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Efficacy and Safety Study of bb2121 in Subjects With Relapsed and Refractory Multiple Myeloma (KarMMa)

Primary Purpose

Multiple Myeloma

Status
Active
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
bb2121
Sponsored by
Celgene
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Myeloma focused on measuring Multiple Myeloma, Efficacy and Safety, BB2121, CAR T Cell, BCMA, Relapsed and Refractory

Eligibility Criteria

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

Inclusion Criteria:

Eligibility is determined prior to leukapheresis. Subjects must satisfy the following criteria to be enrolled in the study:

  1. Subject is ≥ 18 years of age at the time of signing the informed consent form (ICF).
  2. Documented diagnosis of multiple myeloma

    • Must have received at least 3 prior MM treatment regimens. Note: induction with or without hematopoietic stem cell transplant and with or without maintenance therapy is considered a single regimen.
    • Must have undergone at least 2 consecutive cycles of treatment for each regimen, unless PD was the best response to the regimen.
    • Must have received a proteasome inhibitor, an immunomodulatory agent and an anti-CD38 antibody.
    • Must be refractory to the last treatment regimen.
  3. Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1.
  4. Subjects must have measurable disease, including at least one of the criteria below:

    • Serum M-protein greater or equal to 1.0 g/dL
    • Urine M-protein greater or equal to 200 mg/24 h
    • Serum free light chain (FLC) assay: involved FLC level greater or equal to 10 mg/dL (100 mg/L) provided serum FLC ratio is abnormal
  5. Recovery to Grade 1 or baseline of any non-hematologic toxicities due to prior treatments, excluding alopecia and Grade 2 neuropathy.

Exclusion Criteria:

The presence of any of the following will exclude a subject from enrollment:

  1. Subjects with known central nervous system involvement with myeloma.
  2. History or presence of clinically relevant central nervous system (CNS) pathology.
  3. Subjects with active or history of plasma cell leukemia.
  4. Subjects with solitary plasmacytomas or non-secretory myeloma without other evidence of measurable disease
  5. Inadequate organ function
  6. Ongoing treatment with chronic immunosuppressants
  7. Previous history of an allogeneic hematopoietic stem cell transplantation or treatment with any gene therapy-based therapeutic for cancer or investigational cellular therapy for cancer or BCMA targeted therapy
  8. Evidence of human immunodeficiency virus (HIV) infection.
  9. Seropositive for and with evidence of active viral infection with hepatitis B virus (HBV)
  10. Seropositive for and with evidence of active viral infection with hepatitis B virus (HBV) and Hepatitis C virus (HCV)
  11. Subjects with a history of class III or IV congestive heart failure (CHF) or severe non-ischemic cardiomyopathy, history of stroke, unstable angina, myocardial infarction, or ventricular arrhythmia within the previous 6 months.
  12. Subjects with second malignancies in addition to myeloma if the second malignancy has required therapy in the last 3 years or is not in complete remission
  13. Pregnant or lactating women.
  14. Subject with known hypersensitivity to any component of bb2121 productThe presence of any of the following will exclude a subject from enrollment:

1. Subjects with known central nervous system involvement with myeloma. 2. History or presence of clinically relevant central nervous system (CNS) pathology.

3. Subjects with active or history of plasma cell leukemia. 4. Subjects with solitary plasmacytomas or non-secretory myeloma without other evidence of measurable disease 5. Inadequate organ function 6. Ongoing treatment with chronic immunosuppressants 7. Previous history of an allogeneic hematopoietic stem cell transplantation or treatment with any gene therapy-based therapeutic for cancer or investigational cellular therapy for cancer or BCMA targeted therapy 8. Evidence of human immunodeficiency virus (HIV) infection. 9. Seropositive for and with evidence of active viral infection with hepatitis B virus (HBV) and Hepatitis C virus (HCV) 10. Subjects with a history of class III or IV congestive heart failure (CHF) or severe non-ischemic cardiomyopathy, history of stroke, unstable angina, myocardial infarction, or ventricular arrhythmia within the previous 6 months. 11. Subjects with second malignancies in addition to myeloma if the second malignancy has required therapy in the last 3 years or is not in complete remission 12. Pregnant or lactating women. 13 Subject with known hypersensitivity to any component of bb2121 product, cyclophosphamide, fludarabine, or tocilizumab.

