The DIAAMOND-Ava NEXT Trial: In this phase II trial, patients with severe aplastic anaemia who have been treated with, but not responded to immunosuppressive therapy (IST), will receive a new drug (avatrombopag) as a potential treatment for their conditionAvatrombopag iN Relapsed or Refractory severe Aplastic Anaemia as EXtra Therapy - a Bayesian Optimal Phase II study

Exclusion

1. Evidence of a myelodysplastic syndrome, defined according to the World Health Organization 2017 criteria. Patients with AA with cytogenetic abnormalities, which are recurrent in MDS, who do not meet the WHO diagnostic criteria for MDS, are also excluded. Patients with del (20q), +8 and –Y are not included in this category and are therefore eligible for this trial.
2. Known diagnosis or clinical suspicion of inherited bone marrow failure syndrome (IBMFS), including but not limited to Fanconi Anaemia, Dyskeratosis Congenita, Shwachman-Diamond Syndrome and Diamond-Blackfan Anaemia
3. Cancer diagnosis within the last 5 years (except for patients with resected basal cell carcinoma or squamous cell carcinoma of the skin)
4. Previous history of melanoma
5. Pregnant or breast feeding patients2
6. Participants with known hypersensitivity to avatrombopag
7. Severe renal impairment (defined as creatinine clearance =30m/min)
8. Treatment with horse or rabbit ATG within 6 months of trial entry. Concurrent treatment with Cyclosporine A is permitted.
9. Death anticipated within 14 days