A Study to Evaluate the Efficacy and Safety of Daratumumab in Combination With Cyclophosphamide, Bortezomib and Dexamethasone (CyBorD) Compared to CyBorD Alone in Newly Diagnosed Systemic Amyloid Light-chain (AL) Amyloidosis
Amyloidosis
About this trial
This is an interventional treatment trial for Amyloidosis
Eligibility Criteria
Inclusion Criteria:
- Histopathological diagnosis of amyloidosis based on detection by immunohistochemistry and polarizing light microscopy of green bi-refringent material in congo red stained tissue specimens (in an organ other than bone marrow) or characteristic electron microscopy appearance
Measurable disease of amyloid light-chain (AL) amyloidosis as defined by at least one of the following:
- serum monoclonal (M)-protein greater than or equal (>=) 0.5 grams/deciliter (g/dL) by protein electrophoresis (routine serum protein electrophoresis and immunofixation [IFE] performed at a central laboratory)
- serum free light chain greater than or equal to (>=) 50 milligram/Liter (mg/L) with an abnormal kappa:lambda ratio or the difference between involved and uninvolved free light chains (dFLC) >= 50 mg/L
- One or more organs impacted by AL amyloidosis according to consensus guidelines
- Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) 0, 1 or 2
Exclusion Criteria:
- Prior therapy for AL amyloidosis or multiple myeloma including medications that target CD38, with the exception of 160 mg dexamethasone (or equivalent corticosteroid) maximum exposure prior to randomization
- Previous or current diagnosis of symptomatic multiple myeloma, including the presence of lytic bone disease, plasmacytomas, >= 60 percent (%) plasma cells in the bone marrow, or hypercalcemia
Evidence of significant cardiovascular conditions as specified below:
- NT-ProBNP > 8500 nanogram per liter (ng/L)
- New York Heart Association (NYHA) classification IIIB or IV heart failure
- Heart failure that in the opinion of the investigator is on the basis of ischemic heart disease (eg, prior myocardial infarction with documented history of cardiac enzyme elevation and electrocardiogram [ECG] changes) or uncorrected valvular disease and not primarily due to AL amyloid cardiomyopathy
- Inpatient admission to a hospital for unstable angina or myocardial infarction within the last 6 months prior to first dose or percutaneous cardiac intervention with recent stent within 6 months or coronary artery bypass grafting within 6 months
- For participants with congestive heart failure, cardiovascular-related hospitalizations within 4 weeks prior to randomization
- Participants with a history of sustained ventricular tachycardia or aborted ventricular fibrillation or with a history of atrioventricular (AV) nodal or sinoatrial (SA) nodal dysfunction for which a pacemaker/implantable cardioverter-defibrillators [ICD] is indicated but not placed (participants who do have a pacemaker/ICD are allowed on study)
- Screening 12-lead ECG showing a baseline QT interval as corrected by Fridericia's formula (QTcF) > 500 milliseconds (msec). Participants who have a pacemaker may be included regardless of calculated QTc interval
- Supine systolic blood pressure < 90 millimeter of mercury (mmHg), or symptomatic orthostatic hypotension, defined as a decrease in systolic blood pressure upon standing of > 20 mmHg despite medical management (eg, midodrine, fludrocortisones) in the absence of volume depletion
- Planned stem cell transplant during the first 6 cycles of protocol therapy are excluded. Stem cell collection during the first 6 cycles of protocol therapy is permitted
- Known to be seropositive for human immunodeficiency virus (HIV)
Any one of the following:
- Seropositive for hepatitis B (defined by a positive test for hepatitis B surface antigen [HBsAg]). Participants with resolved infection (ie, participants who are HBsAg negative but positive for antibodies to hepatitis B core antigen [anti-HBc] and/or antibodies to hepatitis B surface antigen [anti-HBs]) must be screened using real-time polymerase chain reaction (PCR) measurement of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) levels. Those who are PCR positive will be excluded
- Known to be seropositive for hepatitis C (except in the setting of a sustained virologic response [SVR], defined as aviremia at least 12 weeks after completion of antiviral therapy)
- Grade 2 sensory or Grade 1 painful peripheral neuropathy
Sites / Locations
- Mayo Clinic Arizona
- City of Hope
- University of California, San Francisco
- Stanford University
- University of Colorado
- Colorado Blood Cancer Institute
- Mayo Clinic
- Winship Cancer Institute Emory University
- University of Maryland
- Tufts Medical Center
- Boston University Medical Center
- Dana-Farber Cancer Institute
- Barbara Ann Karmanos Cancer Institute
- Mayo Clinic Rochester
- Washington University School of Medicine
- Columbia University Medical Center
- Weill Cornell Medical College
- University of Rochester Medical Center
- Levine Cancer Institute
- Wake Forest University Health Sciences - Cardiovascular Medicine
- Cleveland Clinic
- The Ohio State University
- Oregon Health & Science University
- University of Pennsylvania Medical Center
- Sarah Cannon Research Institute
- Vanderbilt University Medical Center
