Acute Stem Cell Transplant Complications, GVHD
Conditions
Brief summary
The goal of this observation study is to test in patients undergoing allogeneic hemopoietic stem-cell transplantation (allo-HSCT). The main question it aims to answer is: • Effect of MAGIC algorithm probability guided preemption of aGVHD with ruxolitinib on prevention of severe aGVHD. Participants will take ruxolitinib with the dose of 5mg bid for 28 days. If no signs of aGvHD, the dose of ruxolitinib is gradually tapered within the following 16 days. Researchers will compare patients who don't receive preemption of aGVHD with ruxolitinib to see if there is an improvement in severe aGVHD.
Interventions
DRUGRuxolitinib
Ruxolitinib is asministrated with the dose of 5mg bid for 28 days. If no signs of aGvHD, the dose of ruxolitinib is gradually tapered within the following 16 days.
Sponsors
Sichuan University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
16 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Any donor type (e.g., related, unrelated, haplo) or stem cell source (bone marrow, peripheral blood, cord blood). * Any conditioning regimen (non-myeloablative, myeloablative, or reduced intensity) is acceptable. * GVHD prophylaxis must include a calcineurin inhibitor combined with post transplant cyclophosphamide. * The use of serotherapy to prevent GVHD (e.g., antithymocyte globulin) prior to day 3 post-HCT is permitted * Direct bilirubin must be \<2 mg/dL unless the elevation is known to be due to Gilbert syndrome within 3 days prior to enrollment. * ALT/SGPT and AST/SGOT must be \<5 x the upper limit of the normal range within 3 days prior to enrollment. * Signed and dated written informed consent obtained from patient or legal representative.
Exclusion criteria
* Patients who develop acute GVHD prior to start of study drug * Patients at very high risk for relapse post HCT as defined by very high disease risk index * Patients participating in a clinical trial where prevention of GVHD is the primary endpoint * Uncontrolled active infection (i.e., progressive symptoms related to infection despite treatment or persistently positive microbiological cultures despite treatment or any other evidence of severe sepsis) * Patients who are pregnant * Patients on dialysis within 7 days of enrollment * Patients requiring ventilator support or oxygen supplementation exceeding 40% FiO2 within 14 days of enrollment. * Patients receiving investigational agent within 30 days of enrollment. However, the Principal Investigator (PI) may approve prior use of an investigational agent if the agent is not expected to interfere with the safety or the efficacy of ruxolitinib
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of High Risk Patients Who Develop Grade III or IV aGvHD | Day 100 post HCT | Number of High Risk Patients Who Develop Grade III or IV aGvHD by day 100 post HCT |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Chronic GVHD Requiring Systemic Steroid Treatment | 1 year and 2 years | Number of participants with chronic GVHD requiring systemic steroid treatment. Chronic GVHD Requiring Systemic Steroid Treatment: defined as the development of symptoms of chronic GVHD according to NIH Consensus Criteria that require treatment with oral or intravenous corticosteroids at the end of 1 year and 2 years |
| GvHD free and relapse free survival | 1 year and 2 years | Survival of patients without grade 3 or 4 aGvHD or disseminated cGvHD or relapse of disease at end of 1 year post HCT at the end of 1 year and 2 years |
| Progression-free survival | 1 year and 2 years | Progression-free survival of this group of patients at the end of 1 year and 2 years |
| Overall survival | 1 year and 2 years | Overall survival of this group of patients at the end of 1 year and 2 years |
| Number of Participants With Non-relapse Mortality (NRM) | 6 months | Number of participants with NRM - deaths which could not be attributed to disease relapse or progression. Nonrelapse mortality defined as death without prior relapse at 6 months |
| Number of Participants With Serious Infections | 1 year and 2 years | Number of participants with serious infections (defined as grade 3 by the Blood and Marrow Transplant Clinical Trials Network). Serious Infection: Defined as bacterial, fungal, viral or parasitic infections that required oral or intravenous treatments such as antibiotics |
| cytomegalovirus (CMV) reactivation | 1 year and 2 years | Number of participants with cytomegalovirus (CMV) reactivation at the end of 1 year and 2 years. CMV reactivation was defined as the presence of DNA copies exceeding 10\^3/ml in plasma. |
| grade 2 or higher hemorrhagic cystitis | 1 year and 2 years | Number of participants with grade 2 or higher hemorrhagic cystitis at the end of 1 year and 2 years, which was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE, Version 5.0). |
| MAGIC algorithm probability (MAP) change | Day 28 post HCT | The change in the patient's MAGIC algorithm probability (MAP) at each time |
| Number of Participants With Relapse | 1 year and 2 years | Number of participants with relapse at one year and 2 years. Relapse defined as recurrence of disease that required transplant. |
Countries
China
Contacts
Primary ContactJie Ji, MD
Outcome results
None listed