Modulation of Stem Cell Differentiation in Individuals With High Risk Clonal Haematopoiesis

Inclusion Criteria

• •1. Age ≥ 60 and ≤ 85 years old
• •2. Clonal Cytopenia of Uncertain Significance (CCUS), defined by all of the following:
• •a. Persistent cytopenia, present on at least two occasions, at least four months apart, with no other cause identified: i. Hemoglobin (Hb) \< 120 g/L in people born female, and \< 130 g/L in people born male ii. Platelet count \< 150 x 109/L iii. Absolute Neutrophil Count (ANC) \< 1.8 x109/L b. Clonal hematopoiesis (CH) driver mutation confirmed by custom gene panel mutation analysis c. absence of features diagnostic for defined myeloid neoplasm (MN) on bone marrow examination
• •3. CH driver mutation variant allele fraction (VAF) of ≥ 10%
• •4. For participants living with HIV:
• •1. Receiving and adherent to suppressive antiretroviral therapy for at least 12 months
• •2. CD4+T cell count ≥ 0.35 x 109/L
• •3. HIV viral load \< 50 copies/mL
• •6\. Performance status by Eastern Cooperative Oncology Group (ECOG) Criteria of 0 or 1 7. For participants who are of childbearing potential, or whose partners are of childbearing potential:
• •1. Agreement to use at least two highly effective (per Clinical Trial Facilitation Group) contraceptive methods throughout the course of the trial, and for 6 months following the last dose of trial drug
• •2. Refrain from donating eggs or sperm during the same period
• •3. Confirmation of a negative serum pregnancy test at screening and at the beginning of each treatment cycle visit (for female participants of childbearing potential) 8. Provision of signed written informed consent document prior to any trial-related assessments or procedures being carried out
• •6. Any history of hematological or solid malignancy in previous the 5 years unless the participant has been free of disease for ≥ 36 months. However, participants with the following history/concurrent conditions are not excluded:
• •1. Basal or squamous cell carcinoma of the skin
• •2. Carcinoma in situ of the cervix
• •3. Carcinoma in situ of the breast
• •4. Incidental histologic finding of prostate cancer (T1a or T1b using the tumor, nodes, metastasis \[TNM\] clinical staging system)
• •7. Known hypersensitivity to trial drugs or their constituents
• •8. Currently enrolled in the treatment phase of an interventional investigational trial.
• •9. Pregnant or breast-feeding individuals
• •10. Any condition not already outlined above which, in the opinion of the Principal Investigator, would place the participant at risk if they participated or would jeopardize adherence, follow up, or confound the ability to interpret trial data