Trial Outcomes & Findings for Tadalafil and Lenalidomide Maintenance With or Without Activated Marrow Infiltrating Lymphocytes (MILs) in High Risk Myeloma (NCT NCT01858558)

NCT ID: NCT01858558

Last Updated: 2020-06-29

Results Overview

Feasibility is defined as the ability to harvest, expand, and infuse the MILs product within 120 days. After treating 60 patients with MILs, we will declare MILs not feasible if we can only harvest, expand, and deliver MILs to 40 or fewer patients.

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

102 participants

Primary outcome timeframe

120 days

Results posted on

2020-06-29

Participant Flow

Participants were enrolled at four sites: Johns Hopkins University, Moffitt Cancer Center, Mayo Clinic (Jacksonville) and the Blood and Marrow Transplant Group of Georgia (Northside).

Of the 102 patients randomized, one was randomized to the control group who was lost to follow-up prior to start; did not have aMILs harvested, and was not transplanted. This patient is therefore not included in this report.

Participant milestones

Participant milestones
Measure
aMIL Arm
Patients receive activated Marrow Infiltrating Lymphocytes (aMIL) aMIL: On day 0, patients will receive auto transplant followed by Tadalafil and aMIL. At day 60, patients will receive Lenalidomide.
No aMIL
Patients do not receive activated Marrow Infiltrating Lymphocytes (aMIL) No aMIL: On day 0, patients will receive auto transplant followed by Tadalafil. At day 60, patients will receive Lenalidomide.
Overall Study
STARTED
70
31
Overall Study
COMPLETED
61
29
Overall Study
NOT COMPLETED
9
2

Reasons for withdrawal

Reasons for withdrawal
Measure
aMIL Arm
Patients receive activated Marrow Infiltrating Lymphocytes (aMIL) aMIL: On day 0, patients will receive auto transplant followed by Tadalafil and aMIL. At day 60, patients will receive Lenalidomide.
No aMIL
Patients do not receive activated Marrow Infiltrating Lymphocytes (aMIL) No aMIL: On day 0, patients will receive auto transplant followed by Tadalafil. At day 60, patients will receive Lenalidomide.
Overall Study
Death
1
1
Overall Study
Lost to Follow-up
1
0
Overall Study
Disease progression
3
1
Overall Study
Product contamination
2
0
Overall Study
Failed expansion of cell product
2
0

Baseline Characteristics

Tadalafil and Lenalidomide Maintenance With or Without Activated Marrow Infiltrating Lymphocytes (MILs) in High Risk Myeloma

