Ruxolitinib Phosphate and Danazol in Treating Anemia in Patients With Myelofibrosis

Inclusion Criteria:

• Histological confirmation of primary myelofibrosis (MF), post polycythemia vera (PV) or post essential thrombocythemia (ET) myelofibrosis (intermediate 1, intermediate II or high risk) requiring medical therapy
• Anemia is required for trial entry (defined as hemoglobin < 10g/dL or transfusion dependent)
• Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2 at study entry
• Absolute neutrophil count (ANC) >= 1000 x 10^3
• Platelet count >= 50,000 × 10^3
• Serum creatinine =< 1.5 x the upper limit of normal (ULN)
• Total bilirubin =< 1.5 x ULN; if total bilirubin is > 1.5 x ULN, a direct bilirubin should be performed and must be < 1.5mg/dL
• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 x ULN; higher values (i.e., =< 5 x ULN) are allowed if clinically compatible with hepatic extramedullary hematopoiesis
• Life expectancy of >= 6 months
• Patient able to provide voluntary written informed consent to participate
• Willing to comply with scheduled visits, treatment plans, laboratory assessments, and other study-related procedures
• Negative pregnancy test done =< 7 days prior to registration, for women of childbearing potential only

Exclusion Criteria:

• Any chemotherapy (e.g., hydroxyurea), immunomodulatory drug therapy (e.g., thalidomide, interferon-alpha), immunosuppressive therapy, corticosteroids > 10 mg/day prednisone or equivalent, or growth factor treatment (e.g., erythropoietin), hormones (e.g., androgens, danazol) =< 14 days prior to registration
• Major surgery =< 28 days or radiation =< 6 months prior to registration
• Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
• Active acute infection requiring antibiotics
• Uncontrolled congestive heart failure (New York Heart Association classification 3 or 4), angina, myocardial infarction, cerebrovascular accident, coronary/peripheral artery bypass, graft surgery, transient ischemic attack, or pulmonary embolism within 3 months prior to registration
• Participation in any study of an investigational agent (drug, biologic, device) =< 30 days, unless during non-treatment phase

• Any of the following because this study involves an agent that has known genotoxic, mutagenic and teratogenic effects:

  • Pregnant women
  • Nursing women
  • Men or women of childbearing potential who are unwilling to employ adequate contraception
• Known human immunodeficiency virus or acquired immunodeficiency syndrome-related illness
• Clinically active hepatitis B or C
• Active malignancy other than MF, except adequately treated basal cell carcinoma and squamous cell carcinoma of the skin, cervical carcinoma in situ or other malignancies that have been stable and off therapy for 5 years
• Patient currently taking simvastatin, or lovastatin at a dose greater than 10 mg/day
• Men with prostate specific antigen (PSA) > 4 ng/ml or with uncontrolled benign prostatic hypertrophy

• Receiving any medications or substances that are strong or moderate inhibitors of cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4); use of the following strong or moderate inhibitors are prohibited =< 7 days prior to registration

  • Strong inhibitors of CYP3A4:

    • Indinavir (Crixivan)
    • Nelfinavir (Viracept)
    • Atazanavir (Reyataz)
    • Clarithromycin (Biaxin, Biaxin XL)
    • Itraconazole (Sporanox)
    • Ketoconazole (Nizoral)
    • Nefazodone (Serzone)
    • Saquinavir (Fortovase, Invirase)
    • Telithromycin (Ketek)

  • Moderate inhibitors of CYP3A4

    • Erythromycin (Erythrocin, E.E.S., Ery-Tab, Eryc, EryPed, PCE)
    • Fluconazole (Diflucan)
    • Grapefruit juice
    • Verapamil (Calan, Calan SR, Covera-HS, Isoptin SR, Verelan)
    • Verelan PM
    • Diltiazem (Cardizem, Cardizem CD, Cardizem LA, Cardizem SR, Cartia XT, Dilacor XR, Diltia XT, Taztia XT, Tiazac)