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혈구탐식성 림프조직구증가증(HLH) 치료를 위한 De-Intensified HLH-94가 포함된 룩소리티닙

2026년 9월 15일 업데이트: Jerry Lee, MD, MSc, MPhil

성인 HLH(혈구탐식성 림프조직구증가증)에 대한 De-Intensified HLH-94가 포함된 최전선 Ruxolitinib: 다기관, 단일군 제2상 연구

This phase II trial tests the effects of ruxolitinib in combination with a de-intensified HLH-94 drug regimen has on patients with newly diagnosed hemophagocytic lymphohistiocytosis (HLH), a disorder caused by dysregulated immune responses (that is, immune responses that are too strong and cause inflammatory damage to normal tissues). The therapy used for HLH decreases the activity of the immune system. Ruxolitinib is a type of drug called a kinase inhibitor. It works by blocking the signals that cause inflammatory cells to multiply. De-intensified HLH-94 is a treatment regimen that includes 4 weeks of dexamethasone with the dose being decreased each week, and up to 4 weeks of etoposide. This combination is commonly used to treat HLH. Dexamethasone is a steroid medication that works by fighting inflammation. Etoposide is in a class of medications known as podophyllotoxin derivatives. It blocks a certain enzyme needed for cell division and deoxyribonucleic acid (DNA) repair and may kill cancer cells and is used to kill the types of white blood cells in HLH that are attacking the body. Giving ruxolitinib in combination with a de-intensified HLH-94 drug regimen may reduce toxic exposure to therapy while maintaining efficacy in patients with HLH.

연구 개요

상태

모병

정황

개입 / 치료

상세 설명

PRIMARY OBJECTIVE:

I. To evaluate the efficacy of ruxolitinib with de-intensified HLH-94 (dHLH-94; 4 weeks of dexamethasone and etoposide) for newly diagnosed adults with HLH.

SECONDARY OBJECTIVES:

I. To describe the toxicities of ruxolitinib in combination with de-intensified HLH-94 for the treatment of adult HLH.

II. To evaluate best response, time to best response, and duration of response stratified by mHLH and nmHLH.

III. To evaluate the progression-free survival (PFS) of using ruxolitinib in combination with dHLH-94 for the treatment of adult HLH, stratified by malignancy-associated hemophagocytic lymphohistiocytosis (mHLH) and non-malignancy-associated hemophagocytic lymphohistiocytosis (nmHLH).

IV. To evaluate the overall survival (OS) when using ruxolitinib in combination with de-intensified HLH-94 for the treatment of adult HLH, stratified by mHLH and nmHLH.

V. To evaluate the time to cancer diagnosis for HLH, among those ultimately diagnosed with mHLH.

VI. To evaluate the time to cancer-directed therapy from the diagnosis of mHLH. VII. To describe the practice patterns of adjunctive therapies (i.e., rituximab, intravenous immunoglobulin therapy (IVIG), anakinra) for HLH.

EXPLORATORY OBJECTIVES:

I. To identify T cell subsets that are differentially increased in adult HLH (comparing mHLH and nmHLH).

II. To evaluate the association of CD8+ T cell subsets expressing CD4dim/CD38+/HLA-DR+ ("activated T cells") with clinical deterioration.

III. To evaluate the relationship between the peripheral blood cytokine microenvironment (e.g., Interleukin 1b (IL-1b), Interleukin 2 (IL-2), Interleukin 6 (IL-6), Interleukin 10 (IL-10), Interleukin 18 (IL-18), Interferon gamma (IFN-gamma), Tumor Necrosis Factor alpha (TNF alpha), laboratory parameters (ferritin, blood counts, liver function, fibrinogen), and response to ruxolitinib.

OUTLINE:

During induction therapy, participants receive ruxolitinib plus de-intensified HLH-94 induction with dexamethasone and etoposide and then based on response, another 2 weeks of treatment will be given in the absence of disease progression or unacceptable toxicity. After induction therapy, participants receive continuation therapy with ruxolitinib for a total of up to 6 months after first administration of study drug in the absence of disease progression or unacceptable toxicity. After completion of study treatment, participants are followed up at 30 days and then at 3, 6, and 12 months

연구 유형

중재적

등록 (추정된)

54

단계

  • 2 단계

연락처 및 위치

이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.

