This phase II trial studies how well ixazomib citrate works in treating patients with chronic graft-versus-host disease. Chronic graft-versus-host disease is a complication of a donor bone marrow or blood cell transplant, usually occurring more than three months after transplant, in which donor cells damage the host tissue. Ixazomib citrate may be an effective treatment for chronic graft-versus-host disease.
PRIMARY OBJECTIVES: I. Determine the proportion of subjects with treatment failure by 6 months of ixazomib (ixazomib citrate) treatment for chronic graft-versus-host disease (GVHD). SECONDARY OBJECTIVES: I. Determine 3 month overall (complete + partial), and complete response rate. II. Determine 6 month overall (complete + partial), and complete response rate. III. Report overall survival, non-relapse mortality, primary malignancy relapse, failure-free survival, treatment success, and discontinuation of immune-suppressive therapy at 6 months and 1 year. IV. Examine functional outcome (2-minute walk test) and patient-reported outcomes (Lee Chronic GVHD Symptom Scale, quality of life \[Short Form Health Survey (SF)-36, Functional Assessment of Cancer Therapy Bone Marrow Transplant (FACT-BMT)\], Human Activity Profile \[HAP\]) at study enrollment, 6 months, and 1 year. V. Study biologic effects of proteasome inhibition. OUTLINE: Patients receive ixazomib citrate orally (PO) once weekly on days 1, 8, and 15. Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients with complete response, partial response, or stable disease may receive an additional 6 courses of ixazomib citrate. After completion of study treatment, patients are followed up for 6 months.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
50
Moffitt Cancer Center
Tampa, Florida, United States
Washington University School of Medicine
St Louis, Missouri, United States
University of Nebraska Medical Center
Omaha, Nebraska, United States
UNC Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina, United States
Incidence of Adverse Events
According to National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0
Time frame: Up to 30 days following completion of study treatment
Probability of Treatment Failure at 6 Months
Kaplan-Meier estimate assessed at 6 months for probability of treatment failure, defined as addition of a line of systemic immune-suppressive therapy, recurrent malignancy, or death.
Time frame: 6 months
Biologic Studies
The biologic impact of proteasome inhibition in the treatment of chronic GVHD will be assessed.
Time frame: Up to 6 months
Complete Response (CR) Rate
Response will be determined by both clinician-defined, as well as separately calculated according to the proposed response definitions of the NIH Consensus Conference.
Time frame: 6 months
Probability of Non-relapse Mortality at 1 Year
Kaplan-Meier estimate assessed at 1 year for probability of non-relapse mortality, defined as death in the absence of primary malignancy relapse after transplant.
Time frame: 1 year
Cumulative Incidence of Primary Malignancy Relapse
Defined as hematologic relapse or any unplanned intervention to prevent progression of disease in patients with evidence (molecular, cytogenetic, flow cytometric, radiographic) of malignant disease after transplantation.
Time frame: 1 year
Probability of Failure-free Survival at 1 Year
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Ancillary studies
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Fred Hutch/University of Washington Cancer Consortium
Seattle, Washington, United States
Kaplan-Meier estimate assessed at 1 year for failure-free survival, defined as the absence of death from any cause, relapse or addition of secondary immune suppressive agents.
Time frame: 1 year
Incidence of Discontinuation of All Systemic Immune Suppressive Therapies
The incidence of complete discontinuation of all systemic immune-suppressive therapies will be determined at 1 year.
Time frame: 1 year
Overall Response Rate (ORR) (Complete Response + Partial Response)
ORR at 6 months will be determined by both clinician-defined categories of complete response and partial response, as well as separately calculated according to the proposed response definitions of the NIH Consensus Conference.
Time frame: 6 months
Probability of Overall Survival at 1 Year
Kaplan-Meier estimate assessed at 1 year for overall survival, defined as absence of death from any cause.
Time frame: 1 year
Treatment Success
Treatment success will be estimated at 1 year with a composite outcome of complete resolution of all reversible chronic graft-versus-host disease (GVHD) manifestations, discontinuation of all systemic immune suppressive agents, and freedom from death or primary malignancy relapse after transplant.
Time frame: 1 year
Use of Additional Systemic Immune Suppressive Therapies
Addition of therapy after ixazomib constitutes failure, could occur at any time from baseline to 12mo.
Time frame: 1 year
Symptoms as Measured by Patient Self-report--Short Form-36 (SF-36)
SF-36 subscales have min=0 and max=100; results given are actual scores at 12mo, with higher scores indicating higher quality of life.
Time frame: 1 year
Symptoms as Measured by Patient Self-report--Functional Assessment of Chronic Illness Therapy (FACT)
FACT-BMT subscales have various min/max, see below; results given are actual 12mo scores, with higher scores indicating better functioning. FACT physical well-being (0-28) FACT social/family well-being (0-28) FACT emotional well-being (0-24) FACT functional well-being (0-28) FACT Bone Marrow Transplant (BMT) subscale (0-40) FACT trial outcome index (0-96) FACT-General (G) (0-108) FACT-BMT total (0-148)
Time frame: 1 year
Symptoms as Measured by Patient Self-report--Human Activities Profile (HAP)
HAP subscales have min=0 and max=94; results given are actual 12mo scores, with higher scores indicating better functioning. Maximum Activity Score (MAS) is highest item number answered still doing. Represents highest oxygen demanding activity that respondent still performs. Adjusted Activity Score (AAS) is MAS minus total number of stopped doing responses below MAS. A measure of usual daily activities. Modified AAS is MAS minus total number of stopped doing responses below MAS but not penalized for not doing activities not permitted post transplant. The following items are not counted against the score:11,15,19,20,22,25,34,41,42,47,49,50,52,53,54,57,72,73,77,78.
Time frame: 1 year
Symptoms as Measured by Patient Self-report--Lee Chronic GVHD Symptom Scale
Lee symptom scale (LSS) has subscales with min=0, max=100; results given are 12mo scores, with higher numbers indicating higher symptom burden.
Time frame: 1 year