This is multicenter investigator-initiated randomized open-label phase II clinical trial to compare prophylaxis of graft versus host disease treated with tacrolimus and mycophenolate mofetil versus ruxolitinib after post-transplant cyclophosphamide. In total 128 patients will be included in the study. After inclusion into the study and performing of transplantation patients will be randomized in 1:1 proportion in two arms (64 patients per arm): arm A will include patients who will be treated with cyclophosphamide and ruxolitinib for GVHD prophylaxis; arm B will include patients who will be treated with cyclophosphamide, tacrolimus and MMF for GVHD prophylaxis. After the end of the treatment patients will be followed-up during two years.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
128
Ruxolitinib administered during conditioning 5 mg tid before allogeneic hematopoietic stem cell transplantation, 5 mg tid days 5-21 and 5 mg bid days 22-150 after transplantation instead of tacrolimus and MMF.
Tacrolimus 0.03 mg/kg adjusted to concentrations 5-15 ng/ml from day+5 to +100
Mycophenolate mofetil 30 mg/kg from day +5 to +35
National Hematology Research Center
Moscow, Russia
RM Gorbacheva Research Institute
Saint Petersburg, Russia
Incidence of acute GVHD grade II-IV
Proportion of patients with acute GVHD II-IV grade
Time frame: 125 days
Non-relapse mortality
Cumulative incidence of patients with mortality without hematological relapse of malignancy
Time frame: 2 years
Relapse incidence
Cumulative incidence of patients with relapse
Time frame: 2 years
Incidence of moderate and severe chronic GVHD
Cumulative incidence of patients with moderate and severe chronic GVHD according to NIH 2015 criteria
Time frame: 2 years
Overall survival
Kaplan-Meier estimate of death from all causes
Time frame: 2 years
Event-free survival
Kaplan-Meier estimate of death or relapse
Time frame: 2 years
Incidence of HSCT-associated adverse events (safety and toxicity)
Toxicity assessment is based on NCI CTC AE 5.0 grades. Veno-occlusive disease incidence and severity assessment is based on EBMT criteria 2016. Transplant-associated microangiopathy incidence assessment is based on Cho et al. criteria. All toxicity measurements will be aggregated as severity scores.
Time frame: 125 days
Primary or secondary graft failure
Cumulative incidence of patients with primary or secondary graft failure defined by the absence of donor chimerism.
Time frame: 2 years
Incidence of infections
Number of patients with bacteremia before engraftment, bacteremia after engraftment, severe sepsis (presence of multiple organ failure), pneumonia, soft tissue infection, invasive mycosis (probable or proven invasive aspergillosis, candidaemia, zygomycosis), reactivation of cytomegalovirus, other opportunistic viral infections
Time frame: 6 months
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