Sites / Locations

  • Local Institution - 108
  • Local Institution - 103
  • Local Institution - 107
  • Local Institution - 106
  • Local Institution - 105
  • Local Institution - 102
  • Local Institution - 109
  • Local Institution - 101
  • Local Institution - 104
  • Local Institution - 201
  • Local Institution - 301
  • Local Institution - 402
  • Local Institution - 401
  • Local Institution - 502
  • Local Institution - 503
  • Local Institution - 501
  • Local Institution - 602
  • Local Institution - 601
  • Local Institution - 803
  • Local Institution - 801
  • Local Institution - 802
  • Local Institution - 804
  • Local Institution - 702
  • Local Institution - 701

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Administration of bb2121

Arm Description

bb2121 autologous CAR T cells will be infused at a dose ranging from 15 - 450 x 10^6 CAR+ T cells after receiving lymphodepleting chemotherapy.

Outcomes

Primary Outcome Measures

Overall Response Rate (ORR)
Percentage of subjects who achieved partial response (PR) or better according to IMWG Uniform Response Criteria for Multiple Myeloma.

Secondary Outcome Measures

Complete Response (CR) Rate
Percentage of subjects who achieved CR or better according to IMWG Uniform Response Criteria for Multiple Myeloma
Time to Response
Time from first bb2121 infusion to first documentation of response
Duration of Response
Time from first response to disease progression or death from any cause
Progression-free Survival (PFS)
Time from first bb2121 infusion to first documentation of progressive disease (PD), or death due to any cause, whichever occurs first
Time to Progression (TTP)
Time from first bb2121 infusion to first documentation of PD
Overall Survival (OS)
Time from first bb2121 infusion to time of death due to any cause
Adverse Events (AEs)
Number of participants with adverse events (AEs), severity of adverse events, adverse events of special interest (AESI), and serious adverse events (SAEs)
Pharmacokinetics - Cmax
The maximum transgene level at Tmax
Pharmacokinetics - Tmax
Time to peak transgene level
Pharmacokinetics - AUC
Area under the curve of the transgene level
Immunogenicity
Development of an anti-CAR antibody response
Minimal Residual Disease (MRD)
Proportion of MRD evaluable subjects that are MRD negative
Subject-reported outcomes as measured by European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire (EORTC-QLQ-C30)
Questionnaire will be used as a measure of health-related quality of life
Subject-reported outcomes as measured by EuroQoL Group EQ-5D-5L Health Questionnaire
Is a standardized measure of health status developed by the EuroQol Group in order to provide a simple, generic measure of health for clinical and economic appraisal
Subject-reported outcomes as measured by EORTC-QLQ-MY20
Is a 20-item myeloma module intended for use among patients varying in disease stage and treatment modality

Full Information

First Posted
November 29, 2017
Last Updated
September 27, 2023
Sponsor
Celgene
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1. Study Identification

Unique Protocol Identification Number
NCT03361748
Brief Title
Efficacy and Safety Study of bb2121 in Subjects With Relapsed and Refractory Multiple Myeloma
Acronym
KarMMa
Official Title
A Phase 2, Multicenter Study to Determine the Efficacy and Safety of bb2121 in Subjects With Relapsed and Refractory Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
December 13, 2017 (Actual)
Primary Completion Date
November 28, 2024 (Anticipated)
Study Completion Date
November 28, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Celgene

4. Oversight

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

5. Study Description

Brief Summary
This is an open label, single-arm, multicenter, Phase 2 study to evaluate the efficacy and safety of bb2121 in subjects with relapsed and refractory multiple myeloma. A leukapheresis procedure will be performed to manufacture bb2121 chimeric antigen receptor (CAR) modified T cells. Prior to bb2121 infusion subjects will receive lymphodepleting therapy with fludarabine and cyclophosphamide.
Detailed Description
Anti-myeloma bridging treatment is allowed for disease control while bb2121 is being manufactured.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma
Keywords
Multiple Myeloma, Efficacy and Safety, BB2121, CAR T Cell, BCMA, Relapsed and Refractory

