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Ruxolitinib for the Prophylaxis of Graft-Versus-Host Disease and Cytokine Release Syndrome After T-cell Replete Haploidentical Peripheral Blood Hematopoietic Cell Transplantation

Primary Purpose

Graft Vs Host Disease, Graft-versus-host-disease, Graft Versus Host Disease

Status
Not yet recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Ruxolitinib
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Graft Vs Host Disease focused on measuring Haploidentical, GVHD, CRS

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patients must meet the following criteria within 30 days prior to Day -3 unless otherwise noted. Diagnosis of one of the hematological malignancies listed below: Acute myelogenous leukemia (AML) in complete morphological remission, complete remission with incomplete hematologic recovery, and complete remission with partial hematologic recovery (based on ELN Criteria47). Acute lymphocytic leukemia (ALL) in complete morphological remission (MRD negative by flow cytometry with sensitivity to ≤ 10-4). Myelodysplastic syndrome with ≤ 5% blasts in bone marrow. Non-Hodgkin lymphoma (NHL) or Hodgkin lymphoma (HD) in second or greater complete or partial remission. Myelofibrosis with ≤ 10% blasts in bone marrow. Planned treatment is T cell-replete peripheral blood haploidentical donor transplantation. Available HLA-haploidentical donor who meets the following criteria: Blood-related family member, including (but not limited to) sibling, offspring, cousin, nephew, or parent. Younger donors should be prioritized. At least 18 years of age. HLA-haploidentical donor/recipient match by at least low-resolution typing per institutional standards. In the investigator's opinion, is in general good health and medically able to tolerate leukapheresis required for harvesting hematopoietic stem cells. No active hepatitis. Negative for HTLV and HIV. Not pregnant. Donor selection will be in compliance with FDA guidelines as provided in 21 CFR 1271 for donor eligibility https://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Tissue/UCM091345.pdf Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2. Adequate organ function as defined below: Total bilirubin ≤ 1.5 x IULN. AST (SGOT) and ALT (SGPT) ≤ 3.0 x IULN. Creatinine ≤ 1.5 x IULN OR creatinine clearance ≥ 45 mL/min/1.73 m2 by Cockcroft-Gault Formula. Oxygen saturation ≥ 90% on room air. LVEF ≥ 40%. FEV1 and FVC ≥ 40% predicted, DLCOc ≥ 40% predicted. If DLCO is < 40%, patients will still be considered eligible if deemed safe after a pulmonary evaluation. Able to receive GVHD prophylaxis with tacrolimus, mycophenolate mofetil, and cyclophosphamide. At least 18 years of age at the time of study registration The effects of ruxolitinib on the developing human fetus are unknown. For this reason, women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study and for the duration of the study. Able to understand and willing to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable). Exclusion Criteria: Prior allogeneic transplant (regardless of whether donor was related, unrelated, or cord). Prior autologous transplant is not exclusionary. Presence of donor specific antibodies (DSA) with Mean Fluorescence Intensity (MFI) of ≥ 2000 as assessed by the single antigen bead assay. Known HIV or active hepatitis B or C infection. Known current and/or history of active tuberculosis. Known hypersensitivity to one or more of the study agents. Planning to receive antithymocyte globulin as part of the pre-transplant conditioning regimen. Currently receiving or has received any investigational drugs within the 14 days prior to the first dose of study drug (Day -3). Pregnant and/or breastfeeding. Women of childbearing potential must have a negative pregnancy test within 14 days of study entry. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, autoimmune disease, symptomatic congestive heart failure, unstable angina pectoris, or unstable cardiac arrhythmias. Immunosuppressive doses of steroids. Subjects with steroids for adrenal insufficiency will not be excluded.

Sites / Locations

  • Washington University School of Medicine

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ruxolitinib

Arm Description

Ruxolitinib at 5 mg twice per day (BID) beginning on Day -3 and continuing until Day 180 followed by a taper (duration of taper depends on dose of ruxolitinib at Day 180). Once a patient's counts have reached ANC > 1.5 K/cumm, hemoglobin > 9.0 g/dL, and platelets > 50 K/cumm, ruxolitinib dosing will escalate to 10 mg BID.

