This project aims to test the effectiveness of ITACITINIB in sporadic Hemophagocytosis Lymphohistiocytosis (HLHs)
This project aims to test the effectiveness of ITACITINIB in sporadic Hemophagocytosis Lymphohistiocytosis (HLHs). The existence of an IFN-γ signature, in HLHs, is a strong rational for testing the use of a JAK1 inhibitor in the treatment of HLHs. We hypothesize that ITACITINIB, an inhibitor of JAK-1, may be a therapeutic of interest in the treatment of non-severe HLHs in replacement of corticosteroids by inhibiting the production and effects of IFN-γ but also those of other pro-inflammatory cytokines. The use JAK-1 inhibitor instead of corticosteroids in patients with HLHs without any sign of severity is justified by its probable lesser toxicity and higher efficiency. In this proof of concept study, because of the vital risk associated with severe HLH and the efficacy of Etoposide in this setting, we will first include only patients with moderate HLHs
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
35
Administration of 300 mg of ITACITINIB per os every day for 30 days.
Hôpital Avicenne
Bobigny, Bobigny, France
Efficacy of ITACITINIB
Efficacy at day 15 of ITACITINIB treatment in non-severe adults HLH
Time frame: At day 15
Response rate of ITACITINIB at D8 on clinical and biological symptoms of primitive/refractory/relapse adults HLHs without severity criteria
Response rate at D8 of treatment
Time frame: day 8
Efficacy at the day of etiologic treatment if patients received at least 7 days of treatment (ITACITINIB taken until J15)
Rate of complete response to ITACITINIB treatment for HLHs in adults without any sign of severity at the day of etiologic treatment if patients have been treated by ITACITINIB at least during seven days. Response to ITACITINIB is evaluated at the day of etiologic treatment on the major and minor diagnostic criteria of HLH
Time frame: At day 15
Toxicity of ITACITINIB
Toxicity of ITACITINIB not related to evolution of HLH (cytopenia, worsening of hepatic balance, secondary infections)
Time frame: 21 months
Rescue therapy
In the case of worsening, treatment will be stopped and switch for HLH specific treatment as VP16, (etoposide)
Time frame: 21 months
Reduction of plasma cytokines level between D0 and D15 and correlation to the therapeutic response to D15
Range of decrease in plasma rate of IFN-Gamma, IP-10, Il-1, Il-6, IL-10, TNF-alpha, between D0 and D15 of ITACITINIB treatment in each patient group: response and progression
Time frame: At day 15
Clinical, biological, associated diseases characteristics of patients having CR, PR, Progression
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Clinical, biological, associated diseases and evolutions characteristics of patients in each response
Time frame: 21 months
Overall survival at 3
Overall survival at 3
Time frame: 3 months
Response rate of ITACITINIB at D30 on clinical and biological symptoms of primitive/refractory/relapse adults HLHs without severity criteria
Response rate at D30 of treatment
Time frame: day 30
Response rate of ITACITINIB at D90 on clinical and biological symptoms of primitive/refractory/relapse adults HLHs without severity criteria
Response rate at D90 of treatment
Time frame: day 90