VA-CIG Regimen for Previously Untreated Acute Myeloid Leukemia: A Multicenter Prospective Single-Arm Trial

• Venetoclax, Azacitidine, Cytarabine, Idarubicin, G-CSF (Drug): * Venetoclax: 100 mg on Day 1, 200 mg on Day 2, 400 mg on Day 3, and 400 mg on Days 4-14, orally, once daily; * Azacitidine: 75 mg/m²/d, subcutaneous injection, on Days 1-7; * Cytarabine: 100 mg/m²/d, intravenous infusion, on Days 1-5; * Idarubicin: 6 mg/m²/d, intravenous infusion, on Days 1-3; * Human granulocyte colony-stimulating factor (G-CSF): 200 μg/m²/d, subcutaneous injection, from Day 0 until the white blood cell count > 10×10⁹/L. One cycle lasts for 28 days

Primary outcomes

• Composite complete response rate (CR+CRi) [At the end of Cycle 1 (each cycle is 28 days)]: CR is defined as: following two cycles of induction therapy, a blast count of < 5% in the bone marrow, absence of Auer rods, no evidence of extramedullary leukemia, and peripheral blood absolute neutrophil count (ANC) and platelet count of > 1×10⁹/L and > 100×10⁹/L, respectively. CRi is defined as: fulfilling all criteria for CR, except for a persistent absolute neutrophil count (ANC) < 1×10⁹/L or a persistent platelet count < 100×10⁹/L.

Secondary outcomes

• MRD remission rate [At the end of Cycle 1 (each cycle is 28 days)]: Defined as: the number of patients who achieved MRD-negative status after induction therapy / the total number of patients who underwent MRD testing at that time point × 100%; MRD-negative is defined as an MRD level < 10-⁴ in bone marrow samples;
• Adverse events [Start of treatment to 2 weeks after end of treatment]: Number of subjects with each adverse event.

Sex: All, ages: 18 Years to 70 Years

Inclusion Criteria:

* Diagnosis of acute myeloid leukemia (AML, excluding acute promyelocytic leukemia) confirmed by morphology, immunophenotyping and molecular genetics, in accordance with the WHO 2022 diagnostic criteria for AML;
* Age 18-70 years, with no gender restriction;
* No prior AML-related treatment has been received; exceptions are made for the use of hydroxyurea or similar agents during the diagnostic screening phase to control peripheral blood leukemic blasts;
* Patients must be assessed as tolerable to intensive chemotherapy regimens; evaluation of tolerance to intensive chemotherapy shall be performed in accordance with the Ferrara 2013 criteria (Appendix A);
* Eastern Cooperative Oncology Group (ECOG) performance status score ≤ 2;
* Serum creatinine ≤ 2.0 × upper limit of normal (ULN), or creatinine clearance > 40 mL/min calculated by the Cockcroft-Gault formula for glomerular filtration rate (GFR);
* Total bilirubin ≤ 2 × ULN, and aspartate aminotransferase (AST) or alanine aminotransferase (ALT) ≤ 3 × ULN;
* Left ventricular ejection fraction (LVEF) ≥ 45%, or LVEF measured by echocardiography (ECHO) within the normal range;
* Expected survival > 3 months.

Exclusion Criteria:

* Subjects with a history of myeloproliferative neoplasms (MPNs), including myelofibrosis, essential thrombocythemia, polycythemia vera, chronic myeloid leukemia (CML) with or without BCR-ABL1 translocation, and acute myeloid leukemia (AML) with BCR-ABL1 translocation;
* Patients with a prior history of venetoclax or azacitidine (Aza) treatment for other diseases;
* Known hypersensitivity to any component of the investigational medicinal products;
* History of other concurrent malignancies within 2 years prior to enrollment, except:

Adequately treated carcinoma in situ of the cervix or breast; Basal cell carcinoma or localized squamous cell carcinoma of the skin; Previously controlled malignancies treated with radical surgical resection (or other curative modalities), etc.

* Presence of uncontrolled severe infection or active bleeding;
* Pregnant or lactating women;
* Subjects with active, treatment-uncontrolled viral infection caused by HIV, hepatitis B virus, or hepatitis C virus;
* Subjects with evidence of central nervous system leukemia before treatment initiation;
* Women of childbearing potential who do not agree to use at least one reliable contraceptive method from Day 1 of the study until 90 days after the last dose of study medication; sexually active male subjects who do not agree to use contraceptive measures from Day 1 of the study until 90 days after the last dose of study medication; male subjects who do not agree to refrain from sperm donation from the start of study drug administration until at least 90 days after the last dose;
* Subjects with epilepsy requiring pharmacotherapy, dementia, or other abnormal psychiatric conditions that impair the ability to understand or comply with the study protocol;
* Presence of psychiatric disorders or cognitive impairment that prevents cooperation with treatment and follow-up; conditions limiting oral drug intake or gastrointestinal absorption.