Outcomes

Primary Outcome Measures

Cumulative incidence of graft failure
Cumulative incidence of grades III-IV acute GVHD by MAGIC criteria

Secondary Outcome Measures

Cumulative incidence of grades II-IV acute GVHD by MAGIC criteria
Number of patients who experience cytokine release syndrome (CRS)
Treatment-related mortality
Defined as death resulting from a transplant procedure-related complication rather than from relapse of the underlying disease or an unrelated cause

Full Information

First Posted
August 18, 2023
Last Updated
August 18, 2023
Sponsor
Washington University School of Medicine
Collaborators
Incyte Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT06008808
Brief Title
Ruxolitinib for the Prophylaxis of Graft-Versus-Host Disease and Cytokine Release Syndrome After T-cell Replete Haploidentical Peripheral Blood Hematopoietic Cell Transplantation
Official Title
An Open-Label Phase II Study of JAK Inhibitor Ruxolitinib for the Prophylaxis of Graft-Versus-Host Disease and Cytokine Release Syndrome After T-cell Replete Haploidentical Peripheral Blood Hematopoietic Cell Transplantation
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
October 31, 2023 (Anticipated)
Primary Completion Date
February 9, 2026 (Anticipated)
Study Completion Date
May 11, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine
Collaborators
Incyte Corporation

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Allogeneic hematopoietic cell transplantation (HCT) is one of the only curative intent therapies available for hematologic malignancies. HLA-matched sibling donors have historically offered the best clinical results but are unavailable for the majority of patients, while most patients do have readily available haploidentical donors. One of the risks of a haploidentical HCT is graft vs. host disease (GVHD), but it is difficult to reduce the incidence of GVHD without compromising the graft vs. leukemia (GVL) effect. The hypothesis of this study is that JAK inhibition with haploidentical HCT may mitigate GVHD and cytokine release syndrome while retaining the GVL effect and improving engraftment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Graft Vs Host Disease, Graft-versus-host-disease, Graft Versus Host Disease
Keywords
Haploidentical, GVHD, CRS

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
49 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Ruxolitinib
Arm Type
Experimental
Arm Description
Ruxolitinib at 5 mg twice per day (BID) beginning on Day -3 and continuing until Day 180 followed by a taper (duration of taper depends on dose of ruxolitinib at Day 180). Once a patient's counts have reached ANC > 1.5 K/cumm, hemoglobin > 9.0 g/dL, and platelets > 50 K/cumm, ruxolitinib dosing will escalate to 10 mg BID.
Intervention Type
Drug
Intervention Name(s)
Ruxolitinib
Other Intervention Name(s)
Jakafi
Intervention Description
Ruxolitinib is provided by Incyte Corporation.
Primary Outcome Measure Information:
Title
Cumulative incidence of graft failure
Time Frame
Day 35
Title
Cumulative incidence of grades III-IV acute GVHD by MAGIC criteria
Time Frame
Day 100
Secondary Outcome Measure Information:
Title
Cumulative incidence of grades II-IV acute GVHD by MAGIC criteria
Time Frame
Day 100
Title
Number of patients who experience cytokine release syndrome (CRS)
Time Frame
Through Day 8
Title
Treatment-related mortality
Description
Defined as death resulting from a transplant procedure-related complication rather than from relapse of the underlying disease or an unrelated cause
Time Frame
Day 180

