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Study to Assess for Measurable Residual Disease (MRD) in Multiple Myeloma Patients

Primary Purpose

Multiple Myeloma

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Screening Phase
Discontinuation Phase
Sponsored by
University of Chicago
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Multiple Myeloma

Eligibility Criteria

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

Inclusion Criteria:

  • Males and females > 18 years of age
  • ECOG performance status less than or equal to 2 (Karnofsky > 60%)
  • Patients with a diagnosis of multiple myeloma who have undergone initial treatment, with or without autologous stem cell transplant, and currently treated with single-agent maintenance therapy (lenalidomide, pomalidomide, bortezomib, daratumumab, or ixazomib) for a duration of at least 1 year. The 1 year duration can include time spent receiving at least 8 cycles of doublet or triplet induction regimens OR multi-agent post-transplant maintenance prior to conversion to single agent maintenance therapy.
  • Patients must have had their most recent bone marrow testing within the last 2 years and negative for MRD by flow cytometry (with a sensitivity of at least 10-5) or by NGS with a sensitivity of at least 10-5.
  • Patients must have achieved a CR (CR) by IMWG consensus response criteria. For patients with a persistent low level paraprotein ('M-spike'), mass spectrometry may be used to determine if the paraprotein is significant or not. Results of mass spectrometry may be used to supercede results of serum protein electrophoresis.
  • Patients must have a most recent PET/CT within the last 1.5 years without evidence of myeloma disease.
  • Must have baseline bone marrow sample that can be used for clonality identification for NGS and mass spectrometry if not already performed.
  • Willing and able to undergo a bone marrow biopsy and aspiration.
  • Ability to understand and the willingness to sign a written informed consent document.
  • Females of childbearing potential (FCBP) must agree to use 2 reliable forms of contraception simultaneously or to practice complete abstinence from heterosexual intercourse during the following time periods related to this study: 1) if continued on lenalidomide as part of standard of care and 2) for at least 28 days after discontinuation of lenalidomide
  • All participants in the US must have already been consented to and registered into the mandatory Revlimid REMS® program and be willing and able to comply with the requirements of Revlimid REMS®.
  • Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the intervention are eligible for this trial.

Exclusion Criteria:

  • Progressive disease as determined per IMWG consensus response criteria.
  • Have not met the criteria for CR by IMWG consensus response criteria.
  • MRD-positive disease by flow cytometry, NGS (1 in 1,000,000 cells), or PCR.
  • Concomitant hematologic malignancy.
  • Known or suspected amyloidosis.
  • Unwilling to undergo a bone marrow biopsy.
  • Unwilling to discontinue maintenance therapy.
  • Any clinically significant medical disease or condition that, in the Treating Investigator's opinion, may interfere with protocol adherence or a subject's ability to give informed consent.

Sites / Locations

  • University Of Chicago Medicine Comprehensive Cancer CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

MRD2STOP ARM

Arm Description

Outcomes

Primary Outcome Measures

Determine the MRD conversion rate
Determine the MRD conversion rate from 1 in 1,000,000 cells and 1 in 10,000,000 cells negative to positive after discontinuation of maintenance therapy.
Median Progression Free Survival rate
Assess progression free survival of double MRD-negative (1 in 1,000,000 cells negative/1 in 10,000,000 cells negative) patients and of the 1 in 1,000,000 cells negative/1 in 10,000,000 cells positive patients who have discontinued maintenance therapy
Median overall survival rate
Assess overall survival of double MRD-negative (1 in 1,000,000 cells negative/1 in 10,000,000 cells negative) patients and of the 1 in 1,000,000 cells negative/1 in 10,000,000 cells positive patients who have discontinued maintenance therapy.

Secondary Outcome Measures

NGS-based Minimal Residual Disease testing determined by the ClonoSeq assay
Determine the feasibility of performing NGS-based MRD testing of bone marrow aspirate samples that have undergone CD138+ immunomagnetic cell separation (i.e. 1 in 10,000,000 cells depth) will be determined by the rate of achieving 20 million cells in raw aspirate sample with a sufficient DNA for analysis as determined by the ClonoSeq assay.
Determine the difference in MRD detection by NGS
Determine the difference in MRD detection by NGS in the bone marrow at depths of 1 in 1,000,000 cells and 1 in 10,000,000 cells.

Full Information

First Posted
September 19, 2019
Last Updated
April 26, 2023
Sponsor
University of Chicago
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1. Study Identification

Unique Protocol Identification Number
NCT04108624
Brief Title
Study to Assess for Measurable Residual Disease (MRD) in Multiple Myeloma Patients
Official Title
A Multimodality Approach to Minimal Residual Disease Detection to Guide Post-Transplant Maintenance Therapy in Multiple Myeloma (MRD2STOP)
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 30, 2019 (Actual)
Primary Completion Date
December 1, 2023 (Anticipated)
Study Completion Date
December 1, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Chicago

4. Oversight

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

5. Study Description

Brief Summary
This study is to assess for Measurable Residual Disease (MRD) in multiple myeloma at a deeper level than what is currently available by combining novel imaging and laboratory techniques, determine if patients who are MRD-negative by these multiple modalities can safely and effectively discontinue post-transplant maintenance therapy, and determine if liquid biopsies is a more accurate and/or less invasive sampling technique for multiple myeloma. The purpose of this research is to determine if patients who are MRD-negative by multiple modalities ("multimodality MRD-negative") can safely and effectively discontinue post-transplant maintenance therapy (single agent lenalidomide, pomalidomide, bortezomib, or ixazomib) after receiving at least one year of maintenance therapy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma

