De-escalated Cyclophosphamide (PTCy) and Ruxolitinib for Graft-versus-Host Disease (GVHD) Prophylaxis

• Status: Not yet recruiting
• Trial end date: 2025-07-15
• Target enrollment: 0
• Participant gender: All

Summary

This is an open-label phase 2 study designed to explore the efficacy and safety of low-dose PTCy-ruxolitinib GVHD prophylaxis in older adults undergoing allogeneic HCT with a matched sibling or unrelated donor with a peripheral blood stem cell graft.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Medical College of Wisconsin
• Treatments: Cyclophosphamide; Mycophenolic Acid; Tacrolimus

Criteria

Inclusion Criteria:

1. History of hematologic malignancy.

2. Must be in remission:

• Acute Leukemia, chronic leukemia, or myelodysplasia/myeloproliferative neoplasm (excluding primary myelofibrosis): No circulating blasts and <5% blasts in the bone marrow.

• Hodgkin and non-Hodgkin lymphomas: Chemo-sensitive disease at time of transplant

3. Planned donor must be 8/8 human leukocyte antigen (HLA) -matched at HLA-A, -B, -DR, and -C.

4. Graft source of peripheral blood.

5. Planned reduced intensity conditioning therapy with fludarabine/melphalan, with total dose of melphalan of 100-140 mg/m^2 IV or fludarabine/busulfan with total dose of busulfan of 6.4 mg/kg IV.

6. Karnofsky Performance Scale of 60 or greater.

7. Male participants must agree to abstinence or to use of barrier contraception during the entire study period.

8. Female participants of childbearing potential will require a negative pregnancy test and should agree to practice two effective methods of contraception during the entire study period.

9. Ability to understand a written informed consent document, and the willingness to sign it.

Exclusion Criteria:

1. Prior allogeneic HCT or Chimeric antigen receptor (CAR) -T cell therapy.

2. Patients with liver dysfunction evidenced by bilirubin ≥2x upper limit normal (ULN), except for a history of Gilbert syndrome.

3. Patients with renal impairment defined by creatinine<2mg/dL.

4. Patients with cardiac dysfunction defined by a left ventricular ejection fraction ≤45%.

5. Patients with pulmonary dysfunction defined by a forced expiratory volume in the first second (FEV1) or diffusing capacity for carbon monoxide (DLCO) (corrected for hemoglobin) ≤50% of predicted.

6. Patients with a chronic or active infection requiring systemic treatment during and after transplant.

7. Presence of other active malignant disease diagnosed within 12 months, except for adequately treated non-melanoma skin cancer, adequately treated melanoma grade 2 or less, or cervical intraepithelial neoplasia. Active malignancy is malignancy receiving treatment.

8. Pregnant or lactating subjects.