Treatment Free Remission After Combination Therapy With Ruxolitinib Plus Tyrosine Kinase Inhibitors
Treatment Free Remission After Combination Therapy With Ruxolitinib Plus Tyrosine Kinase Inhibitors in Chronic Phase Chronic Myeloid Leukemia (CP-CML) Patients Who Relapsed After a Prior Attempt at TKI Discontinuation
  • Phase

    Phase 2
  • Study Type

  • Status

  • Study Participants

The purpose of this study is to determine if adding Ruxolitinib to a Tyrone Kinase Inhibitor (TKI), prior to a second attempt at stopping a TKI will lead to prolonged treatment free remission (TFR).
All participants will have a confirmed diagnosis of chronic phase chronic myeloid leukemia (CML) and must have previously attempted to discontinue TKI therapy. All participants must be restarted on a TKI at the time of relapse in order to be eligible for this trial.

After completion of 12 cycles of combination therapy, eligible participants will remain in the TFR phase of the study for up to 36 months, and will have central polymerase chain reaction (PCR) testing during the first 24 months. Therefore, the total duration of the trial will be approximately 48 months (12 months on combination treatment phase + 36 months in the TFR phase).
Study Started
Nov 19
Primary Completion
Jan 31
Study Completion
Jan 31
Last Update
Jul 28

Drug Ruxolitinib

Ruxolitinib: 15 mg by mouth (PO) twice a day (BID).

  • Other names: Jakafi®

Drug BCR-ABL Tyrosine Kinase Inhibitor (TKI) [nilotinib (tasigna), bosutinib (bosulif), dasatinib (sprycel), imatinib (gleevec)]

The BCR-ABL TKIs that will be used include imatinib, dasatinib, nilotinib or bosutinib.

  • Other names: TKI

Combination Therapy + Remission Phase Experimental

Combination therapy followed by treatment free remission (TFR) phase. Combination Therapy: Ruxolitinib plus BCR-ABL Tyrosine Kinase Inhibitors (TKIs). All eligible patients will begin ruxolitinib in combination with their BCR-ABL TKI on cycle 1 day 1 of the combination phase. For cycle 2 and beyond, if day 1 of a cycle is delayed, day 1 procedures should be repeated if out of the specified window and day 1 of the cycle is considered the day study drug is restarted. They will continue combination therapy for a total of 12 cycles. Each cycle will be approximately 28 days. At the end of 12 cycles ruxolitinib will be discontinued and any patient who has met the criteria for the treatment free remission (TFR) screening phase will enter into the TFR phase. Once in the TFR phase, participants will discontinue their BCR-ABL TKI and be monitored off treatment.


Inclusion Criteria:

Willing and able to give informed consent
Diagnosed with CML in chronic phase and have either the b3a2 (e14a2) or b2a2 (e13a2) variants that give rise to the p210 BCR-ABL protein.
Must have a documented history of attempting only one prior TKI discontinuation under the guidance of a treating physician

Must have met ALL the following criteria prior to first attempt to discontinue their TKI:

Stable molecular response (MR4; <0.01% IS) for > 2 years, as documented on at least 4 tests, performed at least 3 months apart
Treatment with one of the following FDA approved TKI; imatinib, dasatinib, nilotinib or bosutinib, at any dose for a minimum of 3 years prior to discontinuing TKIs
Has been on any number of TKIs, but has not been resistant to any TKI (changes made for intolerance are allowed)
Must have relapsed (defined as loss of major molecular response (MMR), RQ-PCR for BCR-ABL > 0.1% IS after first attempted discontinuation of TKI
After first failed TFR attempt, must have a minimum duration of 1 year on a TKI, and must plan to remain on this same TKI for a minimum of 12 months during the combination treatment phase
Current TKI must be the same as the TKI being taken prior to the initial TFR attempt (e.g., if patient is on imatinib prior to first TFR attempt, they should be on imatinib at time of enrollment on this study)
Eastern Cooperative Oncology Group (ECOG) performance status 0-3
Must have a RQ-PCR for BCR-ABL less than 0.01% IS reported by the trial designated central lab at time of study enrollment
Must adhere to all study contraception guidelines

Exclusion Criteria:

History of accelerated or blast phase CML
History of TKI resistance
A second malignancy requiring active treatment
Have previously received treatment with a JAK inhibitor.
Platelet count less than 100 × 10^9/L or an absolute neutrophil count of less than 1 × 10^9/L or Hemoglobin less than 8 g/dL
AST and ALT ≥ 3 times the institutional upper limit of normal (ULN)
Creatinine ≥ 2 times ULN
Total bilirubin ≥ 1.5 times ULN (unless direct bilirubin is within normal limits)
Pregnant or lactating
Unable to comply with lab appointments schedule and patient response outcome assessments
Another investigational drug within 4 weeks of enrollment
Any serious medical or psychiatric illness that could, in the investigator's opinion, interfere with the completion of treatment according to this protocol
Have undergone a prior allogeneic transplant
Screening 12-lead ECG showing a baseline corrected QT interval >500msec (patients with a pacemaker will still be eligible with QTc>500msec)
No Results Posted