- University of Texas, MD Anderson Cancer Center
- Huntsman Cancer Institute
- Seattle Cancer Care Alliance
- Box Hill Hospital
- Sir Charles Gairdner Hospital
- Westmead Hospital
- Princess Alexandra Hospital
- Institut Jules Bordet
- UZ Gent
- Az Groeninge
- Universitair Ziekenhuis Leuven
- Hospital das Clinicas de Porto Alegre
- Sociedade Pernambucana de Combate ao Cancer
- Instituto de Educacao, Pesquisa e Gestao em Saude Instituto Americas (COI)
- Hospital Sao Rafael
- Fundacao Faculdade Regional de Medicina de Sao Jose do Rio Preto - Hospital de Base
- Instituto de Assistencia Medica ao Servidor Publico Estadual - IAMSPE
- Clinica Sao Germano
- Hospital Das Clinicas Da Faculdade De Medicina Da USP
- Alberta Health Services
- Alberta Health Services
- Vancouver General Hospital
- London Health Sciences Center
- University Health Network (UHN) Princess Margaret Cancer Centre
- McGill University Health Centre
- Peking University First Hospital
- Peking University People's Hospital
- First affiliated Hospital of Zhejiang University
- Ruijin Hospital, Shanghai Jiao Tong University
- The First Affiliated Hospital of Wenzhou Medical University
- Aarhus University Hospital
- Dep. of Hematology, Rigshospitalet
- Odense Universitets Hospital
- CHU Dijon
- Hopital Claude Huriez
- CHU de Limoges - Fédération Hépatologie
- Institut Paoli Calmettes
- Chu Hotel Dieu
- Hopital Saint-Louis
- Centre hospitalier Lyon-Sud
- CHU De Poitiers
- CHU Rangueil
- CHU Bretonneau
- CHU de Nancy_ Hopital Brabois
- Charite Campus Benjamin Franklin
- Heinrich-Heine-Universität Düsseldorf
- Universitatsklinikum Essen
- HOPA-Hämatologisch-Onkologische Praxis Altona MVZ GmbH
- Universitaetsklinikum Heidelberg Medizinische Klinik V
- Universitaetsklinikum Tuebingen der Eberhard-Karls-Universitaet, Abteilung fuer Innere Medizin II,
- Universitätsklinikum Würzburg Med. Klinik U. Poliklinik Ii
- Alexandra General Hospital of Athens
- University General Hospital of Rio
- Semmelweis Egyetem I.Belgyogyaszati Klinika
- Semmelweis Egyetem I.Belgyogyaszati Klinika
- Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Szent László Telephely
- Carmel Hospital
- Hadassah Medical Center
- Sheba Medical Center
- Sourasky Medical Center
- Assaf Ha'Rofeh Medical Center
- Policlinico di Bari
- Istituto di Ematologia Seràgnoli azienda ospedaliera univeristaria Policlinico S.Orsola-Malpighi
- Casa di Cura La Maddalena
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo
- Dipartimento Di Biotecnologie Cellulari Ed Ematologia-Università ''La Sapienza'',Policlinico Umberto I
- A.O.U. Città della Salute e della Scienza
- Fukushima Medical University Hospital
- Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital
- Teine Keijinkai Hospital
- Kanazawa University Hospital
- Kumamoto University Hospital
- Kyoto Kuramaguchi Medical Center
- Shinshu University Hospital
- Matsuyama Red Cross Hospital
- Nagoya City University Hospital
- National Hospital Organization Okayama Medical Center
- Japanese Red Cross Medical Center
- Tokushima University Hospital
- Pusan National University Hospital
- Seoul National University Hospital
- Severance Hospital, Yonsei University Health System
- Samsung Medical Center
- The Catholic University of Korea Seoul St. Mary's Hospital
- Centro de Investigación Farmacéutica Especializada
- Hospital Universitario 'Dr. Jose Eleuterio Gonzalez'
- Haga ziekenhuis
- UMCG
- Erasmus MC
- UMC Utrecht
- Maxima Medisch Centrum
- Samodzielny Publiczny Zaklad Opieki Zdrowotnej Zespol Szpitali Miejskich
- SKPP UM w Poznaniu
- Instytut Hematologii i Transfuzjologii
- Inst. Cat. D'Oncologia-Badalona
- Hosp. Univ. Vall D Hebron
- Hosp. Clinic I Provincial de Barcelona
- Hosp. Univ. Ramon Y Cajal
- Hosp. Univ. Fund. Jimenez Diaz
- Hosp. Univ. 12 de Octubre
- Clinica Univ. de Navarra
- Hosp. Clinico Univ. de Salamanca
- Hosp. Univ. de Canarias
- Hosp. Univ. Dr. Peset
- South Elvsborg Hospital
- Skanes universitetssjukhus
- Ankara Universitesi Tip Fakultesi Cebeci Hastanesi
- Akdeniz University Medical Faculty
- Ondokuz Mayis Universitesi Tip Fakultesi
- Istanbul University Istanbul Medical Faculty
- Dokuz Eylul Universitesi Tip Fakultesi
- Erciyes University Medical Faculty
- University Hospitals Birmingham NHS Trust,
- University College Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
CyBorD alone (cyclophosphamide/bortezomib/dexamethasone)
CyBorD plus Daratumumab
Participants will receive dexamethasone (40 milligrams [mg] orally or intravenous [IV] dose), followed by cyclophosphamide (300 milligram per meter square [mg/m^2] orally or IV dose), then bortezomib (1.3 mg/m^2 subcutaneous injection) weekly on Days 1, 8, 15, 22 in every 28-day cycle for a maximum of 6 cycles.
Participants will receive dexamethasone (20 mg orally or IV dose as premedication and 20 mg on the day after daratumumab dosing) followed by 1800 mg of daratumumab subcutaneously followed by cyclophosphamide (300 mg/m^2 orally or IV dose weekly) and bortezomib (1.3 mg/m^2 subcutaneous injection weekly) on Days 1, 8, 15, 22 in every 28-day cycle for a maximum of 6 cycles. Daratumumab will be administered weekly for the first 8 weeks (2 cycles), then every 2 weeks for 4 cycles (cycles 3-6), and then every 4 weeks until progression of disease or subsequent therapy for a maximum of 2 years.