JAK1/2 Inhibitor Ruxolitinib for Relapsed/Refractory Immune Bone Marrow Failure
- Conditions
- Hypoplastic MDSSingle Lineage Cytopenias, T-LGLSevere Aplastic Anemia
- Interventions
- Registration Number
- NCT05998408
- Brief Summary
Background:
Immune bone marrow failure is a condition that occurs when a person s immune system attacks the cells of the bone marrow. This can lead to diseases including different types of anemias and blood cancers. Some of these diseases can be deadly. Better treatments are needed.
Objective:
To test a drug (ruxolitinib) in people with different types of immune bone marrow failure.
Eligibility:
Adults aged 18 and older with an immune bone marrow failure.
Design:
Participants will be screened. They will have a physical exam. They will give samples of blood and saliva. They will have a bone marrow biopsy: A large needle will be inserted into a small cut to remove a sample of the soft tissue inside the bone. Some participants may have a skin biopsy: A small piece of skin will be removed. Some may have a computed tomography (CT) scan: They will lie on a table that slides into a donut-shaped machine that uses X-rays to make pictures of the inside of the body.
Ruxolitinib is a tablet taken by mouth. Participants will take the drug twice a day for up to 6 months.
Participants will have blood tests every week while they are taking the drug. These tests can be done by the participant s own physician and the results sent to the researchers.
Participants will have clinic visits after taking the drug for 3 months and 6 months and then after 1, 2, and 3 years. The blood tests and bone marrow biopsy will be repeated.
Participants who improve while taking the drugs may go on to an extension phase of the study.
- Detailed Description
Study description:
This is a prospective, non-randomized, phase I/II study in which participants with relapsed/refractory immune marrow failure (severe aplastic anemia, moderate aplastic anemia, single lineage cytopenias, T-LGL, and hypoplastic MDS) will be treated with the JAK1/2 inhibitor ruxolitinib. Our hypothesis is that JAK1/2 inhibition with ruxolitinib will result in hematologic improvement in participants with immune marrow failure.
Objectives:
The primary objectives are to assess safety and efficacy of the JAK1/2 inhibitor ruxolitinib in immune marrow failure.
The secondary objectives are to assess early and long-term hematologic response, depth of response, development of transfusion independence, rate of relapse, rate of clonal evolution to myeloid malignancy and Paroxysmal Nocturnal Hemoglobinuria (PNH), 3-year overall survival, response after re-initiation of therapy in relapsed participants, maximum tolerated dose.
Endpoints:
The primary endpoints are: (a) the primary safety endpoint will be number of participants who complete a full course of ruxolitinib without cessation required by hematologic toxicity in the 6 months following treatment initiation; (b) The primary efficacy endpoint is overall response (OR) rate by 6 months.
The secondary endpoints are time to OR, OR at 3 months, development of transfusion independence at 3 and 6 months, type of response at 3 and 6 months, rate of relapse up to 3 years, rate of clonal evolution up to 3 years, 3-year overall survival (OS), and number of participants tolerating maximum ruxolitinib dose.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 145
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Subjects with PRCA Ruxolitinib Subjects are defined as patients with a diagnosis of PRCA clinically confirmed by a licensed physician or advanced practitioners who meet the inclusion and exclusion criteria and can provide informed consent. Subjects with hypoplastic MDS Ruxolitinib Subjects are defined as patients with a diagnosis of hMDS clinically confirmed by a licensed physician or an advanced practitioner who meets the inclusion and exclusion criteria and can provide informed consent. Subjects with MAA Ruxolitinib Subjects are defined as patients with a diagnosis of MAA clinically confirmed by a licensed physician or an advanced practitioner who meets the inclusion andexclusion criteria and can provide informed consent. Subjects with SAA Ruxolitinib Subjects are defined as patients with a diagnosis of SAA clinically confirmed by a licensed physician oran advanced practitioner who meets the inclusion andexclusion criteria and can provide informed consent. Subjects with TLGL Ruxolitinib Subjects are defined as patients with a diagnosis of TLGL clinically confirmed by a licensed physician or advanced practitioner who meets the inclusion and exclusion criteria and can provide informed consent.
- Primary Outcome Measures
Name Time Method The number of patients who complete a full course of ruxolitinib without cessation is required by hematologic toxicity. 6 months The primary safety endpoint will be the number of patients who complete a full course of ruxolitinib without cessation required by hematologic toxicity in the 6 months following treatment initiation.
Overall Response Rate. Patients who develop a Complete response at 3 months and stop the drug will also be deemed responders even if they subsequently relapse. 6 months The primary efficacy endpoint is the OR rate by 6 months. Patients who develop CR at 3 months and stop the drug will also be deemed responders even if they subsequently relapse.
- Secondary Outcome Measures
Name Time Method Hematological response 3, 12 months, and yearly thereafter Time to transfusion independence Variable Rate of clonal evolution Variable Rate of relapse Variable Percent of patients tolerating 20 mg ruxolitinib BID. Variable Overall survival Variable Hematological response of relapse subjects that re-start treatment Variable Depth of response 3, 6 months
Trial Locations
- Locations (1)
National Institutes of Health Clinical Center
🇺🇸Bethesda, Maryland, United States