Methods of treating splenomegaly
Therapeutic methods and pharmaceutical compositions for treating splenomegaly in a human subject are described. In certain embodiments, the invention includes therapeutic methods of treating splenomegaly using a BTK inhibitor.
1 . A method of treating a myeloproliferative neoplasm (MPN) in a human subject in need thereof comprising administering a Bruton's Tyrosine Kinase (BTK) inhibitor to the human subject, wherein the BTK inhibitor is 1-(4-(((6-amino-5-(4-phenoxyphenyl) pyrimidin-4-yl)amino)methyl)-4-fluoropiperidin-1-yl) prop-2-en-1-one or a pharmaceutically acceptable salt thereof, wherein the human subject has an accumulation of malignant CD34+ myeloid cells in their hematopoietic tissue; and wherein the human subject:
(a) has not been treated with a JAK2 inhibitor;
(b) is intolerant to a JAK2 inhibitor;
(c) is ineligible for treatment with a JAK2 inhibitor; or
(d) is relapsed following JAK2 inhibitor treatment or is refractory to JAK2 inhibitor treatment; wherein the BTK inhibitor is administered in an amount sufficient to:
(i) stimulate migration of the malignant CD34+ myeloid cells to peripheral blood of the human subject;
(ii) decrease activity of VLA-4 in the malignant CD34+ myeloid cells; or
(iii) decrease expression of VLA-4 in the malignant CD34+ myeloid cells.
2 . The method of claim 1 , wherein the malignant CD34+ myeloid cells have decreased expression of CXCR4 relative to normal myeloid cells.
3 . The method of claim 1 , wherein the BTK inhibitor is administered in an amount sufficient to stimulate migration of the malignant CD34+ myeloid cells to peripheral blood of the human subject.
4 . The method of claim 1 , wherein the BTK inhibitor is administered in an amount sufficient to decrease activity of VLA-4 in the malignant CD34+ myeloid cells.
5 . The method of claim 1 , wherein the BTK inhibitor is administered in an amount sufficient to decrease expression of VLA-4 in the malignant CD34+ myeloid cells.
6 . The method of claim 1 wherein the human subject is suffering from myelofibrosis.
7 . The method of claim 6 , wherein the myelofibrosis is selected from the group consisting of primary myelofibrosis (PMF), post-polycythemia vera myelofibrosis (post PV-MF), and post-essential thrombocythemia myelofibrosis (post ET-MF).
8 . The method of claim 1 , wherein the human subject did not respond to ruxolitinib therapy.
9 . The method of claim 1 , wherein the human subject has a JAK2V617F mutation.
10 . The method of claim 9 , wherein the human subject has acute myeloid leukemia (AML) secondary to a myeloproliferative neoplasm (MPN).
11 . The method of claim 1 , wherein the human subject does not have a JAK2V617F mutation.
12 . The method of claim 11 , wherein the human subject has acute myeloid leukemia secondary to a myeloproliferative neoplasm.
13 . The method of claim 1 , wherein the human subject has not been treated with a JAK2 inhibitor.
14 . The method of claim 1 , wherein the human subject is intolerant to a JAK2 inhibitor.
15 . The method of claim 1 , wherein the human subject is ineligible for treatment with a JAK2 inhibitor.
16 . The method of claim 1 , wherein the human subject is relapsed following JAK2 inhibitor treatment or is refractory to JAK2 inhibitor treatment.
17 . The method of claim 1 , wherein the BTK inhibitor is administered once daily at a dose selected from the group consisting of 15 mg, 25 mg, 30 mg, 50 mg, 60 mg, 75 mg, 90 mg, 100 mg, 120 mg, 150 mg, 175 mg, 180 mg, 200 mg, 225 mg, 240 mg, 250 mg, 275 mg, 300 mg, 325 mg, 350 mg, 360 mg, 375 mg, 480 mg and 560 mg.
18 . The method of claim 1 , wherein the BTK inhibitor is administered twice daily at a dose selected from the group consisting of 15 mg, 25 mg, 30 mg, 50 mg, 60 mg, 75 mg, 90 mg, 100 mg, 120 mg, 150 mg, 175 mg, 180 mg, 200 mg, 225 mg, 240 mg, 250 mg, 275 mg, 300 mg, 325 mg, 350 mg, 360 mg, 375 mg, 480 mg and 560 mg.
19 . The method of claim 1 , wherein the BTK inhibitor is orally administered.
20 . The method of claim 1 , wherein the hematopoietic tissue is extramedullary hematopoietic tissue, bone marrow, spleen, or liver.
21 . A method of treating a myeloproliferative neoplasm (MPN) in a human subject in need thereof comprising administering a Bruton's Tyrosine Kinase (BTK) inhibitor to the human subject, wherein the BTK inhibitor is 1-(4-(((6-amino-5-(4-phenoxyphenyl)pyrimidin-4-yl)amino)methyl)-4-fluoropiperidin-1-yl) prop-2-en-1-one or a pharmaceutically acceptable salt thereof, wherein the human subject has an accumulation of malignant CD34+ myeloid cells in their hematopoietic tissue; wherein the human subject has a JAK2V617F mutation; wherein the human subject has acute myeloid leukemia (AML) secondary to a MPN; and wherein the human subject:
(a) has not been treated with a JAK2 inhibitor;
(b) is intolerant to a JAK2 inhibitor;
(c) is ineligible for treatment with a JAK2 inhibitor; or
(d) is relapsed following JAK2 inhibitor treatment or is refractory to JAK2 inhibitor treatment.
22 . The method of claim 21 , wherein the malignant CD34+ myeloid cells have decreased expression of CXCR4 relative to normal myeloid cells.
23 . The method of claim 21 , wherein the human subject did not respond to ruxolitinib therapy.
24 . The method of claim 21 , wherein the BTK inhibitor is orally administered.
25 . The method of claim 21 , wherein the hematopoietic tissue is extramedullary hematopoietic tissue, bone marrow, spleen, or liver.
26 . A method of treating a myeloproliferative neoplasm (MPN) in a human subject in need thereof comprising administering a Bruton's Tyrosine Kinase (BTK) inhibitor to the human subject, wherein the BTK inhibitor is 1-(4-(((6-amino-5-(4-phenoxyphenyl)pyrimidin-4-yl)amino)methyl)-4-fluoropiperidin-1-yl) prop-2-en-1-one or a pharmaceutically acceptable salt thereof, wherein the human subject has an accumulation of malignant CD34+ myeloid cells in their hematopoietic tissue; wherein the human subject does not have a JAK2V617F mutation; wherein the human subject has acute myeloid leukemia secondary to a MPN; and wherein the human subject:
(a) has not been treated with a JAK2 inhibitor;
(b) is intolerant to a JAK2 inhibitor;
(c) is ineligible for treatment with a JAK2 inhibitor; or
(d) is relapsed following JAK2 inhibitor treatment or is refractory to JAK2 inhibitor treatment.
27 . The method of claim 26 wherein the malignant CD34+ myeloid cells have decreased expression of CXCR4 relative to normal myeloid cells.
28 . The method of claim 26 , wherein the human subject did not respond to ruxolitinib therapy.
29 . The method of claim 26 , wherein the BTK inhibitor is orally administered.
30 . The method of claim 26 , wherein the hematopoietic tissue is extramedullary hematopoietic tissue, bone marrow, spleen, or liver.