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Administration of bb2121
Arm Type
Experimental
Arm Description
bb2121 autologous CAR T cells will be infused at a dose ranging from 15 - 450 x 10^6 CAR+ T cells after receiving lymphodepleting chemotherapy.
Intervention Type
Biological
Intervention Name(s)
bb2121
Intervention Description
: bb2121 consists of autologous T lymphocytes transduced with an anti-BCMA02 CAR lentiviral vector to express a chimeric antigen receptor targeting the human B cell maturation antigen (anti-BCMA CAR).
Primary Outcome Measure Information:
Title
Overall Response Rate (ORR)
Description
Percentage of subjects who achieved partial response (PR) or better according to IMWG Uniform Response Criteria for Multiple Myeloma.
Time Frame
Minimum of 24 months post-bb2121 infusion
Secondary Outcome Measure Information:
Title
Complete Response (CR) Rate
Description
Percentage of subjects who achieved CR or better according to IMWG Uniform Response Criteria for Multiple Myeloma
Time Frame
Minimum of 24 months post-bb2121 infusion
Title
Time to Response
Description
Time from first bb2121 infusion to first documentation of response
Time Frame
Minimum of 24 months post-bb2121 infusion
Title
Duration of Response
Description
Time from first response to disease progression or death from any cause
Time Frame
Minimum of 24 months post-bb2121 infusion
Title
Progression-free Survival (PFS)
Description
Time from first bb2121 infusion to first documentation of progressive disease (PD), or death due to any cause, whichever occurs first
Time Frame
Minimum of 24 months post-bb2121 infusion
Title
Time to Progression (TTP)
Description
Time from first bb2121 infusion to first documentation of PD
Time Frame
Minimum of 24 months post-bb2121 infusion
Title
Overall Survival (OS)
Description
Time from first bb2121 infusion to time of death due to any cause
Time Frame
Minimum of 24 months post-bb2121 infusion
Title
Adverse Events (AEs)
Description
Number of participants with adverse events (AEs), severity of adverse events, adverse events of special interest (AESI), and serious adverse events (SAEs)
Time Frame
Minimum of 24 months post-bb2121 infusion
Title
Pharmacokinetics - Cmax
Description
The maximum transgene level at Tmax
Time Frame
Minimum of 24 months post-bb2121 infusion
Title
Pharmacokinetics - Tmax
Description
Time to peak transgene level
Time Frame
Minimum of 24 months post-bb2121 infusion
Title
Pharmacokinetics - AUC
Description
Area under the curve of the transgene level
Time Frame
Minimum of 24 months post-bb2121 infusion
Title
Immunogenicity
Description
Development of an anti-CAR antibody response
Time Frame
Minimum of 24 months post-bb2121 infusion
Title
Minimal Residual Disease (MRD)
Description
Proportion of MRD evaluable subjects that are MRD negative
Time Frame
Minimum of 24 months post-bb2121 infusion
Title
Subject-reported outcomes as measured by European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire (EORTC-QLQ-C30)
Description
Questionnaire will be used as a measure of health-related quality of life
Time Frame
Minimum of 24 months post-bb2121 infusion
Title
Subject-reported outcomes as measured by EuroQoL Group EQ-5D-5L Health Questionnaire
Description
Is a standardized measure of health status developed by the EuroQol Group in order to provide a simple, generic measure of health for clinical and economic appraisal
Time Frame
: Minimum of 24 months post-bb2121 infusion
Title
Subject-reported outcomes as measured by EORTC-QLQ-MY20
Description
Is a 20-item myeloma module intended for use among patients varying in disease stage and treatment modality
Time Frame
Minimum of 24 months post-bb2121 infusion

