Myelofibrosis, Splenomegaly
Conditions
Brief summary
To learn if giving ruxolitinib and busulfan before a stem cell transplant can help to reduce spleen size and help the transplant to succeed.
Detailed description
Primary Objective 1\) Compare the proportion of patients alive, disease free, engrafted, and without poor graft function at 100 days post-transplant with the historical rate of 45%. Secondary Objectives: 1. Overall survival 2. Progression-free survival 3. Graft vs host disease relapse free survival 4. Relapse rate 5. Non-relapse Mortality 6. Time to Neutrophil and platelet engraftment 7. Time to red cell transfusion independence 8. Graft failure 9. Acute and chronic GVHD 10. Grade 3 -5 Toxicity 11. Incidence of poor graft function5 12. Need for growth factors (myeloid or thrombopoietic) at 100 days 13. Spleen response around day -7, -1, 30, and 100 days 14. Need for transfusions at 100 days 15. Time to discontinuation of immunosuppressives Exploratory Objectives: 1. Immune reconstitution 2. Cytokine profile
Interventions
DRUGRuxolitinib
Given by PO
PROCEDUREAllogeneic Stem Cell Transplantation
Given by Transplant
DRUGLevetiracetam
Given by PO
DRUGEltrombopag
Given by PO
DRUGBusulfan
Given by IV
DRUGRomiplostim
Given by IV
DRUGFludarabine phosphate
Given by IV
DRUGCyclophosphamide
Given by IV
DRUGMesna
Given by IV
DRUGTacrolimus
Given by IV or PO
Sponsors
M.D. Anderson Cancer Center
Incyte Corporation
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Participants 18 years to less than or equal to 75 years. 2. Able to provide written consent. 3. Primary or secondary Myelofibrosis (may have received Jak inhibitors including ruxolitinib) 4. Enlarged spleen by palpation or imaging. For the purpose of this study, splenomegaly is defined as any clinically palpable spleen or spleen larger than 12 cms on imaging. 5. Has a fully matched (8/8:HLA A, B, C, DRB1) related or matched unrelated donor. 6. Adequate renal function, including: a. Serum creatinine \</= 1.5 mg/dL or estimated Glomerular Filtration Rate (eGFR using the CKI-EPI equation) \>/= 40 ml/min/1.73 m2. 7. Adequate liver function, including: 1. ALT/AST \</= 3 x ULN 2. Direct bilirubin \</= 1mg/dL 3. No history of liver cirrhosis. No ascites. 8. Female participants of childbearing potential must have negative results for a serum pregnancy test. Female participants must agree to not breastfeed during the study and for 3 months post-completion of the study therapy. 9. Subjects who are of childbearing potential, sexually active, and at risk of pregnancy must agree to use a highly effective method of contraception for the duration of the active treatment and at least 3 months post-completion of the study therapy. Highly effective methods of contraception include the following: 1. Hormonal contraception (i.e., birth control pills, injection, implant, transdermal patch, vaginal ring), Intrauterine device (IUD), Tubal Ligation or hysterectomy, Subject/Partner post vasectomy, Implantable or injectable contraceptives, and condoms plus spermicide. Not engaging in sexual activity for the total duration of the trial and the drug washout period is an acceptable practice; however periodic abstinence, the rhythm method, and the withdrawal method are not acceptable methods of birth control. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. 2. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 4 months after completion of study agent administration. Men who are able to have children must use effective birth control while on the study. If the male participant fathers a child or suspects that he has fathered a child while on the study, he must immediately notify his doctor.
Exclusion criteria
1. Positive beta HCG in females of child-bearing potential defined as not postmenopausal for 24 months or no previous surgical sterilization or lactating females. 2. Ejection fraction \<40% 3. Corrected DLCO \< 50% 4. Evidence of other clinically significant uncontrolled condition(s) including, but not limited to: 1. Uncontrolled and/or active systemic infection (viral, bacterial or fungal) 2. Active hepatitis B virus (HBV), hepatitis C (HCV), HIV or TB infection or requiring treatment for the same. 3. Thrombosis including MI, Stroke, PE, DVT in the past 6 months Note: subjects with serologic evidence of prior vaccination to HBV (i.e. hepatitis B surface (HBs) antigen negative-, anti-HBs antibody positive and anti-hepatitis B core (HBc) antibody negative) or positive anti-HBc antibody from intravenous immunoglobulins (IVIG) may participate.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Safety and adverse events (AEs) | Through study completion; an average of 1 year. | Incidence of Adverse Events, Graded According to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version (v) 5.0 |
Countries
United States
Contacts
CONTACTUday Popat, MD
PRINCIPAL_INVESTIGATORUday Popat, MD
M.D. Anderson Cancer Center
Outcome results
None listed