Primary Myelofibrosis, Secondary Myelofibrosis
Conditions
Brief summary
This pilot phase II trial studies P1101 (polyethyleneglycol \[PEG\]-proline-interferon alpha-2b) in treating patients with myelofibrosis. PEG-proline-interferon alpha-2b is a substance that can improve the body's natural response and may slow the growth of myelofibrosis.
Detailed description
PRIMARY OBJECTIVE: I. To evaluate for clinical response (complete remission \[CR\], partial remission \[PR\], or clinical improvement \[CI\]) as defined by International Working Group-Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) criteria in a cohort of intermediate-2/high risk myelofibrosis (MF) patients. Response in a second cohort of early stage MF patients will also be described. SECONDARY OBJECTIVES: I. To evaluate the adverse event profile of P1101 in patients with myelofibrosis by cohort (early vs intermediate-2/high risk). II. To evaluate the tolerability of P1101 in patients with myelofibrosis by cohort (early vs intermediate-2/high risk). EXPLORATORY AND CORRELATIVE RESEARCH OBJECTIVES: I. To evaluate quality of life (QOL) and patient-reported symptoms using the Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) with P1101 for patients with myelofibrosis by cohort (early vs intermediate-2/high risk). II. To evaluate the impact of P1101 on bone marrow and histological features of myelofibrosis including cytogenetics, blast percentage, fibrosis, and JAK2-V617F allele burden by cohort (early vs intermediate-2/high risk). OUTLINE: Patients receive PEG-proline-interferon alpha-2b subcutaneously (SC) on days 1 and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3-6 months for 3 years.
Interventions
OTHERLaboratory Biomarker Analysis
Correlative studies
OTHERQuality-of-Life Assessment
Ancillary studies
BIOLOGICALRopeginterferon Alfa-2B
Given SC
Sponsors
Mayo Clinic
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Evaluable myelofibrosis by IWG-MRT criteria including one or more of the following: * Spleen \>= 5 cm below the left costal margin * MPN-SAF total symptom score (TSS) \> 10 at baseline * Hemoglobin \< 10 g/dL * Confirmed diagnosis of myelofibrosis (primary myelofibrosis or myelofibrosis secondary to essential thrombocythemia or polycythemia vera) by World Health Organization (WHO) diagnostic criteria (3 major and 2 minor criteria: major criteria: megakaryocyte proliferation and atypia with either reticulin and/or collagen fibrosis, not meeting criteria for chronic myelogenous leukemia \[CML\], polycythemia vera \[PV\], myelodysplastic syndrome \[MDS\], or other myeloid neoplasm, JAK2V617F or other clonal marker or no evidence of reactive marrow fibrosis; minor criteria: leukoerythroblastosis, increased lactate dehydrogenase \[LDH\], anemia, palpable splenomegaly) * For cohort 1: early stage MF (low or intermediate 1 stage as defined by Dynamic International Prognostic Scoring System \[DIPSS\]) without currently available treatment options * For cohort 2: intermediate-2 or high risk MF patients as defined by DIPSS either not eligible for ruxolitinib or having failed under ruxolitinib * No prior treatment for myelofibrosis (for cohort 1 only) * Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1 or 2 * Platelet count \>= 100,000/mm\^3 (obtained =\< 14 days prior to registration) * Absolute neutrophil count (ANC) \>= 1000/mm\^3 (obtained =\< 14 days prior to registration) * Aspartate transaminase (AST) =\< 2.5 x upper limit of normal (ULN) (obtained =\< 14 days prior to registration) * Alanine aminotransferase (ALT) =\< 2.5 x ULN (obtained =\< 14 days prior to registration) * Calculated creatinine clearance must be \>= 50 ml/min using the Cockcroft-Gault formula (obtained =\< 14 days prior to registration) * Negative pregnancy test done =\< 7 days prior to registration, for women of childbearing potential only * Ability to complete questionnaire(s) by themselves or with assistance * Provide informed written consent * Willing to return to enrolling institution for follow-up * Willing to provide blood samples for correlative research purposes
Exclusion criteria
* Patients who have had chemotherapy or radiation =\< 2 weeks of registration * For cohort 1 only: patients with evidence of intermediate 2 or high risk disease (according to DIPSS) * For cohort 1 only: patients with a bone marrow biopsy with \< 15% cellularity, evidence of collagen fibrosis, osteosclerosis, or blasts \> 10% in peripheral blood or marrow (demonstrating advanced disease) * Patients who have received a prior stem cell transplant * Patients who have received radiation to the spleen within 3 months prior to registration * Patients with intolerance to compounds similar to pegylated interferon alpha-2b * Patients with evidence of \>= grade 2 peripheral sensory neuropathy * Any of the following: * Pregnant women * Nursing women * Men or women of childbearing potential who are unwilling to employ adequate contraception * Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens * Immunocompromised patients or patients known to be human immunodeficiency virus (HIV) positive and currently receiving antiretroviral therapy * Uncontrolled simultaneous illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, history of depression, or psychiatric illness/social situations that would limit compliance with study requirements * Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm * History of myocardial infarction =\< 6 months prior to registration, or congestive heart failure requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias * History of significant or major funduscopic findings including, but not limited to, retinal exudates, hemorrhage, detachment, neovascularization, papilledema, optic atrophy, micro-aneurysm or macular changes * Other active malignancy at time of registration; EXCEPTIONS: non-melanotic skin cancer or carcinoma-in-situ of the cervix