연구 연락처

  • 이름: UCSF Hematopoietic Malignancies Clinical Trial Recruitment
  • 전화번호: 877-827-3222
  • 이메일: HDFCCC.Heme@ucsf.edu

연구 연락처 백업

연구 장소

    • California
      • Irvine, California, 미국, 92697
        • 모병
        • University of California, Irvine
        • 수석 연구원:
          • Elizabeth Brem, MD
        • 연락하다:
      • Sacramento, California, 미국, 95817
      • San Diego, California, 미국, 92093
        • 모병
        • University of California, San Diego
        • 연락하다:
        • 수석 연구원:
          • Anthony Nguyen, MD
      • San Francisco, California, 미국, 94143
        • 모병
        • University of California, San Francisco
        • 연락하다:
        • 수석 연구원:
          • Jerry Lee, MD
        • 부수사관:
          • Aaron Logan, MD, PhD
        • 연락하다:

참여기준

연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.

자격 기준

공부할 수 있는 나이

18년 이상 (성인, 고령자)

건강한 자원 봉사자를 받아들입니다

아니

연구 대상 성별

모두

설명

Inclusion Criteria:

  • Ability to understand and the willingness to sign a written informed consent document.

  • Males and females, 18 years of age or older at the time of enrollment.

  • Participants must have active HLH and meet >= 5 of 8 of the HLH-2004 diagnostic criteria, or have familial/primary HLH with pathogenic/likely pathogenic germline variant(s) in genes known to cause HLH (e.g., PRF1, UNC13D, Syntaxin 11 (STX11), Syntaxin-binding protein 2 (STXBP2), RAB27A, SH2 domain-containing protein 1A (SH2D1A), baculovirus inhibitor of apoptosis repeat containing protein 4 (BIRC4), Lysosomal trafficking regulator (LYST), interleukin-2-inducible T-cell kinase (ITK), SLC7A7, X-linked immunodeficiency with magnesium defect, Epstein-Barr virus infection, and neoplasia (XMEN), Hermansky-Pudlak syndrome (HPS), NLR family CARD domain-containing protein 4 (NLCR4) or other immune regulatory genes.

    • Fever >= 38.5 degrees Celsius (C) (or >= 38 degrees C if acetaminophen given in prior 6 hours).
    • Splenomegaly.
    • Peripheral cytopenias involving >= 2 of 3 cell lines (absolute neutrophil count < 1000/uL; hemoglobin < 9 g/dL; platelets < 100,000/uL).
    • Hypertriglyceridemia (fasting triglycerides >= 265 mg/dL) or Hypofibrinogenemia (fibrinogen =< 150 g/dL).
    • Hemophagocytosis on tissue biopsy, such as in the bone marrow, spleen, lymph node, or liver.
    • Low/absent natural killer (NK)-cell activity/perforin and/or decreased CD107a mobilization.
    • Ferritin >= 500 ug/L.
    • Soluble IL-2 receptor (sCD25) > 2400 U/mL or two standard deviations above age-adjusted laboratory-specific norms.
  • The effects of ruxolitinib on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception for the duration of study participation and for two months after last administration of study treatment.

    • Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately.
    • Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and two months after last administration of study treatment.

Exclusion Criteria:

  • Participant is receiving or received any other investigational agent within 1 week of the first dose of treatment.

  • Females who are pregnant or breastfeeding. Female participants of child-bearing potential must have a negative pregnancy test within 7 days of treatment and lactating females must discontinue breast feeding during treatment and until two weeks after the final dose of ruxolitinib.

  • Males who expect to conceive children, and/or who decline highly effective methods of contraception during the entire duration of the study.

  • Patient cannot take medications orally or via a nasogastric/orogastric tube.

  • Poor life expectancy < 2 weeks.

