Study to Evaluate the Safety and Efficacy of Daratumumab and Carfilzomib-based Induction/Consolidation/Maintenance Therapy in Transplant-eligible, Ultra High-risk, Newly Diagnosed Multiple Myeloma

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE2

Total Enrollment

54 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-10-20

Study Completion Date

2027-10-20

Brief Summary

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This study will assess whether the combination of daratumumab and carfilzomib-based Induction/Consolidation/Maintenance Therapy with ASCT improves the outcome of patients with ultra high-risk, newly diagnosed multiple myeloma

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Detailed Description

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Survival outcomes for patients with newly diagnosed multiple myeloma (MM) have improved substantially in the past decades, due to the introduction of novel therapeutic strategies. Unfortunately, patients with ultra-high-risk MM, including "double-hit" MM, extramedullary MM (EMM), and primary plasma cell leukemia (pPCL), have a significantly worse prognosis and benefit less from current therapeutic strategies. This study aims to investigate whether a treatment regimen combining daratumumab and carfilzomib-based Induction/Consolidation/Maintenance Therapy with autologous stem cell transplantation (ASCT) can improve the survival outcomes of newly diagnosed, transplant-eligible, ultra high-risk multiple myeloma patients. In the study, participants will receive induction therapy with 2-4 cycles of Dara-KRd-PACE, followed by ASCT, 4 cycles of Dara-KRd consolidation, and then maintenance with 12 cycles of Dara-Kd.

Conditions

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Multiple Myeloma Primary Plasma Cell Leukemia Extramedullary Multiple Myeloma

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Study Treatment

Pretrial induction chemotherapy (if required): bortezomib, cyclophosphamid, dexamethasone (VCD).

Induction Chemotherapy: Daratumumab, Carfilzomib,Lenalidomide, Dexamethasone, CisPlatin, epirubicin, Cyclophosphamide and Etoposide (Dara-KRd-PACE).

Autologous Stem Cell Transplant (ASCT) : Melphalan, ASCT.

Consolidation: Daratumumab, Carfilzomib, Lenalidomide, Dexamethasone (Dara-KRd).

Maintenance: Daratumumab, Carfilzomib, and Dexamethasone (Dara-Kd).

Group Type EXPERIMENTAL

Daratumumab

Intervention Type DRUG

Given by vein: days 1 and 8 of each Induction cycle; days 1 and 15 of each Consolidation cycle; and day 1of each Maintenance cycle.

Carfilzomib

Intervention Type DRUG

Given by vein: days 1,2,8 and 9 of each Induction cycle; days 1, 2, 8, 9,15, and 16 of each Consolidation cycle; days 1, 2,15, and 16 of each Maintenance cycle.

Lenalidomide

Intervention Type DRUG

Given by mouth: days 1-7 of each Induction cycle; days 1-14 of each Consolidation cycle.

Dexamethasone

Intervention Type DRUG

Given by mouth or by vein: days 1, 8, 15, and 22 of each Induction cycle; days 1, 8, 15, and 22 of each Consolidation cycle; and days 1 and 15 of every cycle during Maintenance

Cisplatin

Intervention Type DRUG

Given by vein: days 1-4 of each Induction cycle

epirubicin

Intervention Type DRUG

Given by vein: days 1-4 of each Induction cycle

Cyclophosphamide

Intervention Type DRUG

Given by vein: days 1-4 of each Induction cycle

Etoposide

Intervention Type DRUG

Given by vein: days 1-4 of each Induction cycle

Melphalan

Intervention Type DRUG

Given by vein: day -1 of Transplant

ASCT

Intervention Type PROCEDURE

day 0 of Transplant

bortezomib

Intervention Type DRUG

given by subcutaneous injection: days 1, 4, 8, and 11 of pretrial induction chemotherapy

Interventions

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Daratumumab

Given by vein: days 1 and 8 of each Induction cycle; days 1 and 15 of each Consolidation cycle; and day 1of each Maintenance cycle.

Intervention Type DRUG

Carfilzomib

Given by vein: days 1,2,8 and 9 of each Induction cycle; days 1, 2, 8, 9,15, and 16 of each Consolidation cycle; days 1, 2,15, and 16 of each Maintenance cycle.

Intervention Type DRUG

Lenalidomide

Given by mouth: days 1-7 of each Induction cycle; days 1-14 of each Consolidation cycle.

