Phase 2a Study of Adding Ruxolitinib With Tacrolimus/Methotrexate Regimen for Graft-versus-Host Disease Prophylaxis in Myeloablative Conditioning Hematopoietic Cell Transplantation in Pediatric and Young Adult Patients
试验速览
- 阶段
- 2 期
- 状态
- 招募中
- 发起方
- 入组人数
- 40
- 试验地点
- 1
- 主要终点
- Incidence of adverse events
研究概览
简要总结
This phase II trial tests how well ruxolitinib with tacrolimus and methotrexate work to prevent the development of graft versus host disease in pediatric and young adult patients undergoing allogeneic hematopoietic cell transplant for acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndrome. Ruxolitinib is a type of medication called a kinase inhibitor. It works by blocking the signals of cells that cause inflammation and cell proliferation, which may help prevent graft versus host disease (GVHD). Tacrolimus is a drug used to help reduce the risk of rejection by the body of organ and bone marrow transplants by suppressing the immune system. Methotrexate stops cells from making DNA, may kill cancer cells, and also suppress the immune system, which may reduce the risk of GVHD. Giving ruxolitinib with tacrolimus and methotrexate may prevent GVHD in pediatric and young adults undergoing allogeneic hematopoietic cell transplants.
详细描述
PRIMARY OBJECTIVES:
I. Determine if the addition of ruxolitinib phosphate (ruxolitinib) to tacrolimus and methotrexate as graft-versus-host disease (GVHD) prophylaxis, is safe in pediatric and young adult patients with hematologic malignancies who are eligible to undergo allogeneic hematopoietic cell transplantation (HCT) from a matched donor. (Safety lead-in segment) II. Following a patient safety lead-in, evaluate the efficacy of ruxolitinib, when given as part of reduced intensity HCT from a matched related/unrelated donor, as assessed by 1 year graft-versus-host disease-free and relapse-free (GRFS) rates in pediatric and young adult patients. (Phase II segment)
SECONDARY OBJECTIVES:
I. Estimate the cumulative incidence of acute GVHD (aGVHD) and non-relapse mortality (NRM) at 100-days after transplant.
II. Estimate the cumulative incidence of chronic GVHD (cGVHD) at 1- and 2-years after transplant.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 2 Years 至 22 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Documented informed consent of the participant and/or legally authorized representative
- •Assent, when appropriate, will be obtained per institutional guidelines
- •Agreement to allow the use of archival tissue from diagnostic tumor biopsies
- •If unavailable, exceptions may be granted with study primary investigator (PI) approval
- •Age: 2-22
- •Weight ≥25kg
- •Eastern Cooperative Oncology Group (ECOG) ≤ 2
- •Performance status: Karnofsky ≥ 60% for patients ≥ 16 years old OR Lansky status ≥ 60% for patients < 16 years old
- •Candidate for allogeneic bone marrow transplant with and available matched related donor (MRD) or an 8/8 matched unrelated donor (MUD) who is willing to donate bone marrow (BM) or mobilized peripheral blood stem cells
- •Note: Donor selection process will be in accordance with City of Hope (COH)-standard operating procedures (SOPs) (B.001.09 Allogeneic Cellular Therapy Product Donor Evaluation, Selection & Consent), which follows Food and Drug Administration (FDA) guidelines for donation of hematopoietic stem/progenitor cells (HPCs) obtained from peripheral blood or bone marrow
- •Diagnosis of acute leukemia (acute myeloid leukemia [AML] or acute lymphoblastic leukemia [ALL]) in complete remission, or myelodysplastic syndrome (MDS)
- •Fully recovered from the acute toxic effects (except alopecia) to ≤ grade 1 from prior anti-cancer therapy
- •Women of childbearing potential (WOCBP): negative urine or serum pregnancy test. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required (to be performed within 30 days prior to day 1 of protocol therapy)
- •Agreement by females and males of childbearing potential to use an effective method of birth control or abstain from heterosexual activity for the course of the study through at least 6 months after the last dose of protocol therapy
- •Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for > 1 year (women only)
排除标准
- •Autologous stem cell transplant within 1 year prior to day 1 of protocol therapy
- •Prior allogeneic transplantation
- •Chemotherapy, radiation therapy, biological therapy, immunotherapy within 14 days prior to day 1 of protocol therapy
- •Note: Conditioning regimen within 21 days prior to day 1 of protocol therapy is not considered as an exclusion criterion.
- •Note: Patients on maintenance chemotherapy with agents listed are not excluded
- •Herbal medications
- •History of allergic reactions attributed to compounds of similar chemical or biologic composition to study agent
- •History of active tuberculosis
- •Patients with history of thrombosis including but not limited to myocardial infarction (MI)/stroke and pulmonary embolism (PE)/deep vein thrombosis (DVT) within 6 months of enrollment
- •Active diarrhea due to inflammatory bowel disease or malabsorption syndrome
- •Clinically significant uncontrolled illness
- •Active, uncontrolled systemic infection (viral, bacterial, or fungal) requiring antibiotics
- •Known history of immunodeficiency virus (HIV) or hepatitis B or hepatitis C infection
- •Other active malignancy
- •Females only: Pregnant or breastfeeding
- •Any other condition that would, in the investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures
- •Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)
研究组 & 干预措施
Prevention (Ruxolitinib, tacrolimus, methotrexate)
Patients receive ruxolitinib PO BID from day -1 to day +100, tacrolimus IV on day -1, and methotrexate IV on days +1, +3, +6, and +11, and undergo HCT on day 0. Patients also undergo chest CT and ECHO/MUGA at screening and undergo collection of blood samples throughout the trial.