  • Clinically significant or uncontrolled cardiovascular disease, including unstable angina, acute myocardial infarction, or stroke within 6 months, New York Heart Association class III or IV. congestive heart failure, and arrhythmia requiring therapy or uncontrolled hypertension (blood pressure > 170/100 mmHg) unless approved by the sponsor- investigator.

  • Estimated creatine clearance (CrCl) < 15 mL/min while not on dialysis.

  • Known (biopsy-confirmed) liver cirrhosis or suspected cirrhosis with a Model for End- Stage Liver Disease (MELD) score of > 20, or aspartate aminotransferase (AST) or alanine transaminase (ALT) values > 1000 not expected to improve with HLH therapy.

  • Severe organ dysfunction, such as cardiorespiratory failure requiring inotropic medications or extracorporeal life support. Respiratory support including intubation/ventilation is allowed.

    * Vasopressors are allowed if not required other than low dose vasoconstrictors to compensate the effects of sedation.

  • Newly diagnosed acute and clinically active tuberculosis, hepatitis B, and/or hepatitis C.

    • Patients with active human immunodeficiency virus (HIV) are not excluded from this study but must be on antiretrovirals.
    • Patients with hepatitis B or C viremia can be on study if the hepatitis is not considered clinically active and/or if it is chronic. These patients should be discussed with the principal investigator.
  • Individuals with a prior malignancy whose natural history or treatment has the potential to interfere with the safety or efficacy assessment of the investigational regimen.

  • Individuals with chimeric antigen receptor (CAR)-T-associated HLH.

  • No prior HLH-directed therapy except corticosteroids for < 2 consecutive weeks and anakinra.

    • Adjunctive approaches such as rituximab for Epstein-Barr virus (EBV) viremia or IVIG for viral infection are permitted.
    • Emapalumab, alemtuzumab, anti-thymocyte globulin (ATG), tocilizumab, siltuximab, or prior ruxolitinib are NOT permitted. Cyclosporine and tacrolimus are not permitted in the initial induction period.
  • Hypersensitivity to ruxolitinib or any of its excipients

공부 계획

이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.

연구는 어떻게 설계됩니까?

디자인 세부사항

  • 주 목적: 치료
  • 할당: 해당 없음
  • 중재 모델: 단일 그룹 할당
  • 마스킹: 없음(오픈 라벨)

무기와 개입

참가자 그룹 / 팔
개입 / 치료
실험적: Treatment (ruxolitinib, dexamethasone, etoposide)

During induction therapy, participants receive ruxolitinib orally (PO) twice daily (BID) plus de-intensified HLH-94 induction with dexamethasone PO or intravenously (IV) once daily (QD) or BID for 4 weeks and etoposide IV twice a week (BIW) for 2 weeks and then based on response, once a week (QW) for another 2 weeks in the absence of disease progression or unacceptable toxicity. After induction therapy, participants receive continuation therapy with ruxolitinib PO BID on days 1-28 of each cycle. Treatment repeats every 28 days for a total of up to 6 months after first administration of study drug in the absence of disease progression or unacceptable toxicity.

Undergo blood sample collection

다른 이름들:
  • 표본 수집

Administered Orally (PO)

다른 이름들:
  • INCB18424
  • 구강 JAK

Administered IV

다른 이름들:
  • 라셋
  • 토포사르

Administered PO or IV

다른 이름들:
  • 덱사

Participants undergo abdominal ultrasound and/or magnetic resonance imaging (MRI)

다른 이름들:
  • 초음파
  • 자기공명영상(MRI)

Bone marrow biopsy and lymph node biopsy will be obtained during screening and as clinically indicated throughout the trial.

다른 이름들:
  • 생검

연구는 무엇을 측정합니까?

주요 결과 측정

결과 측정
측정값 설명
기간
Overall response rate (ORR)
기간: 4 weeks

The proportion of responder (complete response (CR), complete response with incomplete hematologic recovery, or partial response (PR)) or non-responder at the end of induction using a physician developed response criteria will be reported. Those with non-malignant HLH (nmHLH) will be assessed for response, defined as complete response (CR) + partial response (PR) at 4 weeks. Participants diagnosed with a malignant trigger are recommended to undergo cancer-directed therapy once acute hypercytokinemia improves. The primary endpoint for malignant HLH (mHLH) is achievement of PR or better and initiation of cancer-directed therapy (non-HLH specific therapy) by 4 weeks.

