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Daratumumab in Treating Participants With Relapsed Multiple Myeloma After Stem Cell Transplant

Primary Purpose

Recurrent Plasma Cell Myeloma

Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Daratumumab
Sponsored by
M.D. Anderson Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Recurrent Plasma Cell Myeloma

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patient must have had relapsed disease prior to transplant, or undergone previous autologous stem cell transplant (ASCT), followed by relapse and at least a partial response to salvage therapy
  • Eligible patients will be enrolled in the protocol no less than 60 days and must be initiated no longer than 180 days post autologous stem cell transplantation (ASCT)
  • Patients must have an Eastern Cooperative Oncology Group (ECOG) status of 0 to 2
  • Platelet count >= 50,000/mm^3 (within 5 days before the first dose of the study drug)
  • Absolute neutrophil count >= 1000/ mm^3 (no growth factors within 5 days) (within 5 days before the first dose of the study drug)
  • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3 x upper limit of normal (ULN) (within 5 days before the first dose of the study drug)
  • Creatinine =< 2.5 mg/dL (within 5 days before the first dose of the study drug)
  • Recovered (i.e., =< grade 2 toxicity) from the reversible effects of autologous stem cell transplant (within 5 days before the first dose of the study drug)
  • Voluntary written informed consent before performance of any study-related procedure not part of normal medical care must be obtained, with the understanding that consent may be withdrawn by the subject at any time without any prejudice to future medical care
  • Left ventricular ejection fraction >/=40% at the patient's last recorded echocardiogram (this could refer to pretransplant ECHO. ECHO may be repeated if the PI considers a repeat ECHO). No uncontrolled arrythmias.

Exclusion Criteria:

  • Major surgery within 14 days before the first dose of study drug
  • Radiotherapy within 14 days before enrollment
  • Non-secretory disease, plasma cell leukemia, or previous allogeneic transplant
  • Known active central nervous system involvement
  • Inability or unwillingness to comply with the drug administration requirements
  • Female subject is pregnant or lactating
  • Seropositive for human immunodeficiency virus (HIV)
  • Seropositive for hepatitis B (defined by a positive test for hepatitis B surface antigen [HBsAg]). Subjects with resolved infection (ie, subjects 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. EXCEPTION: Subjects with serologic findings suggestive of HBV vaccination (anti-HBs positivity as the only serologic marker) AND a known history of prior HBV vaccination, do not need to be tested for HBV DNA by PCR
  • 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)
  • Patients with a known history of asthma or chronic obstructive pulmonary disease with a forced expiratory volume in 1 second (FEV1) <50% of predicted normal.
  • Patients with moderate or severe persistent asthma within the past 2 years and currently uncontrolled asthma of any classification.
  • Infection requiring IV systemic antibiotic therapy within 7 days before cycle 1 day 1 (C1D1) of therapy
  • Known allergy to any of the study medications, their analogues, or excipients in the various formulations
  • Failure to have fully recovered (i.e., =< grade 2 toxicity) from the effects of prior chemotherapy regardless of the interval since last treatment
  • Patient is refractory or resistant to daratumumab and pomalidomide
  • Co-morbid systemic illnesses or other severe concurrent disease that, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
  • If patient was unable to tolerate daratumumab or pomalidomide in the past

Sites / Locations

  • M D Anderson Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (daratumumab)

Arm Description

Beginning 60-120 days after transplant, participants receive daratumumab IV over 4-8 hours on days 1, 8, 15 and 22 of courses 1 and 2 and days 1 and 15 of courses 3-6, then on day 1 of subsequent courses. Courses repeat every 28 days for 3 years in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Complete remission rate (CRR) defined as achieving a negative immunofixation of serum and urine, disappearance of any soft tissue plasmacytomas, and < 5% plasma cells in bone marrow
The student t-test/Wilcoxon rank test and analysis of variance (ANOVA)/Kruskal-Wallis test, or chi-squared test/Fisher's exact test will be used to test associations between the response and the prognostic factors. Complete remission will be estimated along with a 95% credible interval.
Progression-free survival (PFS)
Will be summarized descriptively using the Kaplan-Meier method (including the median, 95% confidence interval, and survival curve). The proportion of patients alive and without disease progression at 6 months of daratumumab maintenance therapy will be summarized. The estimate will be accompanied by a two-sided exact 95% binomial confidence interval. In addition, a Cox regression analysis may be performed if demographic and clinical factors potentially affecting PFS are identified.

