. Borate, MD, MS

    Recruiting

  • UT Southwestern Medical Center at Dallas

    Dallas, Texas, 75235

    Donglan Xia, PhD, BSN, 214-645-9656, Donglan.Xia@utsouthwestern.edu

    Silviya Meletath, MD, MBS, 909-560-9597, silviya.meletath@utsouthwestern.edu

    Recruiting

  • University of Miami

    Miami, Florida, 33136

    Namrata Chandhok, MD, 305-243-8238, nxc691@miami.edu

    Namrata S Chandhok, MD

    Recruiting

  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37232

    Vanderbilt University Medical Center, 1-800-811-8480, cip@vumc.org

    Ashwin Kishtagari, MD

    Recruiting

  • Weill Cornell Medical College

    New York, New York, 10021

    Pinkal Desai, M.D., 646-962-2700

    Pinkal Desai, M.D.

    Recruiting

  • Memorial Sloan Kettering Cancer Center

    New York, New York, 10065

    Tamanna Haque, MD, 646-608-4166, haquet1@mskcc.org

    Tamanna Haque, MD

    Recruiting

Other trials in United States

About this study

Official title: A Randomized Double-Blind Placebo-Controlled Phase II Multi-Center Study of Inflammation Modification of Canakinumab to Prevent Leukemic Progression of Clonal Cytopenias of Unknown Significance (CCUS): IMPACT Study

This phase II trial tests how well canakinumab works to prevent progression to cancer in patients with clonal cytopenias of unknown significance (CCUS). CCUS is a blood condition defined by a decrease in blood cells. Blood cells are composed of either red blood cells, white blood cells, or platelets. In patients with CCUS, blood counts have been low for a long period of time. Patients with CCUS also have a mutation in one of the genes that are responsible for helping blood cells develop. The combination of genetic mutations and low blood cell counts puts patients with CCUS at a higher risk to develop blood cancers in the future. This transformation from low blood cell counts to cancer may be caused by inflammation in the body. Canakinumab is a monoclonal antibody that may block inflammation in the body by targeting a specific antibody called the anti-human interleukin-1beta (IL-1beta).

Read the detailed description

PRIMARY OBJECTIVE:

  1. To evaluate the length of time until development of a myeloid neoplasm (ie myelodysplastic syndrome [MDS], myeloproliferative neoplasm [MPN], chronic myelomonocytic leukemia [CMML], or acute myeloid leukemia [AML]) in high-risk clonal cytopenia of undetermined significance (CCUS) patients receiving canakinumab as therapeutic intervention compared to the control arm.

SECONDARY OBJECTIVES:

  1. To determine the effect of canakinumab on hematological overall response rate.

II. To determine the effect of canakinumab on complete hematological response rate.

III. To determine the effect of canakinumab on response duration. IV. To determine the effect of canakinumab on overall survival. V. To determine the effect of canakinumab on mutational burden. VI. To determine the effect of canakinumab on infection-related adverse events. VII. To determine the effect of canakinumab on recovery of blood cell populations.

VIII. To determine the effect of canakinumab on cardiovascular episodes compared to a control arm.

IX. Patient reported outcomes will be collected using European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C3).

EXPLORATORY OBJECTIVES:

  1. To quantify changes in the bone marrow (BM) microenvironment according to immune cell constitution and cytokine levels over the course of canakinumab treatment compared to a control arm.

II. To characterize the inflammatory milieu in peripheral blood (PB) and BM samples by serial measurement and characterization of key cytokines (IL-1, IL-2, IL-6, TNF alpha and beta, and IFN-gamma), sensitivity of patient samples to these cytokines and relationships to various genes involved in clonal hematopoiesis.

III. To determine the dynamics of change in clone size of various CH genes in serial patient treatment and control samples, during the study, by a variety of assays including single cell sequencing, copy number alterations, and variant allele frequency (VAF) measurement to characterize differences in disease evolution.

IV. To collect serial measurement of immune cell populations in PB and BM of serial patient treatment and control samples, during the study, to characterize various immune cells involving both the innate and adaptive immune system including natural killer (NK) cell, T cell subsets namely effector, regulatory and memory T cells as well as various cell surface molecules such as checkpoint modulators (PD-1/PD-L1/TIM-3, LAG-3).

  1. To understand the effect of global effects on the BM microenvironment of CH status/post (s/p) canakinumab treatment compared to the control patients using ribonucleic acid (RNA) sequencing and global methylation assays to further characterize unique genomic signatures in these patients.

OUTLINE: Patients are randomized to one of two arms.

ARM I: Patients receive canakinumab subcutaneously (SC) on study.

ARM II: Patients receive placebo SC on study.

All patients also undergo echocardiogram (ECHO) and chest x-ray during screening, collection of blood samples during screening and follow up, and bone marrow biopsy and aspiration throughout the trial.

