REscuing Bone Marrow Function in Patients with AplaStic AnaEmia and Bone Marrow FaiLure Post AllogEneiC Transplantation 2

NCT06607367 | Not Yet Recruiting Phase 1 DMC

• 1 other identifier: 2024.231
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 1

Brief Summary

Allogeneic stem cell transplantation involves the transplanting of donor blood stem cells into a recipient, this is performed mainly for the treatment of blood cancers. The bone marrow is the organ that produces all blood cells and allogeneic stem cell transplantation results in the replacement of abnormal recipient bone marrow with donor blood cells as well as the production of donor immune cells from the donor bone marrow. The production of donor immune cells will hopefully lead to an immune response directed at any persisting cancerous cells leading to their eradication. As such, one of the key measures of success of a transplant is establishment of donor engraftment. Engraftment is considered successful when the patient has normal blood cell counts on routine laboratory testing as well as confirmation that the blood cells are being produced by donor bone marrow cells. Confirming donor blood cell production is done by a process called chimerism. Poor graft function (PGF) is a complication of allogeneic stem cell transplantation related to engraftment, manifested by low blood counts despite complete donor chimerism. This has significant consequences for the patient leaving them susceptible to infection because of low white blood cells and bleeding because of low platelets (the cell components that are important for blood clotting). There is currently no established treatment for this condition and patients with this condition who do not recover have a poor survival. Aplastic anaemia (AA) is a rare autoimmune condition that results in a patient's own immune system attacking important components of their bone marrow resulting in low blood counts. The current treatments for AA include suppressing the immune system or a bone marrow transplant, however long term survival for patients who do not respond to these treatments or relapse is poor and more effective treatments are required. There is emerging evidence that demonstrates that the components of the immune system are dysfunctional and result in excessive immune activation resulting in suppression of the bone marrow characteristic of PGF. Similar features of immune dysfunction has been demonstrated in AA. Ruxolitinib is a drug that may be able to reduce this excessive immune activation. Eltrombopag is a drug that has been shown to stimulate the production of blood cells. The aim of this study is to evaluate whether the combination of ruxolitinib and eltrombopag is safe and effective in the treatment of PGF and AA.

Conditions

Poor Graft Function; Aplastic Anemia Idiopathic

Outcome Measures

Primary Outcomes (2)

• Complete Response at 12 weeks

  Number of patients with Complete Response (CR) at 12 weeks defined as: 1. Neutrophils greater than or equal to 1.5x10\^9/L 2. Platelets greater than or equal to 100x10\^9/L without use of transfusions or cytokine support

  12 weeks

• Grade 2 or Higher Non-Haematologic Toxicity

  Rates of grade 2 or higher non haematologic toxicity as graded by the national cancer institute toxicity criteria version 5

  From study enrolment to study completion (maximum of 1 year per subject)

Study Arms (1)

Ruxolitinib and Eltrombopag

EXPERIMENTAL

Ruxolitinib at a dose of 10mg BD and Eltrombopag at a dose of 50mg Dose adjustments may be required based on lack of efficacy, or thrombocytopenia may occur as per the study protocol .

Drug: Ruxolitinib (JAKAVI®); Drug: Eltrombopag (Revolade®)

Interventions

Ruxolitinib (JAKAVI®) DRUG

Initial starting dose will be 10mg BD

Ruxolitinib and Eltrombopag

Eltrombopag (Revolade®) DRUG

Initial starting dose will be 50mg daily

Ruxolitinib and Eltrombopag

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patient must meet ALL of the following:
• Poor Graft function OR Relapsed/refractory AA
• Poor Graft Function defined as follows:≥95% donor chimerism at last reading OR ≥95% CD3 negative chimerism; ≥2 Lineage cytopenias defined as:
• Thrombocytopenia:
• x109 /L from D40-D60 OR
• x10 9/L from D60 onwards; Neutropenia requiring filgrastim support at any time post D40; Hb less than 80g/L;
• Relapsed /Refractory AA defined as: Relapse after stem cell transplant OR relapsed post/refractory to 1st line immunosuppression without an unrelated donor identified.
• Age ≥18
• ECOG performance status 0-1
• Life expectancy greater than 6 months
• Patient's written informed consent

You may not qualify if:

• Active Grade 3-4 acute GVHD
• Relapsed or progressive disease on screening bone marrow biopsy or most recent PET imaging.
• Active second malignancy currently requiring treatment
• Human Immuno-deficiency Virus (HIV) infection.
• Any coexisting medical or psychological condition that would preclude participation in the required study procedures.
• Female patients who are both lactating and breast-feeding or have a positive serum pregnancy test during the screening period or a positive pregnancy test on Day 1 before first dose of study drug

Sponsors & Collaborators

• Melbourne Health: lead

Study Sites (1)

The Royal Melbourne Hospital

Parkville, Victoria, 3050, Australia

Location

MeSH Terms

Conditions

Anemia, Aplastic

Interventions

ruxolitinib; eltrombopag

Condition Hierarchy (Ancestors)

Anemia; Hematologic Diseases; Hemic and Lymphatic Diseases; Bone Marrow Failure Disorders; Bone Marrow Diseases

Central Study Contacts

David Ritchie

CONTACT

+61393427000; david.ritchie@mh.org.au

Ashvind Prabahran

CONTACT

ashvind.prabahran@mh.org.au

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Single group study with historic control

Study Record Dates

• First Submitted: September 15, 2024
• First Posted: September 23, 2024
• Study Start: October 30, 2024
• Primary Completion: October 30, 2025
• Study Completion (Estimated): October 30, 2026
• Last Updated: September 23, 2024

Record last verified: 2024-09

Data Sharing

• IPD Sharing: Will not share

Locations

AU (1)