Secondary Outcome Measures

Full Information

First Posted
July 16, 2018
Last Updated
October 5, 2023
Sponsor
M.D. Anderson Cancer Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT03622775
Brief Title
Daratumumab in Treating Participants With Relapsed Multiple Myeloma After Stem Cell Transplant
Official Title
Daratumumab-Based Maintenance in Patients With Relapsed Multiple Myeloma After Salvage Autologous Stem Cell Transplantation
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
April 11, 2019 (Actual)
Primary Completion Date
September 1, 2024 (Anticipated)
Study Completion Date
September 1, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
M.D. Anderson Cancer Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This phase II trial studies whether daratumumab and hyaluronidase-fihj and pomalidomide work in treating patients with multiple myeloma that has come back (relapsed) after stem cell transplant. Daratumumab and hyaluronidase-fihj is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. Chemotherapy drugs, such as pomalidomide, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving daratumumab and hyaluronidase-fihj with pomalidomide may help control the disease in patients with relapsed multiple myeloma.
Detailed Description
PRIMARY OBJECTIVES: I. To estimate the complete remission rate (CRR) by the International Myeloma Working Group (IMWG) criteria within 9 months post salvage auto-transplant with daratumumab maintenance therapy starting approximately 3 months post salvage auto-transplant in patients with relapsed myeloma. SECONDARY OBJECTIVES: I. To evaluate progression-free survival (PFS). EXPLORATORY OBJECTIVES: I. To discover the impact of daratumumab on graft function and immune reconstitution. OUTLINE: Beginning 60-180 days after transplant, patients daratumumab and hyaluronidase-fihj subcutaneously (SC) on days 1, 8, 15, and 22 of cycles 1 and 2, on days 1 and 15 of cycles 3-6, and then on day 1 of subsequent cycles. Patients also receive pomalidomide orally (PO) once daily (QD) on days 1-21. Cycles repeat every 28 days for up to 3 years in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 30 and 90 days, then every 12 weeks thereafter.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent Plasma Cell Myeloma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
13 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (daratumumab)
Arm Type
Experimental
Arm Description
Beginning 60-120 days after transplant, participants receive daratumumab IV over 4-8 hours on days 1, 8, 15 and 22 of courses 1 and 2 and days 1 and 15 of courses 3-6, then on day 1 of subsequent courses. Courses repeat every 28 days for 3 years in the absence of disease progression or unacceptable toxicity.
Intervention Type
Biological
Intervention Name(s)
Daratumumab
Other Intervention Name(s)
Anti-CD38 Monoclonal Antibody, Darzalex, HuMax-CD38, JNJ-54767414
Intervention Description
Given IV
Primary Outcome Measure Information:
Title
Complete remission rate (CRR) defined as achieving a negative immunofixation of serum and urine, disappearance of any soft tissue plasmacytomas, and < 5% plasma cells in bone marrow
Description
The student t-test/Wilcoxon rank test and analysis of variance (ANOVA)/Kruskal-Wallis test, or chi-squared test/Fisher's exact test will be used to test associations between the response and the prognostic factors. Complete remission will be estimated along with a 95% credible interval.
Time Frame
At course 6 of therapy
Title
Progression-free survival (PFS)
Description
Will be summarized descriptively using the Kaplan-Meier method (including the median, 95% confidence interval, and survival curve). The proportion of patients alive and without disease progression at 6 months of daratumumab maintenance therapy will be summarized. The estimate will be accompanied by a two-sided exact 95% binomial confidence interval. In addition, a Cox regression analysis may be performed if demographic and clinical factors potentially affecting PFS are identified.
Time Frame
From the date of initiation of maintenance therapy assessed up to 2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient must have had relapsed disease prior to transplant, or undergone previous autologous stem cell transplant (ASCT), followed by relapse and at least a partial response to salvage therapy Eligible patients will be enrolled in the protocol no less than 60 days and must be initiated no longer than 180 days post autologous stem cell transplantation (ASCT) Patients must have an Eastern Cooperative Oncology Group (ECOG) status of 0 to 2 Platelet count >= 50,000/mm^3 (within 5 days before the first dose of the study drug) Absolute neutrophil count >= 1000/ mm^3 (no growth factors within 5 days) (within 5 days before the first dose of the study drug) Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3 x upper limit of normal (ULN) (within 5 days before the first dose of the study drug) Creatinine =< 2.5 mg/dL (within 5 days before the first dose of the study drug) Recovered (i.e., =< grade 2 toxicity) from the reversible effects of autologous stem cell transplant (within 5 days before the first dose of the study drug) Voluntary written informed consent before performance of any study-related procedure not part of normal medical care must be obtained, with the understanding that consent may be withdrawn by the subject at any time without any prejudice to future medical care Left ventricular ejection fraction >/=40% at the patient's last recorded echocardiogram (this could refer to pretransplant ECHO. ECHO may be repeated if the PI considers a repeat ECHO). No uncontrolled arrythmias. Exclusion Criteria: Major surgery within 14 days before the first dose of study drug Radiotherapy within 14 days before enrollment Non-secretory disease, plasma cell leukemia, or previous allogeneic transplant Known active central nervous system involvement Inability or unwillingness to comply with the drug administration requirements Female subject is pregnant or lactating Seropositive for human immunodeficiency virus (HIV) Seropositive for hepatitis B (defined by a positive test for hepatitis B surface antigen [HBsAg]). Subjects with resolved infection (ie, subjects 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. EXCEPTION: Subjects with serologic findings suggestive of HBV vaccination (anti-HBs positivity as the only serologic marker) AND a known history of prior HBV vaccination, do not need to be tested for HBV DNA by PCR 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) Patients with a known history of asthma or chronic obstructive pulmonary disease with a forced expiratory volume in 1 second (FEV1) <50% of predicted normal. Patients with moderate or severe persistent asthma within the past 2 years and currently uncontrolled asthma of any classification. Infection requiring IV systemic antibiotic therapy within 7 days before cycle 1 day 1 (C1D1) of therapy Known allergy to any of the study medications, their analogues, or excipients in the various formulations Failure to have fully recovered (i.e., =< grade 2 toxicity) from the effects of prior chemotherapy regardless of the interval since last treatment Patient is refractory or resistant to daratumumab and pomalidomide Co-morbid systemic illnesses or other severe concurrent disease that, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens If patient was unable to tolerate daratumumab or pomalidomide in the past
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Muzaffar H Qazilbash
Organizational Affiliation
M.D. Anderson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
M D Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States

12. IPD Sharing Statement

Links:
URL
http://www.mdanderson.org
Description
MD Anderson Cancer Center

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Daratumumab in Treating Participants With Relapsed Multiple Myeloma After Stem Cell Transplant

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