Being tested
Biospecimen Collection, Bone Marrow Aspiration and Biopsy, Canakinumab, Chest Radiography, Echocardiography

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Biospecimen CollectionProcedure or surgery

    Also called Biological Sample Collection, Biospecimen Collected, Specimen Collection

    Undergo peripheral blood collection

  • Bone Marrow Aspiration and BiopsyProcedure or surgery

    Undergo bone marrow biopsy and aspiration

  • CanakinumabDrug

    Also called ACZ885, Ilaris

    Given SC

  • Chest RadiographyProcedure or surgery

    Also called Chest X-ray

    Undergo chest x-ray

  • EchocardiographyProcedure or surgery

    Also called EC

    Undergo ECHO

  • Placebo AdministrationDrug

    Given SC

  • Quality-of-Life AssessmentOther

    Also called Quality of Life Assessment

    Ancillary studies

Study groups in NCT05641831
Study groupRoleWhat they receive
ARM I (canakinumab)ExperimentalPatients receive canakinumab SC on study. All patients also undergo ECHO and chest x-ray during screening, collection of blood samples during screening and follow up, and bone marrow biopsy and aspiration throughout the trial.
Receives: Procedure: Biospecimen Collection; Procedure: Bone Marrow Aspiration and Biopsy; Drug: Canakinumab; Procedure: Chest Radiography; Procedure: Echocardiography; Other: Quality-of-Life Assessment
ARM II (placebo)Placebo comparatorPatients receive placebo SC on study. All patients also undergo ECHO and chest x-ray during screening, collection of blood samples during screening and follow up, and bone marrow biopsy and aspiration throughout the trial.
Receives: Procedure: Biospecimen Collection; Procedure: Bone Marrow Aspiration and Biopsy; Procedure: Chest Radiography; Procedure: Echocardiography; Drug: Placebo Administration; Other: Quality-of-Life Assessment

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Time to overt myeloid malignancy

    Will be estimated with the non-parametric Kaplan-Meier method to compute the median time as well as the percentage of study participants with a diagnosed hematologic malignancy of myelodysplastic syndrome (MDS), myeloproliferative neoplasm (MPN), chronic myelomonocytic leukemia (CMML)/ acute myeloid leukemia (AML) at landmark time points (e.g., 1-year, 2-years) with corresponding 95% confidence intervals. Since this method will censor patients who die without having developed MDS/MPN/CMML/AML, we will also compute the cumulative incidence of overt myeloid malignancy that accounts for the competing risk of death in the absence of a hematologic malignancy. All randomized patients will be included in the primary endpoint analysis in the arm to which they were randomized (ie, intent-to-treat population).

    Measured: From the date of randomization until the first date of overt myeloid malignancy diagnosis, assessed up to 6 years

Secondary outcomes (9)

  1. Hematological overall response rate

    Number of patients that achieve response divided by the number or randomized patients. Will be summarized using the method of Kaplan-Meier but also using the cumulative incidence function which would treat death in the absence of documented relapse as a completing risk.

    Measured: 6 month assessment

  2. Complete hematological response rate

    Number of patient that achieve complete response divided by the number of randomized patients. Will be summarized using the method of Kaplan-Meier but also using the cumulative incidence function which would treat death in the absence of documented relapse as a completing risk.

    Measured: 6 month assessment

  3. Duration of hematological response

    Will be summarized using the method of Kaplan-Meier but also using the cumulative incidence function which would treat death in the absence of documented relapse as a completing risk.

    Measured: From the date of first documented hematological response until the date of documented diagnosis of MDS, MPN, CMML, or AML, assessed up to 6 years

  4. Overall survival

    Will be estimated using the method of Kaplan-Meier and estimates at landmark time points (e.g., 1-year, 2-years) will be provided with corresponding 95% confidence intervals.

    Measured: From the date of registration until the date of death from any cause, assessed up to 6 years

  5. Changes in variant allele frequencies (VAFs) of somatic mutations

    Will be assessed by bone marrow biopsy (BMBx) samples with next generation sequencing (NGS). VAFs will be analyzed as a continuous variable and as the proportion of patients with at least a 50% of reduction in VAFs of somatic mutations relative to baseline using an Ion Torrent platform.

    Measured: Up to 6 years

  6. Infection-related adverse event rates

    The number of patients who have an adverse event of interest divided by the number of patients who have adverse events assessed.

    Measured: Up to 6 years

  7. Recovery of blood cell populations

    Changes in the percentages of lymphocytes and specific sub-types (ie T-cells) as well as erythroid, platelet, and neutrophil response via 2016 World Health Organization (WHO) International Working Group (IWG) hematological improvement criteria before and after therapy as assessed in bone marrow (BM) and hematological samples.

    Measured: Up to 6 years

  8. Cardiovascular episodes

    The number of patients who has a cardiovascular event of interest divided by the number of patients who have adverse events assessed.

    Measured: Up to 6 years

  9. Patient reported outcomes

    Outcomes reported using EORTC QLQ-C30 and compared between the two arms.

    Measured: Up to 6 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Dec 2022
  2. Study start6 Feb 2023
  3. Primary completion31 Dec 2028 (estimated)
  4. Study completion31 Dec 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
110 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05641831
Sponsor's protocol ID
OSU-22091
Other IDs
NCI-2022-09409
Status last verified
Dec 2025
First submitted
29 Nov 2022
Last updated
2 Jan 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Biospecimen Collection, Bone Marrow Aspiration and Biopsy and Canakinumab in people with Clonal Cytopenia of Undetermined Significance, run by Uma Borate at 6 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 26 inclusion and 23 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 2 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact The Ohio State University Comprehensive Cancer Center (800-293-5066, OSUCCCClinicaltrials@osumc.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Time to overt myeloid malignancy (time frame: From the date of randomization until the first date of overt myeloid malignancy diagnosis, assessed up to 6 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05641831.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Jan 2026.

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