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Allogeneic Stem Cell Transplantation vs. Conventional Therapy as Salvage Therapy for Relapsed / Progressive Patients With Multiple Myeloma After First-line Therapy (AlloRelapseMM)

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ClinicalTrials.gov Identifier: NCT05675319
Recruitment Status : Recruiting
First Posted : January 9, 2023
Last Update Posted : April 25, 2023
Sponsor:
Collaborators:
Gemeinsamer Bundesausschuss (G-BA)
Staburo GmbH
Information provided by (Responsible Party):
Universitätsklinikum Hamburg-Eppendorf

Tracking Information
First Submitted Date  ICMJE November 6, 2022
First Posted Date  ICMJE January 9, 2023
Last Update Posted Date April 25, 2023
Actual Study Start Date  ICMJE March 3, 2023
Estimated Primary Completion Date March 2028   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: January 5, 2023)
Overall survival at five years after randomization [ Time Frame: at 5 years after randomization ]
The present clinical study aims to demonstrate the superiority of allogeneic stem cell transplantation compared to conventional therapy for the difference in overall survival at 5 years in patients with multiple myeloma who have relapsed or progressed after first-line autologous hematopoietic stem cell therapy.
Original Primary Outcome Measures  ICMJE Same as current
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: January 5, 2023)
  • Event-free survival at 1 year after randomization [ Time Frame: from randomization to 1 year after randomization ]
    A secondary objective is to show an improvement of progress free survival and relapse free survival after allogeneic stem cell transplantation compared to conventional therapy. Events are defined as:
    • Progression or
    • Relapse or
    • Engraftment Failure or
    • Death of any cause
  • Event-free survival at 3 years after randomization [ Time Frame: from randomization to 3 years after randomization ]
    A further secondary objective is to show an improvement of progress free survival and relapse free survival after allogeneic stem cell transplantation compared to conventional therapy. Events are defined as:
    • Progression or
    • Relapse or
    • Engraftment Failure or
    • Death of any cause
  • Event-free survival at 5 years after randomization [ Time Frame: from randomization to 5 years after randomization ]
    A secondary objective is to show an improvement of progress free survival and relapse free survival after allogeneic stem cell transplantation compared to conventional therapy. Events are defined as:
    • Progression or
    • Relapse or
    • Engraftment Failure or
    • Death of any cause
  • Change from baseline in total EORTC score at 1 year after randomization [ Time Frame: at visit Screening, at the end of cycle 3 (84 days, each cycle is 28 days) of salvage therapy, 6 months and 12 months after randomization ]
    The aim of the quality of life questionnaires (QLQ) is to provide a comparison between the two treatment arms. Quality of life according EORTC (European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) & Quality of Life Questionnaire - Multiple Myeloma Module (EORTC QLQ-MY20)) will be assessed in both groups.. A high score for a functional scale represents a high/healthy level of functioning whereas a high score for a symptom scale or item represents a high level of symptomatology/ sickness. Patients will be observed from baseline until database lock for final analysis and adjusted mean calculated at 1 year after randomization.
  • Change from baseline in total EORTC score at 3 years after randomization [ Time Frame: at visit Screening, at the end of cycle 3 (84 days, each cycle is 28 days) of salvage therapy, 6 months, 1 year, 2 years and 3 years after randomization ]
    The aim of the quality of life questionnaires (QLQ) is to provide a comparison between the two treatment arms. Quality of life according EORTC (European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) & Quality of Life Questionnaire - Multiple Myeloma Module (EORTC QLQ-MY20)) will be assessed in both groups. A high score for a functional scale represents a high/healthy level of functioning whereas a high score for a symptom scale or item represents a high level of symptomatology/ sickness. Patients will be observed from baseline until database lock for final analysis and adjusted mean calculated at 3 years after randomization.
  • Change from baseline in total EORTC score at 5 years after randomization [ Time Frame: at visit Screening, at the end of cycle 3 (84 days, each cycle is 28 days) of salvage therapy, 6 months, 1, 2, 3, 4 and 5 years after randomization ]
    The aim of the quality of life questionnaires (QLQ) is to provide a comparison between the two treatment arms. Quality of life according EORTC (European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) & Quality of Life Questionnaire - Multiple Myeloma Module (EORTC QLQ-MY20)) will be assessed in both groups. A high score for a functional scale represents a high/healthy level of functioning whereas a high score for a symptom scale or item represents a high level of symptomatology/ sickness. Patients will be observed from baseline until database lock for final analysis and adjusted mean calculated at 5 years after randomization.
