Ruxolitinib for Newly Diagnosed Bronchiolitis Obliterans Syndrome

First Affiliated Hospital of Zhejiang University50 enrolled

Overview

Lung is one of the target organs in chronic graft versus host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Bronchiolitis obliterans syndrome (BOS) after allo-HSCT was a clinical syndrome characterized by persistent airflow restriction which is the result of lung cGVHD. BOS is one of the main causes of late mortality after allo-HSCT, severely restricting the daily activities and respiratory function of patients. It limits the quality of life and increased the non-relapse mortality (NRM) after allo-HSCT. Currently, the first-line treatment for BOS is FAM ( oral fluticasone, azithromycin and montelukast). However, more than 50% of patients develop as steroids resistant (SR)-BOS, and SR-BOS has a poor prognosis and irreversible impaired lung function. Ruxolitinib is an effective drug in the treatment of SR-cGVHD. This is a phase Ⅱ prospective clinical study to explore the efficacy and safety of ruxolitinib as a first-line treatment for newly diagnosed BOS after allo-HSCT.

The incidence of chronic graft versus host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) was 30%-70%, Which extremely limited the quality of life and the survival of patients after allo-HSCT. Lung is one of the target organs in cGVHD after allo-HSCT. Bronchiolitis obliterans syndrome (BOS) after allo-HSCT was a clinical syndrome characterized by persistent airflow restriction which is the result of lung cGVHD. BOS is one of the main causes of late mortality after allo-HSCT, severely restricting the daily activities and respiratory function of patients. It limits the quality of life and increased the non-relapse mortality (NRM) after allo-HSCT. Currently, the first-line treatment for BOS is FAM ( oral fluticasone, azithromycin and montelukast). However, more than 50% of patients develop as steroids resistant (SR)-BOS, and SR-BOS has a poor prognosis and irreversible impaired lung function. Ruxolitinib is an effective drug in the treatment of SR-cGVHD. This is a phase Ⅱ prospective clinical study to explore the efficacy and safety of ruxolitinib as a first-line treatment for newly diagnosed BOS after allo-HSCT.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Male or female; 18-65 years old 2. Diagnosis of BOS after allo-HCT defined as the 2014 NIH criteria 3. Life expectancy \> 6 months at the time of enrollment 4. At least 4 weeks since initiation of the most recent systemic therapy for cGVHD or BOS 5. The ability to understand and willingness to sign a written consent document Exclusion Criteria: 1. Recurrent malignancy or disease progression requiring anticancer therapy 2. Currently receiving or have previously received ruxolitinib for chronic GVHD therapy 3. Known history of allergy to ruxolitinib or its excipients 4. Hepatic dysfunction: transaminases (ALT, AST) \> 5X ULN and/or total bilirubin \> 3X ULN 5. Hematologic dysfunction: absolute neutrophil count \<1000/μL, platelet cout \<30\*10E9/L, and/or Hgb \< 8 g/dL 6. Renal dysfunction: calculated creatinine clearance \< 30 mL/min (Cockcroft-Gault formula) 7. previously received second-line treatment or any drugs in clinical trials for cGVHD

Outcomes

Primary Outcomes

absolute FEV1 increase

The proportion of participants with a sustained, absolute FEV1 increase by ≥ 10% after 3 months of treatment with ruxolitinib (compared to baseline measure prior to study enrollment)

Time frame: 3 Months

Secondary Outcomes

treatment failure rate

The proportion of participants who do not experience a sustained, absolute decrease in FEV1 by ≥ 10% after 3 months of treatment with ruxolitinib (compared to baseline measure prior to study enrollment)

Time frame: 3 Months

absolute FEV1 increase

The proportion of participants with a sustained, absolute FEV1 increase by ≥ 10% after treatment with ruxolitinib (compared to baseline measure prior to study enrollment)

Time frame: 6 Months, 9 Months, 12 Months and 24 Months

Improvements in chronic GVHD organ specific manifestations

mprovements in chronic GVHD organ specific manifestations will be categorized according to the NIH chronic GVHD consensus criteria.

Time frame: 6 Months, 9 Months, 12 Months and 24 Months

Overall Survival

The proportion of patients survival at two years after enrollment of ruxolitinib treatment

Time frame: 2 years

cGVHD progression-free survival

Participants alive without cGVHD progression are censored at the date of last disease evaluation

Time frame: 2 years

The incidence and types of serious adverse events

Adverse events are graded according to Common Terminology Criteria for Adverse Events (CTCAE v4)

Time frame: From the start of treatment until 30 days after the end of treatment, up to 2 years

The change of systemic corticosteroid dose over time

The change of systemic corticosteroid dose over time during the treatment of BOS

Time frame: From the start of treatment until the end of treatment, up to 2 years

Ruxolitinib for Newly Diagnosed Bronchiolitis Obliterans Syndrome

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts