DIAAMOND-Ava FIRST: This phase II trial is trying to understand whether the addition of a new drug (avatrombopag) to standard immunosuppressive therapy (IST) can effectively treat patients with severe aplastic anaemia who have not had prior treatmentAvatrombopag plus up Front ImmunosuppReSsive Therapy in treatment-naive severe aplastic anaemia (AA) - a Bayesian Optimal Phase II study

Exclusion

1. Planned for a sibling allogeneic stem cell transplant
2. Evidence of a myelodysplastic syndrome, defined according to the World Health Organization 2017 criteria. Patients with AA with cytogenetic abnormalities that 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.
3. 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
4. Previous history of stem cell transplantation
5. Cancer diagnosis within the last 5 years (except for patients with resected basal cell carcinoma or squamous cell carcinoma of the skin)
6. Previous history of melanoma
7. Pregnant or breast feeding patients2,3
8. Active CMV disease
9. Participants with known hypersensitivity to any of the component medications (avatrombopag, cyclosporine, horse or rabbit ATG)
10. Concurrent hepatic, renal or cardiac disease of such severity that it would in the investigator’s opinion, preclude the patient’s ability to tolerate protocol therapy
11. Death anticipated within 14 days