A phase 2 study of ruxolitinib in combination with azacitidine in patients with myelofibrosis

Lucia Masarova, Srdan Verstovsek, Juliana E. Hidalgo-Lopez, Naveen Pemmaraju, Prithviraj Bose, Zeev Estrov, Elias J. Jabbour, Farhad Ravandi-Kashani, Koichi Takahashi, Jorge E. Cortes, Jing Ning, Maro Ohanian, Yesid Alvarado, Lingsha Zhou, Sherry Pierce, Romany Gergis, Keyur P. Patel, Rajyalakshmi Luthra, Tapan M. Kadia, Courtney D. DiNardoGautam Borthakur, Kapil Bhalla, Guillermo Garcia-Manero, Carlos E. Bueso-Ramos, Hagop M. Kantarjian, Naval Daver

Research output: Contribution to journalArticle

Abstract

Ruxolitinib (RUX)-based combinations may provide benefit for patients with myelofibrosis (MF). In this open-label, nonrandomized, prospective phase 2 study, patients with MF initially received RUX twice per day continuously in 28-day cycles for the first 3 cycles. Azacitidine (AZA) 25 mg/m2 (days 1-5) was added starting with cycle 4 and could be subsequently increased to 75 mg/m2 (days 1-5). Forty-six patients were enrolled with a median follow-up of 28 months (range, 4-501 months). An International Working Group for Myelofibrosis Research and Treatment (IWG-MRT) response was achieved in 33 patients (72%), with a median time to response of 1.8 months (range, 0.7-19.0 months). One-fourth (7 of 33) of the IWG-MRT responses occurred after the addition of AZA. A reduction of >50% in palpable spleen length at 24 weeks and at any time on the study was achieved in 62% and 71% of the evaluable patients, respectively. Among patients who achieved a >50% reduction in spleen length at 24 weeks, 95% had maintained it at 48 weeks. Notably, improvements in bone marrow reticulin fibrosis grade occurred in 57% of the patients at 24 months. Treatment discontinuations as a result of drug-related toxicities occurred in 4 patients (9%), all as a result of cytopenias. New onset grade 3 to 4 anemia and thrombocytopenia occurred in 35% and 26% of patients, respectively. RUX and AZA were safe, with encouraging spleen response rates and improvement in bone marrow fibrosis in patients with MF. This trial was registered at www.clinicaltrials.gov as #NCT01787487.

Original languageEnglish (US)
Pages (from-to)1664-1674
Number of pages11
JournalBlood
Volume132
Issue number16
DOIs
StatePublished - Oct 18 2018
Externally publishedYes

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Azacitidine
Primary Myelofibrosis
Bone
Reticulin
Toxicity
Labels
Spleen
Pharmaceutical Preparations
INCB018424
Drug-Related Side Effects and Adverse Reactions
Research
Anemia
Therapeutics

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Masarova, L., Verstovsek, S., Hidalgo-Lopez, J. E., Pemmaraju, N., Bose, P., Estrov, Z., ... Daver, N. (2018). A phase 2 study of ruxolitinib in combination with azacitidine in patients with myelofibrosis. Blood, 132(16), 1664-1674. https://doi.org/10.1182/blood-2018-04-846626

A phase 2 study of ruxolitinib in combination with azacitidine in patients with myelofibrosis. / Masarova, Lucia; Verstovsek, Srdan; Hidalgo-Lopez, Juliana E.; Pemmaraju, Naveen; Bose, Prithviraj; Estrov, Zeev; Jabbour, Elias J.; Ravandi-Kashani, Farhad; Takahashi, Koichi; Cortes, Jorge E.; Ning, Jing; Ohanian, Maro; Alvarado, Yesid; Zhou, Lingsha; Pierce, Sherry; Gergis, Romany; Patel, Keyur P.; Luthra, Rajyalakshmi; Kadia, Tapan M.; DiNardo, Courtney D.; Borthakur, Gautam; Bhalla, Kapil; Garcia-Manero, Guillermo; Bueso-Ramos, Carlos E.; Kantarjian, Hagop M.; Daver, Naval.

In: Blood, Vol. 132, No. 16, 18.10.2018, p. 1664-1674.