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Eligibility is determined prior to leukapheresis. Subjects must satisfy the following criteria to be enrolled in the study: Subject is ≥ 18 years of age at the time of signing the informed consent form (ICF). Documented diagnosis of multiple myeloma Must have received at least 3 prior MM treatment regimens. Note: induction with or without hematopoietic stem cell transplant and with or without maintenance therapy is considered a single regimen. Must have undergone at least 2 consecutive cycles of treatment for each regimen, unless PD was the best response to the regimen. Must have received a proteasome inhibitor, an immunomodulatory agent and an anti-CD38 antibody. Must be refractory to the last treatment regimen. Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1. Subjects must have measurable disease, including at least one of the criteria below: Serum M-protein greater or equal to 1.0 g/dL Urine M-protein greater or equal to 200 mg/24 h Serum free light chain (FLC) assay: involved FLC level greater or equal to 10 mg/dL (100 mg/L) provided serum FLC ratio is abnormal Recovery to Grade 1 or baseline of any non-hematologic toxicities due to prior treatments, excluding alopecia and Grade 2 neuropathy. Exclusion Criteria: The presence of any of the following will exclude a subject from enrollment: Subjects with known central nervous system involvement with myeloma. History or presence of clinically relevant central nervous system (CNS) pathology. Subjects with active or history of plasma cell leukemia. Subjects with solitary plasmacytomas or non-secretory myeloma without other evidence of measurable disease Inadequate organ function Ongoing treatment with chronic immunosuppressants Previous history of an allogeneic hematopoietic stem cell transplantation or treatment with any gene therapy-based therapeutic for cancer or investigational cellular therapy for cancer or BCMA targeted therapy Evidence of human immunodeficiency virus (HIV) infection. Seropositive for and with evidence of active viral infection with hepatitis B virus (HBV) Seropositive for and with evidence of active viral infection with hepatitis B virus (HBV) and Hepatitis C virus (HCV) Subjects with a history of class III or IV congestive heart failure (CHF) or severe non-ischemic cardiomyopathy, history of stroke, unstable angina, myocardial infarction, or ventricular arrhythmia within the previous 6 months. Subjects with second malignancies in addition to myeloma if the second malignancy has required therapy in the last 3 years or is not in complete remission Pregnant or lactating women. Subject with known hypersensitivity to any component of bb2121 productThe presence of any of the following will exclude a subject from enrollment: 1. Subjects with known central nervous system involvement with myeloma. 2. History or presence of clinically relevant central nervous system (CNS) pathology. 3. Subjects with active or history of plasma cell leukemia. 4. Subjects with solitary plasmacytomas or non-secretory myeloma without other evidence of measurable disease 5. Inadequate organ function 6. Ongoing treatment with chronic immunosuppressants 7. Previous history of an allogeneic hematopoietic stem cell transplantation or treatment with any gene therapy-based therapeutic for cancer or investigational cellular therapy for cancer or BCMA targeted therapy 8. Evidence of human immunodeficiency virus (HIV) infection. 9. Seropositive for and with evidence of active viral infection with hepatitis B virus (HBV) and Hepatitis C virus (HCV) 10. Subjects with a history of class III or IV congestive heart failure (CHF) or severe non-ischemic cardiomyopathy, history of stroke, unstable angina, myocardial infarction, or ventricular arrhythmia within the previous 6 months. 11. Subjects with second malignancies in addition to myeloma if the second malignancy has required therapy in the last 3 years or is not in complete remission 12. Pregnant or lactating women. 13 Subject with known hypersensitivity to any component of bb2121 product, cyclophosphamide, fludarabine, or tocilizumab.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Bristol-Myers Squibb
Organizational Affiliation
Bristol-Myers Squibb
Official's Role
Study Director
Facility Information:
Facility Name
Local Institution - 108
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Facility Name
Local Institution - 103
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Facility Name
Local Institution - 107
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Local Institution - 106
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Facility Name
Local Institution - 105
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
Local Institution - 102
City
Hackensack
State/Province
New Jersey
ZIP/Postal Code
07601
Country
United States
Facility Name
Local Institution - 109
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Facility Name
Local Institution - 101
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37203
Country
United States
Facility Name
Local Institution - 104
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390
Country
United States
Facility Name
Local Institution - 201
City
Leuven
ZIP/Postal Code
B-3000
Country
Belgium
Facility Name
Local Institution - 301
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2M9
Country
Canada
Facility Name
Local Institution - 402
City
Lille
ZIP/Postal Code
59037
Country
France
Facility Name
Local Institution - 401
City
Nantes
ZIP/Postal Code
44093
Country
France
Facility Name
Local Institution - 502
City
Heidelberg
ZIP/Postal Code
69120
Country
Germany
Facility Name
Local Institution - 503
City
Tübingen
ZIP/Postal Code
72076
Country
Germany
Facility Name
Local Institution - 501
City
Würzburg
ZIP/Postal Code
97080
Country
Germany
Facility Name
Local Institution - 602
City
Bergamo
ZIP/Postal Code
24128
Country
Italy
Facility Name
Local Institution - 601
City
Bologna
ZIP/Postal Code
40138
Country
Italy
Facility Name
Local Institution - 803
City
Isehara City, Kanagawa
ZIP/Postal Code
259-1193
Country
Japan
Facility Name
Local Institution - 801
City
Shibuya-ku
ZIP/Postal Code
150-8935
Country
Japan
Facility Name
Local Institution - 802
City
Shimotsuke
ZIP/Postal Code
329-0498
Country
Japan
Facility Name
Local Institution - 804
City
Shinjuku City
ZIP/Postal Code
162-8666
Country
Japan
Facility Name
Local Institution - 702
City
Badalona (Barcelona)
ZIP/Postal Code
08916
Country
Spain
Facility Name
Local Institution - 701
City
Pamplona
ZIP/Postal Code
31008
Country
Spain

