This clinical trial evaluates the safety and effectiveness of adding itacitinib to cyclophosphamide and tacrolimus for the prevention of graft versus host disease (GVHD) in patients undergoing hematopoietic stem cell transplant. Itacitinib is an enzyme inhibitor that may regulate the development, proliferation, and activation of immune cells important for GVHD development. Cyclophosphamide and tacrolimus are immunosuppressive agents that may prevent GVHD in patients who receive stem cell transplants. Giving itacitinib in addition to cyclophosphamide and tacrolimus may be more effective at preventing GVHD in patients receiving hematopoietic stem cell transplants.
PRIMARY OBJECTIVES: I. Safety lead-in: Determine if shortening tacrolimus administration period to 60 days (day +65 post-hematopoietic cell transplantation \[HCT\]), when combined with post-transplant cyclophosphamide (PTCy) and itacitinib at a fixed dose level as graft-versus-host disease (GVHD) prophylaxis, is safe and effective after mobilized peripheral blood stem cell (PBSC) allogeneic hematopoietic cell transplantation (HCT) from a matched related/unrelated donor, as assessed by grade 3-4 GVHD as dose limiting toxicity. II. Following the safety lead-in, evaluate the efficacy of PTCy, itacitinib and tacrolimus GVHD prophylaxis, as assessed by 1-year GVHD-free relapse-free survival (GRFS). SECONDARY OBJECTIVES: I. Evaluate the safety of this regimen by assessing: Ia. Adverse events: type, frequency, severity, attribution, time course, duration. Ib. Complications including acute and chronic GVHD, infections and delayed engraftment. II. Estimate overall survival (OS), progression-free survival (PFS), cumulative incidences of relapse/disease progression, and non-relapse mortality (NRM) at 100 days, and 1-year post-transplant. III. Estimate rates of acute and chronic GvHD, infections, and neutrophil recovery. EXPLORATORY OBJECTIVES: I. Donor cell engraftment will be assessed by count monitoring and short tandem repeat (STR) chimerism analysis on days +30 and day +100. II. Describe the kinetics of immune cell recovery. III. Evaluate patient's quality of life on day +100, 6 months and one-year post-HCT. IV. Pharmacokinetics: serial blood sampling will be done to evaluate the steady-state pharmacokinetics of itacitinib after PTCy. V. Describe the kinetics of GVHD biomarkers, JAK-related inflammatory cytokines and STAT phosphorylation. VI. Evaluate and describe the cytokine release syndrome (CRS) post-HCT by assessing the incidence, frequency, and severity of CRS. VII. Obtain a preliminary estimate of gut microbiome diversity at baseline (preferably before fludarabine administration), and then on days +14, +30, and +100. OUTLINE: Patients undergo peripheral blood stem cell infusion on day 0. Patients receive cyclophosphamide intravenously (IV) once daily (QD) on days 3 and 4, itacitinib orally (PO) QD on days 5-100, and tacrolimus IV or PO on days 6-65. After completion of study treatment, patients are followed up at day 180 and 1 year.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Enrollment
20
Given IV
Given PO
Undergo peripheral blood stem cell infusion
Ancillary studies
Given IV or PO
City of Hope Medical Center
Duarte, California, United States
Number of participants with Grade III-IV acute graft versus host disease (GVHD)
Acute GVHD will be graded and staged according to Mount Sinai Acute GVHD International Consortium (MAGIC) criteria.
Time frame: By day 100
GVHD-free relapse-free survival rate
Will be calculated using the Kaplan-Meier method.
Time frame: From start of hematopoietic cell transplantation to grade III-IV acute GvHD, chronic GvHD requiring systemic treatment, relapse, or death (from any cause), whichever occurs first, assessed at 1 year
Incidence of adverse events
The toxicity/adverse event information recorded on each subject will include type, severity, duration, and attribution/ association with the study regimen. Tables will be constructed to summarize the observed incidence, severity and type of toxicity, including infection.
Time frame: Up to 2 years
Overall survival
Will be calculated using the Kaplan-Meier method.
Time frame: Day of stem cell infusion (day 0) until death or last follow-up, assessed at 100 days
Overall survival
Will be calculated using the Kaplan-Meier method.
Time frame: Day of stem cell infusion (day 0) until death or last follow-up, assessed at 180 days
Overall survival
Will be calculated using the Kaplan-Meier method.
Time frame: Day of stem cell infusion (day 0) until death or last follow-up, assessed at 1 year
Progression free survival
Will be calculated using the Kaplan-Meier method.
Time frame: From the date of stem cell infusion to the date of death, disease relapse/progression, or last follow-up, assessed at 100 days
Progression free survival
Will be calculated using the Kaplan-Meier method.
Time frame: From the date of stem cell infusion to the date of death, disease relapse/progression, or last follow-up, assessed at 180 days
Progression free survival
Will be calculated using the Kaplan-Meier method.
Time frame: From the date of stem cell infusion to the date of death, disease relapse/progression, or last follow-up, assessed at 1 year
Relapse/progression
The cumulative incidence will be calculated using the competing risk method.
Time frame: Day 0 to relapse/progression, assessed at 100 days
Relapse/progression
The cumulative incidence will be calculated using the competing risk method.
Time frame: Day 0 to relapse/progression, assessed at 180 days
Relapse/progression
The cumulative incidence will be calculated using the competing risk method.
Time frame: Day 0 to relapse/progression, assessed at 1 year
Non-relapse mortality
The cumulative incidence will be calculated using the competing risk method.
Time frame: Day 0 until non-disease related death or last follow-up, assessed at 100 days
Non-relapse mortality
The cumulative incidence will be calculated using the competing risk method.
Time frame: Day 0 until non-disease related death or last follow-up, assessed at 180 days
Non-relapse mortality
The cumulative incidence will be calculated using the competing risk method.
Time frame: Day 0 until non-disease related death or last follow-up, assessed at 1 year
Rate of acute GVHD
Acute GVHD will be graded and staged according to MAGIC criteria. The first day of acute GVHD onset at a certain grade will be used to calculate the cumulative incidence (grades II-IV). The endpoint will be evaluated from day 0 through 100 days post-transplant. The cumulative incidence will be calculated using the competing risk method.
Time frame: On day 100
Rate of chronic GVHD
Chronic graft versus host disease will be evaluated and scored according to National Institutes of Health Consensus Staging. The first day of chronic GVHD onset will be used to calculate the cumulative incidence. The cumulative incidence will be calculated using the competing risk method.
Time frame: From day 80 through 1 year post-transplant
Rate of infection
Microbiologically documented infections will be reported by site of disease, date of onset, severity and resolution, if any. This data will be captured via case report form and will be collected from day -7 to day 120 post-transplant and will follow the same data collection intervals as the toxicity and adverse event data.
Time frame: Day -7 to day 120
Rate of hematologic recovery
Absolute neutrophil count \>= 0.5 x 10\^3/uL achieved and sustained for 3 consecutive lab values on different days with no subsequent decline. Platelets \>= 20 K/uL independent of platelet transfusion support (date should reflect no transfusions in previous 7 days, and the first of 3 consecutive lab values on different days).
Time frame: Up to 2 years
Incidence of cytokine release syndrome
Defined and graded per American Society for Transplantation and Cellular Therapy criteria.
Time frame: Up to 2 years
Gut microbiome assessment
Gut microbiome diversity will be assessed by the inverse Simpson Index and compared among CBM588-treated/untreated patients; the inverse Simpson index is an ecological measure of α microbial diversity calculated by the inverse of the expected probability of 2 randomly selected bacterial sequences as belonging to the same operational taxonomic unit.
Time frame: Up to 2 years
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