Enasidenib in Treating Patients with IDH2-Mutant Myeloid Cancers after Stem Cell Transplant
- Pathologically confirmed diagnosis of IDH2-mutant acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) or chronic myelomonocytic leukemia (CMML) * IDH2 mutations will include any IDH2 R140 or R172 alterations * Eligibility and enrollment will be based on local IDH2 mutational testing performed at any center. The presence of an IDH2 mutation at the time of initial diagnosis or any other time thereafter is necessary and sufficient. The presence of an IDH2 mutation at time of enrollment is not necessary for the purposes of eligibility
- Will undergo first allogeneic hematopoietic stem cell transplantation (HSCT) for their malignancy. Conditioning may have been either conventional myeloablative (MAC) or reduced intensity conditioning (RIC)
- HSCT Donor will be one of the following: * 5/6 or 6/6 (human leukocyte antigen [HLA]-A, B, DR) matched related donor * 7/8 or 8/8 (HLA-A, B, DR, C) matched unrelated donor. Matching in the unrelated setting must be at the allele level * Haploidentical related donor, defined as >= 3/6 (HLA-A, B, DR) matched * >= 4/6 (HLA-A, B, DR) umbilical cord blood (UCB). Matching in the UCB setting is at the antigen level. Recipients may receive either one or two UCB units. In the case of 2 UCB units, both units must have been at least 4/6 matched with the recipient
- Eastern Cooperative Oncology Group (ECOG) performance status =< 2
- Absolute neutrophil count >= 1000/uL without growth factor support (e.g. granulocyte colony stimulating factor [GCSF]) in the previous 7 days. This criterion does not apply to patients with myelodysplastic syndromes, myeloproliferative neoplasms in leukemic phase, or CMML, who will not necessarily be expected to achieve marrow recovery prior to HSCT
- Platelet count >= 50,000/uL without transfusional support in the previous 7 days. This criterion does not apply to patients with myelodysplastic syndromes, myeloproliferative neoplasms in leukemic phase, or CMML, who will not necessarily be expected to achieve marrow recovery prior to HSCT
- Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]), alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) < 3 x institutional upper limit of normal (ULN)
- Alkaline phosphatase < 3 x institutional upper limit of normal (ULN)
- Direct bilirubin < 2.0 mg/dL
- Calculated creatinine clearance >= 40 mL/min (Cockcroft-Gault formula)
- Left ventricular ejection fraction (LVEF) must be equal to or greater than 50%, as measured by multigated acquisition (MUGA) scan or echocardiogram
- Female patients of childbearing potential must have a negative pregnancy test, as measured by serum or urine testing
- The effects of enasidenib on the developing human fetus are unknown. For this reason women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) during the entire study treatment period and through 6 months after the last dose of treatment
- Ability to understand and the willingness to sign a written informed consent document
- Prior allogeneic hematopoietic stem cell transplants
- For patients with acute myeloid leukemia, morphologically relapsed or refractory disease as assessed by bone marrow aspirate and biopsy performed within 42 days prior to study entry. For patients with myelodysplastic syndromes or chronic myelomonocytic leukemia, the presence of less than 5% myeloblasts is allowed on a bone marrow biopsy within 42 days prior to study entry
- History of other malignancy(ies) unless * The participant has been disease-free for at least 5 years and is deemed by the investigator to be at low risk of recurrence of that malignancy, or * The only prior malignancy was cervical cancer in situ and/or basal cell or squamous cell carcinoma of the skin
- Known diagnosis of active hepatitis B or hepatitis C
- Current or history of congestive heart failure New York Heart Association (NHYA) class 3 or 4, or any history of documented diastolic or systolic dysfunction (LVEF < 50%, as measured by MUGA scan or echocardiogram)
- Current or history of ventricular or life-threatening arrhythmias or diagnosis of long-QT syndrome
- Systemic uncontrolled infection
- Known dysphagia, short-gut syndrome, gastroparesis, or other condition(s) that limits the ingestion or gastrointestinal absorption of drugs administered orally
- Uncontrolled hypertension (systolic blood pressure [BP] > 180 mmHg or diastolic BP > 100 mmHg)
- Corrected QT (QTc) interval (i.e., Fridericia's correction [QTcF]) >= 450 ms or other factors that increase the risk of QT prolongation or arrhythmic events [e.g., heart failure, hypokalemia, family history of long QT interval syndrome]) at screening
- Concomitant receipt of the following sensitive CYP substrate medications that have a narrow therapeutic range (unless the participant can be transferred to other medications at least 5 half-lives prior to the start of study treatment): paclitaxel and docetaxel (CYP2C8), phenytoin (CYP2C9), S-mephenytoin (CYP2C19), thioridazine (CYP2D6), theophylline, and tizanidine (CYP1A2)
- Concomitant receipt of the breast cancer resistance protein (BCRP) transporter-sensitive substrate rosuvastatin (unless the participant can be transferred to another medication at least 5 half-lives prior to the start of study treatment)
- Uncontrolled intercurrent illness that would limit compliance with study requirements
- Human immunodeficiency virus (HIV)-positive participants on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with study drug. In addition, these participants are at increased risk of lethal infections when treated with marrow-suppressive therapy
I. To identify the maximum tolerated dose (MTD) of enasidenib in patients with IDH2-mutant myeloid neoplasms after hematopoietic stem cell transplantation.
II. To explore the safety and tolerability of enasidenib in patients with IDH2-mutant myeloid neoplasms in the post-stem cell transplant setting as assessed by the frequency and severity of enasidenib-related adverse events.
I. To detect and categorize, according to severity, enasidenib-related toxicities in patients with IDH2-mutant myeloid neoplasms receiving enasidenib after hematopoietic stem cell transplantation.
II. To examine the cumulative incidence of acute graft versus host disease (GVHD) from start of enasidenib in patients with IDH2-mutant myeloid neoplasms who receive enasidenib after hematopoietic stem cell transplantation.
III. To examine the cumulative incidence of chronic GVHD from start of enasidenib in patients with IDH2-mutant myeloid neoplasms who receive enasidenib after hematopoietic stem cell transplantation.
IV. To monitor plasma and marrow 2-hydroxyglutarate levels in patients with IDH2-mutant myeloid neoplasms who receive enasidenib after hematopoietic stem cell transplantation.
V. To assess IDH clonal evolution via whole genome sequencing and mutational burden via next-generation sequencing in patients with IDH2-mutant myeloid neoplasms who receive enasidenib after hematopoietic stem cell transplantation.
I. To examine the rate of relapse of IDH2-mutant myeloid neoplasms in patients receiving enasidenib after hematopoietic stem cell transplantation.
II. To examine relapse-free survival in patients with IDH2-mutant myeloid neoplasms who receive enasidenib after hematopoietic stem cell transplantation.
III. To examine overall survival rates for 24 months from the time of transplant in patients with IDH2-mutant myeloid neoplasms who receive enasidenib after hematopoietic stem cell transplantation.
IV. To assess the proportion of patients who successfully screen for study prior to transplantation but who do not reach the maintenance phase due to transplant related morbidity or mortality.
OUTLINE: This is a dose-escalation study.
Patients receive enasidenib mesylate orally (PO) once daily (QD) on days 1-28. Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up for 24 months and then every 3 months.
Trial Phase Phase I
Trial Type Treatment
Dana-Farber Harvard Cancer Center
Amir Tahmasb Fathi
- Primary ID 18-022
- Secondary IDs NCI-2018-01327
- Clinicaltrials.gov ID NCT03515512