12. IPD Sharing Statement

Citations:
PubMed Identifier
31042825
Citation
Raje N, Berdeja J, Lin Y, Siegel D, Jagannath S, Madduri D, Liedtke M, Rosenblatt J, Maus MV, Turka A, Lam LP, Morgan RA, Friedman K, Massaro M, Wang J, Russotti G, Yang Z, Campbell T, Hege K, Petrocca F, Quigley MT, Munshi N, Kochenderfer JN. Anti-BCMA CAR T-Cell Therapy bb2121 in Relapsed or Refractory Multiple Myeloma. N Engl J Med. 2019 May 2;380(18):1726-1737. doi: 10.1056/NEJMoa1817226.
Results Reference
background
PubMed Identifier
33626253
Citation
Munshi NC, Anderson LD Jr, Shah N, Madduri D, Berdeja J, Lonial S, Raje N, Lin Y, Siegel D, Oriol A, Moreau P, Yakoub-Agha I, Delforge M, Cavo M, Einsele H, Goldschmidt H, Weisel K, Rambaldi A, Reece D, Petrocca F, Massaro M, Connarn JN, Kaiser S, Patel P, Huang L, Campbell TB, Hege K, San-Miguel J. Idecabtagene Vicleucel in Relapsed and Refractory Multiple Myeloma. N Engl J Med. 2021 Feb 25;384(8):705-716. doi: 10.1056/NEJMoa2024850.
Results Reference
background
PubMed Identifier
35485211
Citation
Shah N, Mojebi A, Ayers D, Cope S, Dhanasiri S, Davies FE, Hari P, Patel P, Hege K, Dhanda D. Indirect treatment comparison of idecabtagene vicleucel versus conventional care in triple-class exposed multiple myeloma. J Comp Eff Res. 2022 Jul;11(10):737-749. doi: 10.2217/cer-2022-0045. Epub 2022 Apr 29.
Results Reference
derived
PubMed Identifier
35046063
Citation
Sharma P, Kanapuru B, George B, Lin X, Xu Z, Bryan WW, Pazdur R, Theoret MR. FDA Approval Summary: Idecabtagene Vicleucel for Relapsed or Refractory Multiple Myeloma. Clin Cancer Res. 2022 May 2;28(9):1759-1764. doi: 10.1158/1078-0432.CCR-21-3803.
Results Reference
derived
PubMed Identifier
34933328
Citation
Delforge M, Shah N, Miguel JSF, Braverman J, Dhanda DS, Shi L, Guo S, Yu P, Liao W, Campbell TB, Munshi NC. Health-related quality of life with idecabtagene vicleucel in relapsed and refractory multiple myeloma. Blood Adv. 2022 Feb 22;6(4):1309-1318. doi: 10.1182/bloodadvances.2021005913.
Results Reference
derived
PubMed Identifier
33619368
Citation
Da Via MC, Dietrich O, Truger M, Arampatzi P, Duell J, Heidemeier A, Zhou X, Danhof S, Kraus S, Chatterjee M, Meggendorfer M, Twardziok S, Goebeler ME, Topp MS, Hudecek M, Prommersberger S, Hege K, Kaiser S, Fuhr V, Weinhold N, Rosenwald A, Erhard F, Haferlach C, Einsele H, Kortum KM, Saliba AE, Rasche L. Homozygous BCMA gene deletion in response to anti-BCMA CAR T cells in a patient with multiple myeloma. Nat Med. 2021 Apr;27(4):616-619. doi: 10.1038/s41591-021-01245-5. Epub 2021 Feb 22.
Results Reference
derived
Links:
URL
https://www.bms.com/researchers-and-partners/clinical-trials-and-research.html
Description
BMS Clinical Trial Information
URL
http://www.BMSStudyConnect.com
Description
BMS Clinical Trial Patient Recruiting

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Efficacy and Safety Study of bb2121 in Subjects With Relapsed and Refractory Multiple Myeloma

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