Overview

Peritransplant Ruxolitinib for Patients With Primary and Secondary Myelofibrosis

Status:
Recruiting
Trial end date:
2028-12-31
Target enrollment:
0
Participant gender:
All
Summary
This phase II trial studies how well administering ruxolitinib before, during, and after allogeneic hematopoietic stem cell transplantation works in preventing graft versus host disease and improving transplant outcomes in patients with primary and secondary myelofibrosis. Donor hematopoietic stem cell transplantation (HSCT) is currently the only treatment with proven curative potential for myelofibrosis, however, myelofibrosis patients have a high risk for developing graft versus host disease post-transplant. Graft versus host disease is a condition where the transplanted cells from a donor can attack the body's normal cells. Ruxolitinib, a janus-associated kinase (JAK) inhibitor, is known to decrease inflammatory signals, which may reduce spleen size and decrease symptoms such as night sweats and weight loss. Administering ruxolitinib before, during, and after transplant may decrease the incidence and severity of graft versus host disease, increase survival, and improve quality of life in patients with primary and secondary myelofibrosis.
Phase:
Phase 2
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
Fred Hutchinson Cancer Research Center
Collaborator:
National Cancer Institute (NCI)
Treatments:
Busulfan
Cyclophosphamide
Fludarabine
Mechlorethamine
Melphalan
Methotrexate
Mycophenolic Acid
Nitrogen Mustard Compounds
Tacrolimus
Criteria
Inclusion Criteria:

- JAK INHIBITOR ADMINISTRATION INCLUSION: (PART I)

- Disease criteria:

- Diagnosis of primary myelofibrosis (PMF) as defined by the 2016 World Health
Organization classification system or diagnosis of secondary myelofibrosis (MF)
as defined by the International Working Group (IWG) for Myeloproliferative
Neoplasms Research and Treatment criteria

- Patients meeting the criteria for intermediate-1, intermediate-2 or high-risk
disease by Dynamic International Prognostic Scoring System (DIPSS) or DIPSS plus

- Ability to understand and the willingness to sign a written informed consent document

- Patient must be a potential hematopoietic stem cell transplant candidate as assessed
by the consenting physician

- Patient must be willing to start ruxolitinib within a 6-month time period

- ALLOGENEIC STEM CELL TRANSPLANT INCLUSION: (PART II)

- Meeting criteria for part 1, as above, at time of initiation of ruxolitinib, including
the ability to understand and willingness to sign a written informed consent. Patients
arriving to our institution for transplant and not enrolled in part 1 may still be
enrolled in part 2 if part 1 criteria are met. These patients will have part 1
endpoints transcribed from medical records

- Received ruxolitinib for at least 8 weeks immediately prior to conditioning and be
willing to continue until 9 months post-transplant as tolerated

- Performance status score: Karnofsky >= 70

- Calculated creatinine clearance using the Cockcroft-Gault formula or 24 hour (hr)
urine creatinine clearance must be > 60 ml/min

- Total serum bilirubin must be < 3 mg/dL unless the elevation is thought to be due to
Gilbert's disease or hemolysis

- Transaminases must be < 3 x the upper limit of normal

- Patients with clinical or laboratory evidence of liver disease will be evaluated for
the cause of liver disease, its clinical severity in terms of liver function, and the
degree of portal hypertension. Patients with fulminant liver failure, cirrhosis with
evidence of portal hypertension or bridging fibrosis, alcoholic hepatitis, hepatic
encephalopathy, or correctable hepatic synthetic dysfunction evidenced by prolongation
of the prothrombin time, ascites related to portal hypertension, bacterial or fungal
abscess, biliary obstruction, chronic viral hepatitis with total serum bilirubin >
3mg/dL, and symptomatic biliary disease will be excluded

- Diffusion capacity of lung for carbon monoxide (DLCO) corrected > 60% normal. May be
not be on supplemental oxygen

- Left ventricular ejection fraction > 40% OR shortening fraction > 26%

- Comorbidity index < 5 at the time of pre-transplant evaluation

Exclusion Criteria:

- JAK INHIBITOR ADMINISTRATION EXCLUSION: (PART I)

- Contraindication to receiving ruxolitinib including:

- Patients who have known hypersensitivity to JAK inhibitors

- Clinical or laboratory evidence of significant renal or hepatic impairment
including cirrhosis

- Active uncontrolled infection

- Known human immunodeficiency virus (HIV) positivity

- Women who are pregnant or trying to conceive

- Caution should be used in patients with platelets < 100 though adjustments in
dose can be made to accommodate anyone with platelets > 50

- History of prior allogeneic transplant

- Leukemic transformation (> 20% blasts)

- ALLOGENEIC STEM CELL TRANSPLANT EXCLUSION: (PART II)

- Uncontrolled viral or bacterial infection at the time of transplant data review and
consent conference

- Active or recent (prior 6 month) invasive fungal infection without infectious disease
(ID) consult and approval

- History of HIV infection

- Pregnant or breastfeeding

- Patients without a human leukocyte antigen (HLA)-identical sibling donor, 10 of 10
HLA-matched or 9 of 10 allele mismatched unrelated donor, or umbilical cord blood
units that meet transplant criteria

- Patients with a spleen > 22 cm (>16 cm for cord blood patients) who have NOT received
a surgical splenectomy consultation