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
aMIL Arm
n=70 Participants
Patients receive activated Marrow Infiltrating Lymphocytes (aMIL) aMIL: On day 0, patients will receive auto transplant followed by Tadalafil and aMIL. At day 60, patients will receive Lenalidomide.
No aMIL
n=31 Participants
Patients do not receive activated Marrow Infiltrating Lymphocytes (aMIL) No aMIL: On day 0, patients will receive auto transplant followed by Tadalafil. At day 60, patients will receive Lenalidomide.
Total
n=101 Participants
Total of all reporting groups
Age, Continuous
62.5 years
n=5 Participants
59.0 years
n=7 Participants
61.7 years
n=5 Participants
Sex: Female, Male
Female
36 Participants
n=5 Participants
15 Participants
n=7 Participants
51 Participants
n=5 Participants
Sex: Female, Male
Male
34 Participants
n=5 Participants
16 Participants
n=7 Participants
50 Participants
n=5 Participants
Race/Ethnicity, Customized
Asian
1 Participants
n=5 Participants
1 Participants
n=7 Participants
2 Participants
n=5 Participants
Race/Ethnicity, Customized
Black
14 Participants
n=5 Participants
8 Participants
n=7 Participants
22 Participants
n=5 Participants
Race/Ethnicity, Customized
Other
2 Participants
n=5 Participants
1 Participants
n=7 Participants
3 Participants
n=5 Participants
Race/Ethnicity, Customized
White
53 Participants
n=5 Participants
21 Participants
n=7 Participants
74 Participants
n=5 Participants
Region of Enrollment
United States
70 participants
n=5 Participants
31 participants
n=7 Participants
101 participants
n=5 Participants
Disease Status
Newly Diagnosed
60 Participants
n=5 Participants
26 Participants
n=7 Participants
86 Participants
n=5 Participants
Disease Status
Relapsed
10 Participants
n=5 Participants
5 Participants
n=7 Participants
15 Participants
n=5 Participants
Myeloma Prognostic Risk Signature (MYPRS) Risk Category
High Risk
12 Participants
n=5 Participants
4 Participants
n=7 Participants
16 Participants
n=5 Participants
Myeloma Prognostic Risk Signature (MYPRS) Risk Category
Low Risk
25 Participants
n=5 Participants
15 Participants
n=7 Participants
40 Participants
n=5 Participants
Myeloma Prognostic Risk Signature (MYPRS) Risk Category
N/A
8 Participants
n=5 Participants
2 Participants
n=7 Participants
10 Participants
n=5 Participants
Myeloma Prognostic Risk Signature (MYPRS) Risk Category
Indeterminate
25 Participants
n=5 Participants
10 Participants
n=7 Participants
35 Participants
n=5 Participants
70-gene expression Prognostic Risk Score (GEP-70)
Not High Risk
58 Participants
n=5 Participants
27 Participants
n=7 Participants
85 Participants
n=5 Participants
70-gene expression Prognostic Risk Score (GEP-70)
High Risk
12 Participants
n=5 Participants
4 Participants
n=7 Participants
16 Participants
n=5 Participants
Eastern Cooperative Oncology Group (ECOG) Performance Status
0
27 Participants
n=5 Participants
7 Participants
n=7 Participants
34 Participants
n=5 Participants
Eastern Cooperative Oncology Group (ECOG) Performance Status
1 or 2
34 Participants
n=5 Participants
21 Participants
n=7 Participants
55 Participants
n=5 Participants
Eastern Cooperative Oncology Group (ECOG) Performance Status
Missing
9 Participants
n=5 Participants
3 Participants
n=7 Participants
12 Participants
n=5 Participants
International Staging System (ISS) Multiple Myeloma Classification
Stage I
20 Participants
n=5 Participants
10 Participants
n=7 Participants
30 Participants
n=5 Participants
International Staging System (ISS) Multiple Myeloma Classification
Stage II
19 Participants
n=5 Participants
7 Participants
n=7 Participants
26 Participants
n=5 Participants
International Staging System (ISS) Multiple Myeloma Classification
Stage III
17 Participants
n=5 Participants
8 Participants
n=7 Participants
25 Participants
n=5 Participants
International Staging System (ISS) Multiple Myeloma Classification
missing
14 Participants
n=5 Participants
6 Participants
n=7 Participants
20 Participants
n=5 Participants
Salmon Stage multiple myeloma classification
IA-IB
9 Participants
n=5 Participants
0 Participants
n=7 Participants
9 Participants
n=5 Participants
Salmon Stage multiple myeloma classification
IIA-IIB
14 Participants
n=5 Participants
7 Participants
n=7 Participants
21 Participants
n=5 Participants
Salmon Stage multiple myeloma classification
IIIA-IIIB
35 Participants
n=5 Participants
21 Participants
n=7 Participants
56 Participants
n=5 Participants
Salmon Stage multiple myeloma classification
missing
12 Participants
n=5 Participants
3 Participants
n=7 Participants
15 Participants
n=5 Participants
Number of Prior Multiple Myeloma Treatments
1 prior treatments
n=5 Participants
2 prior treatments
n=7 Participants
1 prior treatments
n=5 Participants
Time to Diagnosis
0.53 years
n=5 Participants
0.76 years
n=7 Participants
0.55 years
n=5 Participants
Time to stem cell transplant (SCT)
63.0 Days
n=5 Participants
56.0 Days
n=7 Participants
60.0 Days
n=5 Participants

PRIMARY outcome

Timeframe: 120 days

Population: 71 patients were evaluable in the feasibility set: 70 randomized to the aMILs Arm, plus one patient who was not randomized due to harvest failure.

Feasibility is defined as the ability to harvest, expand, and infuse the MILs product within 120 days. After treating 60 patients with MILs, we will declare MILs not feasible if we can only harvest, expand, and deliver MILs to 40 or fewer patients.