干预措施: Biospecimen Collection (Procedure)
Prevention (Ruxolitinib, tacrolimus, methotrexate)
Patients receive ruxolitinib PO BID from day -1 to day +100, tacrolimus IV on day -1, and methotrexate IV on days +1, +3, +6, and +11, and undergo HCT on day 0. Patients also undergo chest CT and ECHO/MUGA at screening and undergo collection of blood samples throughout the trial.
干预措施: Chest Computed Tomography (Procedure)
Prevention (Ruxolitinib, tacrolimus, methotrexate)
Patients receive ruxolitinib PO BID from day -1 to day +100, tacrolimus IV on day -1, and methotrexate IV on days +1, +3, +6, and +11, and undergo HCT on day 0. Patients also undergo chest CT and ECHO/MUGA at screening and undergo collection of blood samples throughout the trial.
干预措施: Echocardiography (Procedure)
Prevention (Ruxolitinib, tacrolimus, methotrexate)
Patients receive ruxolitinib PO BID from day -1 to day +100, tacrolimus IV on day -1, and methotrexate IV on days +1, +3, +6, and +11, and undergo HCT on day 0. Patients also undergo chest CT and ECHO/MUGA at screening and undergo collection of blood samples throughout the trial.
干预措施: Hematopoietic Cell Transplantation (Procedure)
Prevention (Ruxolitinib, tacrolimus, methotrexate)
Patients receive ruxolitinib PO BID from day -1 to day +100, tacrolimus IV on day -1, and methotrexate IV on days +1, +3, +6, and +11, and undergo HCT on day 0. Patients also undergo chest CT and ECHO/MUGA at screening and undergo collection of blood samples throughout the trial.
干预措施: Methotrexate (Drug)
Prevention (Ruxolitinib, tacrolimus, methotrexate)
Patients receive ruxolitinib PO BID from day -1 to day +100, tacrolimus IV on day -1, and methotrexate IV on days +1, +3, +6, and +11, and undergo HCT on day 0. Patients also undergo chest CT and ECHO/MUGA at screening and undergo collection of blood samples throughout the trial.
干预措施: Multigated Acquisition Scan (Procedure)
Prevention (Ruxolitinib, tacrolimus, methotrexate)
Patients receive ruxolitinib PO BID from day -1 to day +100, tacrolimus IV on day -1, and methotrexate IV on days +1, +3, +6, and +11, and undergo HCT on day 0. Patients also undergo chest CT and ECHO/MUGA at screening and undergo collection of blood samples throughout the trial.
干预措施: Ruxolitinib Phosphate (Drug)
Prevention (Ruxolitinib, tacrolimus, methotrexate)
Patients receive ruxolitinib PO BID from day -1 to day +100, tacrolimus IV on day -1, and methotrexate IV on days +1, +3, +6, and +11, and undergo HCT on day 0. Patients also undergo chest CT and ECHO/MUGA at screening and undergo collection of blood samples throughout the trial.
干预措施: Tacrolimus (Drug)
结局指标
主要结局
Incidence of adverse events
时间窗: Up to day +30 post hematopoietic cell transplant (HCT)
Defined using the modified Bearman Scale and the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 scale.
Graft-versus-host disease (GVHD)-free and relapse-free (GRFS)
时间窗: From the date of transplantation to the first time of observing the following events: grade 3-4 acute GVHD, chronic GVHD requiring systemic treatment, relapse, or death, assessed at 1 year post transplantation
Will be estimated using the product-limit method of Kaplan and Meier.
次要结局
- Acute GVHD biomarkers(Up to 2 years)
- JAK-regulated pro-inflammatory cytokines(Up to 2 years)
- STAT3 phosphorylation(Up to 2 years)
- Incidence of chronic GVHD(At 1 and 2 years post HCT transplant)
- Overall survival(From the day of stem cell infusion until death, up to 2 years)
- Progression free survival(From the date of stem cell infusion to the date of death, disease relapse/progression, whichever occurs first, up to 2 years)
- incidence of relapse/progression(From day of stem cell infusion (day 0) to first observation of disease relapse/progression, up to 2 years)
- Infection rate(From day -1 to day 130 post HCT transplant)
- Incidence of secondary malignancies(From day of stem cell infusion (day 0) to first observation of event of interest, assessed at 1 and 2 years post HCT transplant)
- Hematologic recovery, donor cell engraftment and immune reconstitution(Up to 2 years)
- Incidence of adverse events during phase II segment(Up to day +30 post HCT transplant)
- Patients receiving planned doses of ruxolitinib (feasibility)(At completion of therapy (up to day+100))
- Incidence of acute GVHD(At 100 days post HCT transplant)
- Incidence of non-relapse mortality(At 100 days post HCT transplant)