Intervention Type DRUG

Dexamethasone

Given by mouth or by vein: days 1, 8, 15, and 22 of each Induction cycle; days 1, 8, 15, and 22 of each Consolidation cycle; and days 1 and 15 of every cycle during Maintenance

Intervention Type DRUG

Cisplatin

Given by vein: days 1-4 of each Induction cycle

Intervention Type DRUG

epirubicin

Given by vein: days 1-4 of each Induction cycle

Intervention Type DRUG

Cyclophosphamide

Given by vein: days 1-4 of each Induction cycle

Intervention Type DRUG

Etoposide

Given by vein: days 1-4 of each Induction cycle

Intervention Type DRUG

Melphalan

Given by vein: day -1 of Transplant

Intervention Type DRUG

ASCT

day 0 of Transplant

Intervention Type PROCEDURE

bortezomib

given by subcutaneous injection: days 1, 4, 8, and 11 of pretrial induction chemotherapy

Intervention Type DRUG

Other Intervention Names

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Darzalex Kyprolis Revlimid Baycadron Platinol Pharmorubicin Cytoxan Eposin Alkeran autologous stem cell transplantation Velcade

Eligibility Criteria

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Inclusion Criteria

1. Patients must have newly diagnosed ultra high-risk disease, as defined by one of the following:1)"Double hit"Multiple Myeloma (≥2 adverse markers: t(4;14), t(14;16), t(14;20), 1q21+, del(17p),p53 mutation) ,2)Extramedullary Multiple Myeloma, 3) primary plasma cell leukemia.
2. Patients must be either untreated or have not received systemic MM therapy. Prior bisphosphonates and localized radiation are allowed.
3. Aged 18 years to 70 years.
4. Fit for intensive chemotherapy and autologous stem cell transplant (at clinician's discretion).
5. Eastern Cooperative Oncology Group (ECOG) score ≤2 before induction chemotherapy.

Exclusion Criteria

1. No evidence of high-risk disease.
2. Primary diagnosis of Waldenstrom's disease/POEMS syndrome/light chain amyloidosis.
3. Received therapy for multiple myeloma.
4. Prior or concurrent invasive malignancies.
5. Eastern Cooperative Oncology Group (ECOG) score \>2 before induction chemotherapy.
6. Clinically significant allergies or intolerance to daratumumab,carfilzomib,lenalidomide, dexamethasone, cisPlatin, epirubicin, cyclophosphamide,melphalan, and etoposide.
7. Participants with contraindication to thromboprophylaxis.
8. Any uncontrolled or severe cardiovascular or pulmonary disease.
9. Platelet count \< 50,000/μL, absolute neutrophil count \<1000/μL, and haemoglobin \<60 g/L before induction chemotherapy.
10. Calculated creatinine clearance \<30 mL/min, alanine transaminase (ALT) or aspertate aminotransferase (AST) \>3 times upper limit of normal (ULN). Bilirubin \>2 times ULN, except in participants with congenital bilirubinemia, such as Gilbert syndrome (direct bilirubin \>2.0 times ULN).
11. Known to be seropositive for history of HIV or known to have active hepatitis B or hepatitis C.
12. Ejection fraction by echocardiogram (ECHO) ≥ 45%, pulmonary function studies \<50% of predicted on mechanical aspects (Forced Expiratory Volume 1 (FEV1), Forced Vital Capacity (FVC) and diffusion capacity (DLCO) \< 50% of predicted.
13. Uncontrolled or severe cardiovascular or pulmonary disease, clinically significant cardiac disease, uncontrolled diabetes mellitus, or other serious medical or psychiatric illness that could potentially interfere with the completion of treatment according to this protocol.
14. Known/underlying medical conditions that, in the investigator's opinion, would make the administration of the study drug hazardous.
15. Participant is a woman who is pregnant, or breast feeding, or planning to become pregnant while enrolled in this trial or within at least 6 months after the last dose of trial treatment. Or, participant is a man who plans to father a child while taking part in this trial or within at least 6 months after the last dose of trial treatment.
16. Received an investigational drug (including investigational vaccines) or used an invasive investigational medical device within 4 weeks before treatment protocol registration or is currently enrolled in an interventional investigational study.
17. Major surgery within 2 weeks before treatment protocol registration or has not fully recovered from surgery, or has surgery planned during the time the participant is expected to participate in the study. Kyphoplasty or vertebroplasty is not considered major surgery.
18. Known or suspected of not being able to comply with the study protocol.

Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No