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RecruitingLast updated: 7 February 2024

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

Clinical summary


Eligible patients will receive oral Avatrombopag at a maximum dose of 60 mg per day for up to 180 days. The Avatrombopag dose will be adjusted every 2 weeks guided by reticulocyte count, platelet count/platelet transfusion and neutrophil count.


This trial is treating patients with severe aplastic anaemia


Blood Cancers Haematological





Trial Acronym


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Trial Identifiers

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Trial sponsor

Monash University

Scientific Title

Avatrombopag plus up Front ImmunosuppReSsive Therapy in treatment-naive severe aplastic anaemia (AA) - a Bayesian Optimal Phase II study



1. Severe or very severe aplastic anaemia characterised by bone marrow cellularity <30% (excluding lymphocytes) and at least two of the following:
a. Absolute neutrophil count <0.5 x10^9/L
b. Platelet count <20 x 10^9/L
c. Absolute reticulocyte count <60 x 10^9/L
2. No prior ATG-based immunosuppressive therapy
3. Age >18 years
4. Negative pregnancy test for women of child bearing potential


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


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Clinical trials have complex eligibility criteria.

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