7. Study Design

Primary Purpose
Other
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
56 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
MRD2STOP ARM
Arm Type
Experimental
Intervention Type
Other
Intervention Name(s)
Screening Phase
Intervention Description
This will identify subjects who are MRD (minimal residual disease) negative and eligible for the discontinuation phase.
Intervention Type
Device
Intervention Name(s)
Discontinuation Phase
Intervention Description
Patients will undergo discontinuation of their maintenance therapy if they are MRD negative by PET/CT (Positron Emission Tomography/Computed Tomography), flow cytometry and next generation sequencing
Primary Outcome Measure Information:
Title
Determine the MRD conversion rate
Description
Determine the MRD conversion rate from 1 in 1,000,000 cells and 1 in 10,000,000 cells negative to positive after discontinuation of maintenance therapy.
Time Frame
3 years
Title
Median Progression Free Survival rate
Description
Assess progression free survival of double MRD-negative (1 in 1,000,000 cells negative/1 in 10,000,000 cells negative) patients and of the 1 in 1,000,000 cells negative/1 in 10,000,000 cells positive patients who have discontinued maintenance therapy
Time Frame
3 years
Title
Median overall survival rate
Description
Assess overall survival of double MRD-negative (1 in 1,000,000 cells negative/1 in 10,000,000 cells negative) patients and of the 1 in 1,000,000 cells negative/1 in 10,000,000 cells positive patients who have discontinued maintenance therapy.
Time Frame
3 years
Secondary Outcome Measure Information:
Title
NGS-based Minimal Residual Disease testing determined by the ClonoSeq assay
Description
Determine the feasibility of performing NGS-based MRD testing of bone marrow aspirate samples that have undergone CD138+ immunomagnetic cell separation (i.e. 1 in 10,000,000 cells depth) will be determined by the rate of achieving 20 million cells in raw aspirate sample with a sufficient DNA for analysis as determined by the ClonoSeq assay.
Time Frame
3 years
Title
Determine the difference in MRD detection by NGS
Description
Determine the difference in MRD detection by NGS in the bone marrow at depths of 1 in 1,000,000 cells and 1 in 10,000,000 cells.
Time Frame
3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males and females > 18 years of age ECOG performance status less than or equal to 2 (Karnofsky > 60%) Patients with a diagnosis of multiple myeloma who have undergone initial treatment, with or without autologous stem cell transplant, and currently treated with single-agent maintenance therapy (lenalidomide, pomalidomide, bortezomib, daratumumab, or ixazomib) for a duration of at least 1 year. The 1 year duration can include time spent receiving at least 8 cycles of doublet or triplet induction regimens OR multi-agent post-transplant maintenance prior to conversion to single agent maintenance therapy. Patients must have had their most recent bone marrow testing within the last 2 years and negative for MRD by flow cytometry (with a sensitivity of at least 10-5) or by NGS with a sensitivity of at least 10-5. Patients must have achieved a CR (CR) by IMWG consensus response criteria. For patients with a persistent low level paraprotein ('M-spike'), mass spectrometry may be used to determine if the paraprotein is significant or not. Results of mass spectrometry may be used to supercede results of serum protein electrophoresis. Patients must have a most recent PET/CT within the last 1.5 years without evidence of myeloma disease. Must have baseline bone marrow sample that can be used for clonality identification for NGS and mass spectrometry if not already performed. Willing and able to undergo a bone marrow biopsy and aspiration. Ability to understand and the willingness to sign a written informed consent document. Females of childbearing potential (FCBP) must agree to use 2 reliable forms of contraception simultaneously or to practice complete abstinence from heterosexual intercourse during the following time periods related to this study: 1) if continued on lenalidomide as part of standard of care and 2) for at least 28 days after discontinuation of lenalidomide All participants in the US must have already been consented to and registered into the mandatory Revlimid REMS® program and be willing and able to comply with the requirements of Revlimid REMS®. Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the intervention are eligible for this trial. Exclusion Criteria: Progressive disease as determined per IMWG consensus response criteria. Have not met the criteria for CR by IMWG consensus response criteria. MRD-positive disease by flow cytometry, NGS (1 in 1,000,000 cells), or PCR. Concomitant hematologic malignancy. Known or suspected amyloidosis. Unwilling to undergo a bone marrow biopsy. Unwilling to discontinue maintenance therapy. Any clinically significant medical disease or condition that, in the Treating Investigator's opinion, may interfere with protocol adherence or a subject's ability to give informed consent.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Andrzej Jakubowiak, MD
Phone
773-834-1592
Email
ajakubowiak@medicine.bsd.uchicago.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Andrzej Jakubowiak, MD
Organizational Affiliation
University of Chicago
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Of Chicago Medicine Comprehensive Cancer Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Amanda McIver
Phone
773-834-5884
Email
amciver@medicine.bsd.uchicago.edu
First Name & Middle Initial & Last Name & Degree
Andrzej Jakubowiak, MD

12. IPD Sharing Statement

Learn more about this trial

Study to Assess for Measurable Residual Disease (MRD) in Multiple Myeloma Patients

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