Research output: Contribution to journalArticle

Masarova, L, Verstovsek, S, Hidalgo-Lopez, JE, Pemmaraju, N, Bose, P, Estrov, Z, Jabbour, EJ, Ravandi-Kashani, F, Takahashi, K, Cortes, JE, Ning, J, Ohanian, M, Alvarado, Y, Zhou, L, Pierce, S, Gergis, R, Patel, KP, Luthra, R, Kadia, TM, DiNardo, CD, Borthakur, G, Bhalla, K, Garcia-Manero, G, Bueso-Ramos, CE, Kantarjian, HM & Daver, N 2018, 'A phase 2 study of ruxolitinib in combination with azacitidine in patients with myelofibrosis', Blood, vol. 132, no. 16, pp. 1664-1674. https://doi.org/10.1182/blood-2018-04-846626
Masarova L, Verstovsek S, Hidalgo-Lopez JE, Pemmaraju N, Bose P, Estrov Z et al. A phase 2 study of ruxolitinib in combination with azacitidine in patients with myelofibrosis. Blood. 2018 Oct 18;132(16):1664-1674. https://doi.org/10.1182/blood-2018-04-846626
Masarova, Lucia ; Verstovsek, Srdan ; Hidalgo-Lopez, Juliana E. ; Pemmaraju, Naveen ; Bose, Prithviraj ; Estrov, Zeev ; Jabbour, Elias J. ; Ravandi-Kashani, Farhad ; Takahashi, Koichi ; Cortes, Jorge E. ; Ning, Jing ; Ohanian, Maro ; Alvarado, Yesid ; Zhou, Lingsha ; Pierce, Sherry ; Gergis, Romany ; Patel, Keyur P. ; Luthra, Rajyalakshmi ; Kadia, Tapan M. ; DiNardo, Courtney D. ; Borthakur, Gautam ; Bhalla, Kapil ; Garcia-Manero, Guillermo ; Bueso-Ramos, Carlos E. ; Kantarjian, Hagop M. ; Daver, Naval. / A phase 2 study of ruxolitinib in combination with azacitidine in patients with myelofibrosis. In: Blood. 2018 ; Vol. 132, No. 16. pp. 1664-1674.
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AU - Pemmaraju, Naveen

AU - Bose, Prithviraj

AU - Estrov, Zeev

AU - Jabbour, Elias J.

AU - Ravandi-Kashani, Farhad

AU - Takahashi, Koichi

AU - Cortes, Jorge E.

AU - Ning, Jing

AU - Ohanian, Maro

AU - Alvarado, Yesid

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AU - Pierce, Sherry

AU - Gergis, Romany

AU - Patel, Keyur P.

AU - Luthra, Rajyalakshmi

AU - Kadia, Tapan M.

AU - DiNardo, Courtney D.

AU - Borthakur, Gautam

AU - Bhalla, Kapil

AU - Garcia-Manero, Guillermo

AU - Bueso-Ramos, Carlos E.

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N2 - Ruxolitinib (RUX)-based combinations may provide benefit for patients with myelofibrosis (MF). In this open-label, nonrandomized, prospective phase 2 study, patients with MF initially received RUX twice per day continuously in 28-day cycles for the first 3 cycles. Azacitidine (AZA) 25 mg/m2 (days 1-5) was added starting with cycle 4 and could be subsequently increased to 75 mg/m2 (days 1-5). Forty-six patients were enrolled with a median follow-up of 28 months (range, 4-501 months). An International Working Group for Myelofibrosis Research and Treatment (IWG-MRT) response was achieved in 33 patients (72%), with a median time to response of 1.8 months (range, 0.7-19.0 months). One-fourth (7 of 33) of the IWG-MRT responses occurred after the addition of AZA. A reduction of >50% in palpable spleen length at 24 weeks and at any time on the study was achieved in 62% and 71% of the evaluable patients, respectively. Among patients who achieved a >50% reduction in spleen length at 24 weeks, 95% had maintained it at 48 weeks. Notably, improvements in bone marrow reticulin fibrosis grade occurred in 57% of the patients at 24 months. Treatment discontinuations as a result of drug-related toxicities occurred in 4 patients (9%), all as a result of cytopenias. New onset grade 3 to 4 anemia and thrombocytopenia occurred in 35% and 26% of patients, respectively. RUX and AZA were safe, with encouraging spleen response rates and improvement in bone marrow fibrosis in patients with MF. This trial was registered at www.clinicaltrials.gov as #NCT01787487.

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