Outcome measures

Outcome measures
Measure
aMIL Arm
n=71 Participants
Patients receive activated Marrow Infiltrating Lymphocytes (aMIL) aMIL: On day 0, patients will receive auto transplant followed by Tadalafil and aMIL. At day 60, patients will receive Lenalidomide.
No aMIL
Patients do not receive activated Marrow Infiltrating Lymphocytes (aMIL) No aMIL: On day 0, patients will receive auto transplant followed by Tadalafil. At day 60, patients will receive Lenalidomide.
Feasibility of MILs as Assessed by the Ability to Harvest, Expand, and Infuse the MILs Product
Total number who received aMILS
71 Participants
Feasibility of MILs as Assessed by the Ability to Harvest, Expand, and Infuse the MILs Product
Feasible
46 Participants
Feasibility of MILs as Assessed by the Ability to Harvest, Expand, and Infuse the MILs Product
Reason not feasible- failed harvest
1 Participants
Feasibility of MILs as Assessed by the Ability to Harvest, Expand, and Infuse the MILs Product
Reason not feasible- disease progression
4 Participants
Feasibility of MILs as Assessed by the Ability to Harvest, Expand, and Infuse the MILs Product
Reason not feasible- death
1 Participants
Feasibility of MILs as Assessed by the Ability to Harvest, Expand, and Infuse the MILs Product
Reason not feasible- lost to follow-up
1 Participants
Feasibility of MILs as Assessed by the Ability to Harvest, Expand, and Infuse the MILs Product
Reason not feasible- failed expansion
2 Participants
Feasibility of MILs as Assessed by the Ability to Harvest, Expand, and Infuse the MILs Product
Reason not feasible- cell product contamination
2 Participants
Feasibility of MILs as Assessed by the Ability to Harvest, Expand, and Infuse the MILs Product
Reason not feasible- greater than 120 days
14 Participants

SECONDARY outcome

Timeframe: 60 days from aMILs harvest until day 60 after transplant

Total number of adverse events grade 3 or higher that occur from MILs harvest through 60 days after transplant.

Outcome measures

Outcome measures
Measure
aMIL Arm
n=70 Participants
Patients receive activated Marrow Infiltrating Lymphocytes (aMIL) aMIL: On day 0, patients will receive auto transplant followed by Tadalafil and aMIL. At day 60, patients will receive Lenalidomide.
No aMIL
n=31 Participants
Patients do not receive activated Marrow Infiltrating Lymphocytes (aMIL) No aMIL: On day 0, patients will receive auto transplant followed by Tadalafil. At day 60, patients will receive Lenalidomide.
Toxicity as Determined by Total Number of Grade 3 or Higher Adverse Events
129 adverse events
65 adverse events

SECONDARY outcome

Timeframe: 3 years

Population: This is an analysis by intention-to-treat and only considers transplanted patients randomized to the aMILs arm.

OS assessed by number of participants alive at the end of follow up period.

Outcome measures

Outcome measures
Measure
aMIL Arm
n=70 Participants
Patients receive activated Marrow Infiltrating Lymphocytes (aMIL) aMIL: On day 0, patients will receive auto transplant followed by Tadalafil and aMIL. At day 60, patients will receive Lenalidomide.
No aMIL
Patients do not receive activated Marrow Infiltrating Lymphocytes (aMIL) No aMIL: On day 0, patients will receive auto transplant followed by Tadalafil. At day 60, patients will receive Lenalidomide.
Overall Survival (OS)
55 Participants

SECONDARY outcome

Timeframe: 5 years

Population: This is an analysis by intention-to-treat and only considers transplanted patients randomized to the aMILs arm.

Median PFS time equals the time of randomization (in months) until disease progression, death from any cause, or protocol deviation due to lenalidomide dosing (above 10mg), whichever occurs first.

Outcome measures

Outcome measures
Measure
aMIL Arm
n=70 Participants
Patients receive activated Marrow Infiltrating Lymphocytes (aMIL) aMIL: On day 0, patients will receive auto transplant followed by Tadalafil and aMIL. At day 60, patients will receive Lenalidomide.
No aMIL
Patients do not receive activated Marrow Infiltrating Lymphocytes (aMIL) No aMIL: On day 0, patients will receive auto transplant followed by Tadalafil. At day 60, patients will receive Lenalidomide.
Progression-free Survival (PFS)
21.82 months
Interval 18.53 to 41.82