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Best Overall Response (Complete Remission, Partial Remission, or Clinical Improvement) as Determined by International Working Group Criteria | Up to 3 years | Patients will be assessed for response according to the Revised International Working Group for Myeloproliferative Neoplasms Research and Treatment criteria. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression-free Survival Time | Up to 3 years | The distribution of survival time will be estimated using the method of Kaplan-Meier. |
| Number of Patients Experiencing a Grade 3+ Adverse Event, as Measured by National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0 (NCI CTCAE v4) | Up to 3 years | The maximum grade for each type of adverse event will be recorded for each patient, and frequency tables will be reviewed to determine patterns. Additionally, the relationship of the adverse event(s) to the study treatment will be taken into consideration. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Changes in Patient-reported Symptoms and QOL as Measured by MPN-SAF | Baseline to up to 3 years | Patient-reported symptoms and QOL will be described at each time point using the mean, confidence interval, median, and range. Changes in individual symptoms, changes in a symptom scale composed of symptoms specific to MF patients, and changes in the MPN TSS will be investigated. Graphical procedures will include stream plots of individual patient scores and plots of average values over time. Correlational analyses will be done to determine the relationships among patients-reported symptoms and QOL, as well as with clinical outcomes and clinician-assessed symptoms. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Treatment (PEG-proline-interferon alpha-2b) Patients receive PEG-proline-interferon alpha-2b SC on days 1 and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. All patients will be started at a dose level of 100 micrograms (mcg) every other week, and then dose will be titrated up by 50mcg increments to a maximum dose of 300mcg every other week as tolerated.
\>
\> Laboratory Biomarker Analysis: Correlative studies
\>
\> Quality-of-Life Assessment: Ancillary studies
\>
\> Ropeginterferon Alfa-2B: Given SC | 11 |
| Total | 11 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 1 |
| Overall Study | Alternate treatment | 1 |
| Overall Study | Disease progression | 3 |
| Overall Study | Physician Decision | 2 |
| Overall Study | Study closure | 4 |
Baseline characteristics
| Characteristic | Treatment (PEG-proline-interferon alpha-2b) |
|---|---|
| Age, Continuous | 69 years |
| ECOG Performance Status 0 | 8 Participants |
| ECOG Performance Status 1 | 2 Participants |
| ECOG Performance Status 2 | 1 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 10 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants |
| Myelofibrosis Risk Stage Intermediate-2/high risk stage | 7 Participants |
| Myelofibrosis Risk Stage Low/Intermediate-1 risk stage | 4 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 11 Participants |
| Region of Enrollment United States | 11 participants |
| Sex: Female, Male Female | 5 Participants |
| Sex: Female, Male Male | 6 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 3 / 11 |
| other Total, other adverse events | 11 / 11 |
| serious Total, serious adverse events | 8 / 11 |
Outcome results
Primary
Best Overall Response (Complete Remission, Partial Remission, or Clinical Improvement) as Determined by International Working Group Criteria
Patients will be assessed for response according to the Revised International Working Group for Myeloproliferative Neoplasms Research and Treatment criteria.
Time frame: Up to 3 years
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Treatment (PEG-proline-interferon alpha-2b) | Best Overall Response (Complete Remission, Partial Remission, or Clinical Improvement) as Determined by International Working Group Criteria | Progression | 1 Participants |
| Treatment (PEG-proline-interferon alpha-2b) | Best Overall Response (Complete Remission, Partial Remission, or Clinical Improvement) as Determined by International Working Group Criteria | Clinical Improvement | 7 Participants |
| Treatment (PEG-proline-interferon alpha-2b) | Best Overall Response (Complete Remission, Partial Remission, or Clinical Improvement) as Determined by International Working Group Criteria | Stable Disease | 3 Participants |
Secondary
Number of Patients Experiencing a Grade 3+ Adverse Event, as Measured by National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0 (NCI CTCAE v4)
The maximum grade for each type of adverse event will be recorded for each patient, and frequency tables will be reviewed to determine patterns. Additionally, the relationship of the adverse event(s) to the study treatment will be taken into consideration.
Time frame: Up to 3 years
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment (PEG-proline-interferon alpha-2b) | Number of Patients Experiencing a Grade 3+ Adverse Event, as Measured by National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0 (NCI CTCAE v4) | 10 Participants |
Secondary
Progression-free Survival Time
The distribution of survival time will be estimated using the method of Kaplan-Meier.
Time frame: Up to 3 years
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Treatment (PEG-proline-interferon alpha-2b) | Progression-free Survival Time | NA months |
Other Pre-specified
Changes in Patient-reported Symptoms and QOL as Measured by MPN-SAF
Patient-reported symptoms and QOL will be described at each time point using the mean, confidence interval, median, and range. Changes in individual symptoms, changes in a symptom scale composed of symptoms specific to MF patients, and changes in the MPN TSS will be investigated. Graphical procedures will include stream plots of individual patient scores and plots of average values over time. Correlational analyses will be done to determine the relationships among patients-reported symptoms and QOL, as well as with clinical outcomes and clinician-assessed symptoms.
Time frame: Baseline to up to 3 years