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RecruitingInterventionalPhase 1/Phase 2

TINI 2: Total Therapy for Infants With Acute Lymphoblastic Leukemia II

NCT ID: NCT05848687Sponsor: Tanja Andrea GruberLast updated: 2026-06-03

Summary

The purpose of this study is to improve upon the TINI study treatment. The study will test the ability of a type of immunotherapy called blinatumomab to clear persistent leukemia. Blinatumomab targets CD19 which is located on the leukemia cells outer membrane.

Arms & interventions

  • DrugDexamethasone

    Given orally (PO) or naso-gastrically (NG) or intravenously (IV).

  • DrugMitoxantrone

    Given IV

  • DrugPEG asparaginase

    Given IV

  • DrugBortezomib

    Given IV

  • DrugVorinostat

    Taken PO or NG

  • DrugMercaptopurine

    Given PO or NG.

  • DrugMethotrexate

    Given IV, IM or PO

  • DrugBlinatumomab

    Will be administered at 15 mcg/m2/day for 28 days following induction and reinduction

  • DrugZiftomenib

    3+3 dose escalation will be done. Dose level 1 will start at 75% of the adult recommended phase two dosing which has been established in phase I studies. Based on tolerability, we will either de-escalate to 50% RP2D (dose level -1) or escalate to 100% RP2D

Outcome measures

Primary

  • Minimal Residual Disease

    Proportion of patients who are minimal residual disease positive at the end of Induction Intensification

    Time frame: 5 years and 2 months

Secondary

  • Ziftomenib Minimum safe and Biologically-Effective Dose in Combination with Chemotherapy

    Time frame: 5 years and 6 months

  • Event Free Survival

    Time frame: 8 years

  • Overall Survival

    Time frame: 8 years

Eligibility criteria

Sex: AllAge: Up to 1 YearHealthy volunteers: No
Inclusion Criteria: * Patient is ≤ 365 days of age at the time of diagnosis. * Patient has newly diagnosed CD19 positive acute lymphoblastic leukemia (ALL) or acute undifferentiated leukemia. Subjects with bilineage or biphenotypic acute leukemia are eligible provided they express CD19. Patients with CD19 positive mature B-cell ALL who carry a KMT2A rearrangement are eligible. * Limited prior therapy, including hydroxyurea for 72 hours or less, systemic glucocorticoids for one week or less, cytarabine for 72 hours or less, one dose of vincristine, and one dose of intrathecal chemotherapy. * Written informed consent following Institutional Review Board, NCI, FDA, and OHRP Guidelines. Exclusion Criteria: * Patients with prior therapy, other than therapy specified in inclusion criteria. * Patients with mature B-cell ALL that do not have a KMT2A rearrangement or patients with acute myelogenous (AML) or T-cell ALL. * Patients with Down syndrome. * Inability or unwillingness of legal guardian/representative to give written informed consent

Study locations (17)

Phoenix Children's Hospital

Phoenix, Arizona, 85016

Recruiting
Chris Oless, RN · Contact
Dana Salzberg, MD · Principal Investigator

Arkansas Children's Hospital

Little Rock, Arkansas, 72202

Recruiting
Kevin Bielamowicz, MD · Contact
Kevin Bielamowicz, MD · Principal Investigator

Children's Hospital Los Angeles

Los Angeles, California, 90027

Recruiting
Deepa Bhojwani, MD · Contact
Amber Medina · Contact
Deepa Bhojwani, MD · Principal Investigator

Valley Children's Hospital

Madera, California, 93636

Recruiting
Faisal Razzaqi, MD · Contact
Faisal Razzaqi, MD · Principal Investigator

Children's Hospital of Orange County

Orange, California, 92868

Recruiting
Jamie N Frediani, MD · Contact
Dorian Chan · Contact
Jamie N Frediani, MD · Principal Investigator

Stanford University

Palo Alto, California, 94304

Recruiting
Tanja A Gruber, MD, PhD · Contact

Rady Children's Hospital San Diego

San Diego, California, 92123

Not Yet Recruiting
Deborah Schiff, MD · Contact
Deborah Schiff, MD · Principal Investigator

Arnold Palmer Hospital for Children

Orlando, Florida, 32806

Recruiting
Claudia P Zapata, MD · Principal Investigator

Children's Hospital of Minnesota

Minneapolis, Minnesota, 55404

Recruiting
Michael K Richards, MD, PhD · Contact
Michael K Richards, MD, PhD · Principal Investigator

Memorial Sloan Kettering Cancer Center

New York, New York, 10065

Recruiting
Tanya Trippett, MD · Contact
Tanya Trippett, MD · Principal Investigator

Novant Health - Hemby Children's Hospital

Charlotte, North Carolina, 28204

Not Yet Recruiting
Christine Bolen, MD · Contact
Christine Bolen, MD · Principal Investigator

Doernbecher Children's Hospital

Portland, Oregon, 97239

Recruiting
Bill Hoon Chang, Md, PhD · Contact
Bill Hoon Chang, MD, PhD · Principal Investigator

Penn State Milton S Hershey Medical Center

Hershey, Pennsylvania, 17033-0850

Recruiting
Valerie Brown, MD,PhD · Contact
Valerie Brown, Md, PhD · Principal Investigator

MD Anderson

Houston, Texas, 77030

Recruiting
David McCall, MD · Contact

University of Texas Health Science Center San Antonio

San Antonio, Texas, 78229

Recruiting
Jaclyn Hung Y Hung, PhD · Contact
Anne-Marie Langevin, MD · Principal Investigator

University of Utah Huntsman Cancer Institute

Salt Lake City, Utah, 84108

Recruiting
David S Mangum, MD · Contact
David Mangum, MD · Principal Investigator

Children's Hospital of The King's Daughters

Norfolk, Virginia, 23507

Recruiting
Eric Lowe, MD · Contact
Eric Lowe, MD · Principal Investigator

References

  • Davis KL, Yao CC, Zimmerman JAO, Rau RE. Immunotherapy in B-Cell Acute Lymphoblastic Leukemia. J Natl Compr Canc Netw. 2025 Dec;23(12):e257067. doi: 10.6004/jnccn.2025.7067.(PubMed)
TINI 2: Total Therapy for Infants With Acute Lymphoblastic Leukemia II | Cancerify