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must meet the following criteria within 30 days prior to Day -3 unless otherwise noted. Diagnosis of one of the hematological malignancies listed below: Acute myelogenous leukemia (AML) in complete morphological remission, complete remission with incomplete hematologic recovery, and complete remission with partial hematologic recovery (based on ELN Criteria47). Acute lymphocytic leukemia (ALL) in complete morphological remission (MRD negative by flow cytometry with sensitivity to ≤ 10-4). Myelodysplastic syndrome with ≤ 5% blasts in bone marrow. Non-Hodgkin lymphoma (NHL) or Hodgkin lymphoma (HD) in second or greater complete or partial remission. Myelofibrosis with ≤ 10% blasts in bone marrow. Planned treatment is T cell-replete peripheral blood haploidentical donor transplantation. Available HLA-haploidentical donor who meets the following criteria: Blood-related family member, including (but not limited to) sibling, offspring, cousin, nephew, or parent. Younger donors should be prioritized. At least 18 years of age. HLA-haploidentical donor/recipient match by at least low-resolution typing per institutional standards. In the investigator's opinion, is in general good health and medically able to tolerate leukapheresis required for harvesting hematopoietic stem cells. No active hepatitis. Negative for HTLV and HIV. Not pregnant. Donor selection will be in compliance with FDA guidelines as provided in 21 CFR 1271 for donor eligibility https://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Tissue/UCM091345.pdf Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2. Adequate organ function as defined below: Total bilirubin ≤ 1.5 x IULN. AST (SGOT) and ALT (SGPT) ≤ 3.0 x IULN. Creatinine ≤ 1.5 x IULN OR creatinine clearance ≥ 45 mL/min/1.73 m2 by Cockcroft-Gault Formula. Oxygen saturation ≥ 90% on room air. LVEF ≥ 40%. FEV1 and FVC ≥ 40% predicted, DLCOc ≥ 40% predicted. If DLCO is < 40%, patients will still be considered eligible if deemed safe after a pulmonary evaluation. Able to receive GVHD prophylaxis with tacrolimus, mycophenolate mofetil, and cyclophosphamide. At least 18 years of age at the time of study registration The effects of ruxolitinib on the developing human fetus are unknown. For this reason, women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study and for the duration of the study. Able to understand and willing to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable). Exclusion Criteria: Prior allogeneic transplant (regardless of whether donor was related, unrelated, or cord). Prior autologous transplant is not exclusionary. Presence of donor specific antibodies (DSA) with Mean Fluorescence Intensity (MFI) of ≥ 2000 as assessed by the single antigen bead assay. Known HIV or active hepatitis B or C infection. Known current and/or history of active tuberculosis. Known hypersensitivity to one or more of the study agents. Planning to receive antithymocyte globulin as part of the pre-transplant conditioning regimen. Currently receiving or has received any investigational drugs within the 14 days prior to the first dose of study drug (Day -3). Pregnant and/or breastfeeding. Women of childbearing potential must have a negative pregnancy test within 14 days of study entry. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, autoimmune disease, symptomatic congestive heart failure, unstable angina pectoris, or unstable cardiac arrhythmias. Immunosuppressive doses of steroids. Subjects with steroids for adrenal insufficiency will not be excluded.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ramzi Abboud, M.D.
Phone
314-454-8304
Email
rabboud@wustl.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ramzi Abboud, M.D.
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ramzi Abboud, M.D.
Phone
314-454-8304
Email
rabboud@wustl.edu
First Name & Middle Initial & Last Name & Degree
Ramzi Abboud, M.D.
First Name & Middle Initial & Last Name & Degree
Camille Abboud, M.D.
First Name & Middle Initial & Last Name & Degree
Kelly Bolton, M.D.
First Name & Middle Initial & Last Name & Degree
Amanda Cashen, M.D.
First Name & Middle Initial & Last Name & Degree
Matt Christopher, M.D.
First Name & Middle Initial & Last Name & Degree
Zachary Crees, M.D.
First Name & Middle Initial & Last Name & Degree
John Dipersio, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
Todd Fehniger, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
Armin Ghobadi, M.D.
First Name & Middle Initial & Last Name & Degree
Meagan Jacoby, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
Brad Kahl, M.D.
First Name & Middle Initial & Last Name & Degree
Iskra Pusic, M.D.
First Name & Middle Initial & Last Name & Degree
Mark Schroeder, M.D.
First Name & Middle Initial & Last Name & Degree
Keith Stockerl-Goldstein, M.D.
First Name & Middle Initial & Last Name & Degree
Geoffrey Uy, M.D.
First Name & Middle Initial & Last Name & Degree
Ravi Vij, M.D.
First Name & Middle Initial & Last Name & Degree
Matthew Walter, M.D.
First Name & Middle Initial & Last Name & Degree
Feng Gao, Ph.D.

12. IPD Sharing Statement

Plan to Share IPD
No
Links:
URL
http://www.siteman.wustl.edu
Description
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

Learn more about this trial

Ruxolitinib for the Prophylaxis of Graft-Versus-Host Disease and Cytokine Release Syndrome After T-cell Replete Haploidentical Peripheral Blood Hematopoietic Cell Transplantation

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