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ideasIdea

Menin inhibitors for infant KMT2A-rearranged ALL

Infant leukaemia is driven almost entirely by KMT2A fusions, which menin inhibitors were built to attack. Add them to the new blinatumomab-containing backbone.

Infant ALL EFS plateaued below 50% for two decades; blinatumomab (Interfant-21) is the first step forward. Revumenib is approved for KMT2Ar acute leukaemia including children ≥1 year and has paediatric formulation data; combining with chemotherapy and blinatumomab in the first year of life is the obvious next trial.

Hypothesis
Adding a menin inhibitor to Interfant-21-type therapy raises 2-year EFS above 80% in KMT2A-rearranged infants without excess differentiation syndrome or hepatotoxicity.
Rationale
KMT2A fusion is the sole driver in most infant ALL; menin inhibition produces MRD-negative remissions in relapsed KMT2Ar leukaemia.
What would test it
International single-arm pilot then randomised addition of revumenib or ziftomenib to Interfant-21 backbone, with pharmacokinetics and CYP3A4 interaction monitoring in infants.
Maturity
early clinical

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