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    Ruxolitinib for Glucocorticoid-Refractory Acute Graft-versus-Host Disease

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    Author
    Zeiser, R; von Bubnoff, N; Butler, J; Mohty, M; Niederwieser, D; Or, R; Szer, J; Wagner, EM; Zuckerman, T; Mahuzier, B; ...
    Date
    2020-05-07
    Source Title
    New England Journal of Medicine
    Publisher
    MASSACHUSETTS MEDICAL SOC
    University of Melbourne Author/s
    Szer, Jeffrey
    Affiliation
    Medicine and Radiology
    Metadata
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    Document Type
    Journal Article
    Citations
    Zeiser, R., von Bubnoff, N., Butler, J., Mohty, M., Niederwieser, D., Or, R., Szer, J., Wagner, E. M., Zuckerman, T., Mahuzier, B., Xu, J., Wilke, C., Gandhi, K. K. & Socie, G. (2020). Ruxolitinib for Glucocorticoid-Refractory Acute Graft-versus-Host Disease. NEW ENGLAND JOURNAL OF MEDICINE, 382 (19), pp.1800-1810. https://doi.org/10.1056/NEJMoa1917635.
    Access Status
    Access this item via the Open Access location
    URI
    http://hdl.handle.net/11343/254064
    DOI
    10.1056/NEJMoa1917635
    Open Access URL
    https://iris.unibs.it/bitstream/11379/531211/2/nejmoa1917635.pdf
    Abstract
    BACKGROUND: Acute graft-versus-host disease (GVHD) remains a major limitation of allogeneic stem-cell transplantation; not all patients have a response to standard glucocorticoid treatment. In a phase 2 trial, ruxolitinib, a selective Janus kinase (JAK1 and JAK2) inhibitor, showed potential efficacy in patients with glucocorticoid-refractory acute GVHD. METHODS: We conducted a multicenter, randomized, open-label, phase 3 trial comparing the efficacy and safety of oral ruxolitinib (10 mg twice daily) with the investigator's choice of therapy from a list of nine commonly used options (control) in patients 12 years of age or older who had glucocorticoid-refractory acute GVHD after allogeneic stem-cell transplantation. The primary end point was overall response (complete response or partial response) at day 28. The key secondary end point was durable overall response at day 56. RESULTS: A total of 309 patients underwent randomization; 154 patients were assigned to the ruxolitinib group and 155 to the control group. Overall response at day 28 was higher in the ruxolitinib group than in the control group (62% [96 patients] vs. 39% [61]; odds ratio, 2.64; 95% confidence interval [CI], 1.65 to 4.22; P<0.001). Durable overall response at day 56 was higher in the ruxolitinib group than in the control group (40% [61 patients] vs. 22% [34]; odds ratio, 2.38; 95% CI, 1.43 to 3.94; P<0.001). The estimated cumulative incidence of loss of response at 6 months was 10% in the ruxolitinib group and 39% in the control group. The median failure-free survival was considerably longer with ruxolitinib than with control (5.0 months vs. 1.0 month; hazard ratio for relapse or progression of hematologic disease, non-relapse-related death, or addition of new systemic therapy for acute GVHD, 0.46; 95% CI, 0.35 to 0.60). The median overall survival was 11.1 months in the ruxolitinib group and 6.5 months in the control group (hazard ratio for death, 0.83; 95% CI, 0.60 to 1.15). The most common adverse events up to day 28 were thrombocytopenia (in 50 of 152 patients [33%] in the ruxolitinib group and 27 of 150 [18%] in the control group), anemia (in 46 [30%] and 42 [28%], respectively), and cytomegalovirus infection (in 39 [26%] and 31 [21%]). CONCLUSIONS: Ruxolitinib therapy led to significant improvements in efficacy outcomes, with a higher incidence of thrombocytopenia, the most frequent toxic effect, than that observed with control therapy. (Funded by Novartis; REACH2 ClinicalTrials.gov number, NCT02913261.).

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