Some patients with antibody-mediated autoimmune hematological diseases (warm autoimmune hemolytic anemia (wAIHA), cold agglutinin disease (cAIHA) and immune thrombocytopenia (ITP)) shows no or only minor and transient response to therapy despite several treatment-lines. Such patients are more likely to have a severe disease, with a higher morbidity and mortality. Hypothesis Effective depletion of autoreactive plasma cells might be the key for a curative approach of these diseases. Therefore, there is a rationale for using proteasome inhibitors (PIs) in these refractory patients. The rationale is that non-tumoral autoreactive plasma cells are rapidly targeted by proteasome inhibitors. It led us to propose a short course of dexamethasone and ixazomib (5 cycles), to evaluate the safety/efficacy of this innovative strategy of treatment. Method Prospective interventional uncontrolled single arm open study evaluating the rate of patients achieving 5 cycles of ixazomib and dexamethasone without severe toxicity and response on therapy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Oral ixazomib will be given on days 1, 8, 15 of a 28-day cycle, the investigator will start with first test dose levels of ixazomib of 3 mg and process with dose escalation, in case of non-response and no severe adverse events at cycle 1 (see above) or de-escalation in case of response and severe adverse events.
Mahevas
Créteil, France
Rate of patients achieving a response (CR+R) with 5 cycles without severe toxicity (grade III/IV)
Criteria of response: ITP: A complete response is defined by a platelet count \> 100 x 109/L maintained in the absence of any other ITP directed therapies. A responder to treatment is defined by a patient with a maintained platelet count at \> 30 x109/L (Rodeghiero et al Blood 2008) and a minimum twofold increase from initial platelet levels in the absence of bleeding and/or use of ITP directed therapies. AIHA: Complete response (CR) is defined as normalization in haemoglobin concentration (Hb≥12 g/dL) without any ongoing immunosuppressive treatment and without any biochemical signs of hemolytic activity. Response (R) is defined as a haemoglobin concentration ≥10 g/dL and requiring continued low-dose prednisolone (\<20 mg/day prednisone) or at least 2 g/dL increase in Hb, and no transfusion requirement
Time frame: 6 months
Number of patients responding to treatment (CR+R)
CR=complete response, R= Response
Time frame: At Day 28, Day 56, Day 84, Day 112, 6 months, 9 months and 12 months.
Number of patients experiencing a A treatment-emergent adverse event (TEAE) along the course of the study.
A treatment-emergent adverse event (TEAE) is defined as an adverse event with an onset that occurs after receiving study drug (AE start date ≥ first dose date) and within 30 days after receiving the last dose of study drug. TEAE will be scaled according to Common Terminology Criteria for Adverse Events (CTCAE) version 4. A severe toxicity severe toxicity is defined as ≥ grade III. For ITP patients, thrombocytopenia will not be included in TEAE if it is due to disease activity. But severe bleeding manifestations as unexpected severe hemorrhagic events defined as intracranial hemorrhage, gastrointestinal or visceral bleeding with a decrease of hemoglobin by more than 2 g/dl should be reported as SAE. For AIHA patients, anemia will not be included in TEAE if it is due to disease activity. But, severe, unexpected anemia (less thant 6 g/dl) in patients who have previously achieved a response should be reported as SAE.
Time frame: Up to 12 months
Gammablobulin level (and isotype) along the study
Time frame: Day 28, Day 56, Day 84, Day 112, 9 months and 12 months
Number of infectious events along the study
Time frame: Up to 12 months
Number of bleeding manifestations according to the French bleeding score for ITP patients
Time frame: At Day 28, Day 56, Day 84, Day 112, 6 months, 9 months and 12 months.
Protective antibody titers (measles, mumps, tetanus) (Ancillary Study)
Time frame: Day 0, Day 84, 6 months, 9 months and 12 months
Number of pathogenic circulating plasmablasts (Ancillary study)
Time frame: Day 0, 28, 56, 84, 112 months 6, 9, 12 months
Number and program of bone marrow pathogenic plasma cells for patients with refractory disease (Ancillary study).
Time frame: Day 0, 6 months
Anti-platelets/red blood cells antibodies (Ancillary study)
Time frame: Day 0, Day 84, 6 months
Level of serum cytokines (Ancillary study)
Time frame: Day 0, Day 28, Day 56, Day 84, Day 112 and 6 months , 9 months , 12 months
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