4 weeks

2차 결과 측정

결과 측정
측정값 설명
기간
Proportion of participants reporting high-grade adverse events
기간: Up to 1 year

Safety analyses will be descriptive and performed based on the safety population, defined as patients who received at least one dose of study drug. Serious adverse events (SAEs), adverse events (AEs) ≥ grade 3, and AEs resulting in discontinuation of treatment, withdrawal from the study, and deaths on-study will be tabulated.

Up to 1 year
Best Response Rate
기간: Up to 1 year

The proportion of responders by best response defined as a complete response (CR), complete response with incomplete hematologic recovery, partial response (PR) or stable disease (SD)) using a physician developed response criteria will be reported.

Up to 1 year
Median Time to Best Response
기간: Up to 12 months after the end of continuation therapy, approximately 2 years total

The median time in months from the time of treatment initiation until participants best response at 12 months after the end of continuation therapy will be reported.

Up to 12 months after the end of continuation therapy, approximately 2 years total
Median Duration of Best Response
기간: Up to 12 months after the end of continuation therapy, approximately 2 years total

The median time in months from the participants obtained a best response from until 12 months after the end of continuation therapy, participant withdrawal, or death will be reported.

Up to 12 months after the end of continuation therapy, approximately 2 years total
Median progression free survival (PFS)
기간: Up to 1 year

PFS is defined as the median number of months from first dose to disease relapse, progression, or death, whichever occurs first using using Kaplan-Meier methods.

Up to 1 year
Median overall survival (OS)
기간: Up to 1 year

OS is defined as the median number of months from first dose to until death or study discontinuation, whichever occurs first using using Kaplan-Meier methods.

Up to 1 year
Median time from the diagnosis of hemophagocytic lymphohistiocytosis (HLH) to diagnosis of cancer
기간: Up to 1 year

The duration of time in days from the diagnosis of hemophagocytic lymphohistiocytosis (HLH) to the diagnosis of cancer will be reported.

Up to 1 year
Median time from diagnosis of malignancy-associated HLH to initiation of cancer-directed therapy
기간: Up to 1 year

The duration of time in days from the diagnosis of malignancy-associated hemophagocytic lymphohistiocytosis to the initiation of cancer-directed therapy will be reported using Kaplan-Meier methods.

Up to 1 year
Number of different adjunctive therapies
기간: Up to 2 years

The number of adjunctive therapies for HLH will be reported by type, frequency, and indication.

Up to 2 years

공동 작업자 및 조사자

여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.

스폰서

협력자

수사관

  • 수석 연구원: Jerry Lee, MD, University of California, San Francisco

연구 기록 날짜

이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.

연구 주요 날짜

연구 시작 (실제)

2024년 10월 1일

기본 완료 (추정된)

2028년 12월 31일

연구 완료 (추정된)

2029년 11월 30일

연구 등록 날짜

최초 제출

2023년 11월 29일

QC 기준을 충족하는 최초 제출

2023년 11월 29일

처음 게시됨 (실제)

2023년 12월 7일

연구 기록 업데이트

마지막 업데이트 게시됨 (실제)

2026년 9월 21일

QC 기준을 충족하는 마지막 업데이트 제출

2026년 9월 15일

마지막으로 확인됨

2026년 9월 1일

추가 정보

이 연구와 관련된 용어

키워드

기타 연구 ID 번호

  • 232513
  • NCI-2023-09578 (레지스트리 식별자: NCI Clinical Trials Reporting Program (CTRP))

개별 참가자 데이터(IPD) 계획

개별 참가자 데이터(IPD)를 공유할 계획입니까?

예

IPD 계획 설명

De-identified data will be shared with study collaborators during the course of the study.

IPD 공유 지원 정보 유형

  • 연구_프로토콜
  • 수액

약물 및 장치 정보, 연구 문서

미국 FDA 규제 의약품 연구

예

미국 FDA 규제 기기 제품 연구

아니

이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .