A Sequential Two-Stage Dose Escalation Study to Evaluate the Safety and Efficacy of Ruxolitinib

This is a phase 1/2, two-stage, sequential cohort dose escalation study. If dose escalation
is completed as planned, no more than 53 subjects are expected to enroll onto this study at a
rate of approximately 3 subjects every month. For the Phase 2 study the Simon's optimal
two-stage design will be employed to test the null hypothesis that response rate (RR) equals
to 10% versus the alternative that RR equals to 30%.

Demographic and clinical variables for the study patients will be summarized using
descriptive statistics (mean, standard deviation, median, inter-quartile range, range, and
frequency counts and percentages). Safety and efficacy data will be analyzed overall as well
as separately for each dose cohort when appropriate.

Inclusion Criteria:

- Confirmed diagnosis of CMML using the World Health Organization (WHO) classification

- Age >18 years at the time of obtaining informed consent

- Must be able to adhere to the study visit schedule and other protocol requirements

- Must be able to provide adequate bone marrow (BM) aspirate and biopsy specimens for
histopathological analysis and standard cytogenetic analysis during the screening
procedure

- An Eastern Cooperative Oncology Group (ECOG) performance status score of 0,1, or 2

- Women of childbearing potential must have a negative pregnancy test at time of
screening and baseline visits and agree to use two reliable forms of contraception
simultaneously or to practice complete abstinence from heterosexual intercourse 1) for
at least 28 days before starting study drug; 2) while participating in the study; and
3) for at least 28 days after discontinuation from the study.

- Must understand and voluntarily sign an informed consent form

- Must have a life expectancy of greater than 3 months at time of screening

Exclusion Criteria:

- Platelet count of less than 35,000/uL

- Absolute Neutrophil Count (ANC) of less than 250/uL

- Serum Creatinine >2.0

- Serum total bilirubin >1.5 x upper limit of normal (ULN)

- Use of cytotoxic chemotherapeutic agents, or experimental agents (agents that are not
commercially available) for the treatment of CMML within 28 days of the first day of
study drug treatment

- Any serious medical condition or psychiatric illness that will prevent the subject
from signing the informed consent form or will place the subject at unacceptable risk
if he/she participates in the study

- Concurrent use of Granulocyte/macrophage colony stimulating factor (GM-CSF).
Granulocyte colony-stimulating factor (G-CSF) could be used for the short-term
management of neutropenic infection. Stable doses of erythropoietin stimulating agents
that were started >8 weeks from first ruxolitinib dose or corticosteroids that were
being administered prior to screening are allowed.

- Uncontrolled current illness including, but not limited to ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that would limit compliance with
study requirements

- Pregnant women are excluded from this study because ruxolitinib has not been studied
in pregnant subjects. Because there is an unknown but potential risk for adverse
events in nursing infants secondary to treatment of the mother with ruxolitinib,
breastfeeding should be discontinued if the mother is treated with ruxolitinib.

- Patients who have participated in other interventional (treatment-related) clinical
trials within 30 days of enrollment are excluded.