Adverse Events

aMIL Arm

Serious events: 64 serious events
Other events: 11 other events
Deaths: 1 deaths

No aMIL

Serious events: 29 serious events
Other events: 0 other events
Deaths: 1 deaths

Serious adverse events

Serious adverse events
Measure
aMIL Arm
n=70 participants at risk
Patients receive activated Marrow Infiltrating Lymphocytes (aMIL) aMIL: On day 0, patients will receive auto transplant followed by Tadalafil and aMIL. At day 60, patients will receive Lenalidomide.
No aMIL
n=31 participants at risk
Patients do not receive activated Marrow Infiltrating Lymphocytes (aMIL) No aMIL: On day 0, patients will receive auto transplant followed by Tadalafil. At day 60, patients will receive Lenalidomide.
Blood and lymphatic system disorders
Febrile neutropenia
51.4%
36/70 • Number of events 45 • 60 Days from aMILs harvest until Day 60 after transplant
58.1%
18/31 • Number of events 22 • 60 Days from aMILs harvest until Day 60 after transplant
Renal and urinary disorders
Acute Kidney Injury
0.00%
0/70 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
Blood and lymphatic system disorders
Anemia
4.3%
3/70 • Number of events 3 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
Cardiac disorders
Atrial Fibrillation
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
Musculoskeletal and connective tissue disorders
Back Pain
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
Blood and lymphatic system disorders
Pancytopenia
2.9%
2/70 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
Musculoskeletal and connective tissue disorders
Bone Pain
4.3%
3/70 • Number of events 3 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
Gastrointestinal disorders
Colitis
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
Metabolism and nutrition disorders
dehydration
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
Injury, poisoning and procedural complications
Device related infection
0.00%
0/70 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
Gastrointestinal disorders
Diarrhea
11.4%
8/70 • Number of events 8 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
Infections and infestations
Enterocolitis infection
0.00%
0/70 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
Gastrointestinal disorders
Esophagitis
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
General disorders
Fatigue
2.9%
2/70 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
General disorders
fever
5.7%
4/70 • Number of events 4 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
Gastrointestinal disorders
Gastric ulcer
0.00%
0/70 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
Nervous system disorders
headache
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
Metabolism and nutrition disorders
hypocalcemia
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
Metabolism and nutrition disorders
hypophosphatemia
5.7%
4/70 • Number of events 5 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
Vascular disorders
hypotension
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
Respiratory, thoracic and mediastinal disorders
hypoxia
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
Infections and infestations
bacteremia
4.3%
3/70 • Number of events 3 • 60 Days from aMILs harvest until Day 60 after transplant
6.5%
2/31 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
Renal and urinary disorders
Kidney infection
0.00%
0/70 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
Infections and infestations
lung infection
2.9%
2/70 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
6.5%
2/31 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
Blood and lymphatic system disorders
lymphocyte count decreased
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
Infections and infestations
mucosal infection
15.7%
11/70 • Number of events 11 • 60 Days from aMILs harvest until Day 60 after transplant
16.1%
5/31 • Number of events 5 • 60 Days from aMILs harvest until Day 60 after transplant
Gastrointestinal disorders
nausea
1.4%
1/70 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
6.5%
2/31 • Number of events 3 • 60 Days from aMILs harvest until Day 60 after transplant
Blood and lymphatic system disorders
neutrophil count decreased
10.0%
7/70 • Number of events 10 • 60 Days from aMILs harvest until Day 60 after transplant
9.7%
3/31 • Number of events 4 • 60 Days from aMILs harvest until Day 60 after transplant
Blood and lymphatic system disorders
platelet count decreased
4.3%
3/70 • Number of events 7 • 60 Days from aMILs harvest until Day 60 after transplant
12.9%
4/31 • Number of events 4 • 60 Days from aMILs harvest until Day 60 after transplant
Renal and urinary disorders
renal calculi
0.00%
0/70 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
Infections and infestations
Scrotal Infection
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
Infections and infestations
Sepsis
2.9%
2/70 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
Nervous system disorders
Stroke
0.00%
0/70 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
Nervous system disorders
syncope
2.9%
2/70 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
6.5%
2/31 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
Vascular disorders
thromboembolic event
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
Infections and infestations
upper respiratory infection
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
Cardiac disorders
ventricular arrhythmia
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
Gastrointestinal disorders
vomiting
0.00%
0/70 • 60 Days from aMILs harvest until Day 60 after transplant
6.5%
2/31 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
Blood and lymphatic system disorders
white blood cell decreased
2.9%
2/70 • Number of events 4 • 60 Days from aMILs harvest until Day 60 after transplant
3.2%
1/31 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant

Other adverse events

Other adverse events
Measure
aMIL Arm
n=70 participants at risk
Patients receive activated Marrow Infiltrating Lymphocytes (aMIL) aMIL: On day 0, patients will receive auto transplant followed by Tadalafil and aMIL. At day 60, patients will receive Lenalidomide.
No aMIL
n=31 participants at risk
Patients do not receive activated Marrow Infiltrating Lymphocytes (aMIL) No aMIL: On day 0, patients will receive auto transplant followed by Tadalafil. At day 60, patients will receive Lenalidomide.
Product Issues
manufacture failure
2.9%
2/70 • Number of events 2 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
Product Issues
product contamination
1.4%
1/70 • Number of events 1 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant
General disorders
infusion related reaction
12.7%
8/63 • Number of events 8 • 60 Days from aMILs harvest until Day 60 after transplant
0.00%
0/31 • 60 Days from aMILs harvest until Day 60 after transplant

Additional Information

Philip Imus, MD

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Phone: 410-955-8873

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place