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 [having needed a transfusion anytime in the past 6 months])
Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2 at study entry
Absolute neutrophil count (ANC) >= 1000/uL
Platelet count >= 50,000/uL
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; note: patients who are on ruxolitinib may continue on without a 14 day wash out at the treating physician's discretion
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:

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
Patient received prior combination treatment with ruxolitinib and danazol together; note: previous treatment with ruxolitinib and/or danazol as single agent therapy is allowed

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)