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Must be able to complete the Myelofibrosis Symptom Assessment Form (MFSAF) v4.0 on at least 4 out of 7 days prior to randomization |
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\-- Has at least 2 symptoms with a score >= 3 or a total score of >= 12, as |
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measured by the MFSAF v4.0 |
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Documented diagnosis of primary myelofibrosis (MF), post polycythemia vera (PPV)-MF, or post essential thrombocytopenia (PET)-MF as defined by the World Health Organization (WHO) classification |
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Classified as intermediate-2 or high-risk MF, as defined by the Dynamic International Prognostic Scoring System Plus (DIPSS+) |
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Must currently be on treatment or have received prior treatment with a single Janus Kinase 2 (JAK2) inhibitor, ruxolitinib, and meet one of the following criteria (in addition to the minimum splenomegaly and symptom burden also required for eligibility) |
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Treatment with ruxolitinib for >= 24 weeks that was stopped due to loss of spleen response (refractory), or loss of spleen response or symptom control after a previous response (relapsed), or was continued despite relapsed/refractory status |
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Treatment with ruxolitinib for < 24 weeks with documented disease progression while on therapy as defined by any of the following |
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Appearance of new splenomegaly that is palpable to at least 5 cm below the left costal margin (LCM) in participants with no evidence of splenomegaly prior to the initiation of ruxolitinib |
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A >= 100% increase in the palpable distance below the LCM in participants with measurable spleen distance 5 to 10 centimeters (cm) prior to the initiation of ruxolitinib |
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A >= 50% increase in the palpable distance below the LCM in participants with measurable spleen distance > 10 cm prior to the initiation of ruxolitinib |
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A spleen volume increase of >= 25% (as assessed by Magnetic Resonance Imaging [MRI] or Computed Tomography [CT] scan) in participants with a spleen volume assessment prior to the initiation of ruxolitinib |
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Prior or current treatment with ruxolitinib for >= 28 days with intolerance defined as new RBC transfusion requirement (at least 2 units/month for 2 months) while receiving a total daily ruxolitinib dose of >= 30 mg but unable to reduce dose further due to lack of efficacy |
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Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2 |
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Splenomegaly defined as palpable spleen measurement >= 5 cm below costal margin or spleen volume >= 450 cm3 as assessed centrally by MRI or CT scan |
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Baseline platelet count >= 100 10^9/L |
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Receiving medication that interferes with coagulation or platelet function except for low dose aspirin (up to 100 milligrams daily) and low molecular weight heparin (LMWH) within 3 days prior to the first dose of study drug or during the study treatment period
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Received prior treatment with a BH3-mimetic compound, bromodomain and extra-terminal (BET) inhibitor, or prior use of > 1 JAK2 inhibitor
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Receiving anticancer therapy including chemotherapy, radiation therapy, hormonal therapy (with the exception of hormones for thyroid conditions or estrogen replacement therapy) within 30 days prior to first dose of study drug, and during the study treatment period (other than any overlapping therapy as part of the selected BAT)
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Eligible for allogeneic stem cell transplantation at the time of study entry
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