  • Time to first occurrence of remission after randomization [ Time Frame: at 30 days, 100 days, 6 months, 1 and 2 years after randomization ]
    Patients will be followed from randomization until database lock for final analysis and cumulative incidence of first remission (partial or complete), at 2 years after randomization, is reported.
  • Non-relapse mortality (NRM) at 1 year after randomization [ Time Frame: from randomization to 1 year after randomization, an average of 1 year ]
    Patients will be observed from randomization until database lock for final analysis and cumulative incidence of death before any relapse at 1 year after randomization was reported.
  • Non-relapse mortality (NRM) at 3 years after randomization [ Time Frame: from randomization to 3 years after randomization, an average of 3 years ]
    Patients will be observed from randomization until database lock for final analysis and cumulative incidence of death before any relapse at 3 years after randomization was reported.
  • Non-relapse mortality (NRM) at 5 years after randomization [ Time Frame: from randomization to 5 years after randomization, an average of 5 years ]
    Patients will be observed from randomization until database lock for final analysis and cumulative incidence of death before any relapse at 5 years after randomization was reported.
  • Cumulative incidence of acute GvHD after allogeneic stem cell transplantation at 1 year after randomization [ Time Frame: at 30 days, 100 days, 6 months and 1 year after randomization, an average of 1 year ]
    Patients will be observed from randomization until database lock for final analysis and cumulative incidence of any acute Graft-versus-Host Disease (GvHD, according to Przepiorka et al.) at 1 year after randomization is reported
  • Cumulative incidence of acute GvHD after allogeneic stem cell transplantation at 3 years after randomization [ Time Frame: at 30 days, 100 days, 6 months, 1 year, 18 months and 2 years, 30 months and 3 years after randomization, an average of 3 years ]
    Patients will be observed from randomization until database lock for final analysis and cumulative incidence of any acute GvHD (according to Przepiorka et al.) at 3 years after randomization is reported
  • Cumulative incidence of acute GvHD after allogeneic stem cell transplantation at 5 years after randomization [ Time Frame: at 30 days, 100 days, 6 months, 1 year, 18 months and 2 years, 30 months, 3, 4 and 5 years after randomization, an average of 5 years ]
    Patients will be observed from randomization until database lock for final analysis and cumulative incidence of any acute GvHD (according to Przepiorka et al.) at 5 years after randomization is repoted.
  • Cumulative incidence of chronic GvHD after allogeneic stem cell transplantation at 1 year after randomization [ Time Frame: at 30 days, 100 days, 6 months and 1 year after randomization, an average of 1 year ]
    Patients will be observed from randomization until database lock for final analysis and cumulative incidence of any chronic GvHD (according to Jagasia et al.) at 1 year after randomization is reported.
  • Cumulative incidence of chronic GvHD after allogeneic stem cell transplantation at 3 years after randomization [ Time Frame: at 30 days, 100 days, 6 months, 1 year, 18 months and 2 years, 30 months and 3 years after randomization, an average of 3 years ]
    Patients will be observed from randomization until database lock for final analysis and cumulative incidence of any chronic GvHD (according to Jagasia et al.) at 3 years after randomization is reported.
  • Cumulative incidence of chronic GvHD after allogeneic stem cell transplantation at 5 years after randomization [ Time Frame: at 30 days, 100 days, 6 months, 1 year, 18 months and 2 years, 30 months, 3, 4 and 5 years after randomization, an average of 5 years ]
    Patients will be observed from randomization until database lock for final analysis and cumulative incidence of any chronic GvHD (according to Jagasia et al.) at 5 years after randomization is reported.
  • Time to first occurrence of infection reported as cumulative incidence of infection with CTCAE grade 3 - 5 at 1 year after randomization [ Time Frame: from randomization to 1 year after randomization, an average of 1 year ]
    The severity and/or intensity of an adverse event will be graded based upon the patient's symptoms according to the current active version of National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE). Patients will be observed from randomization until database lock for final analysis and cumulative incidence of any infectious complication with CTCAE grade 3 - 5 at 1 year after randomization is reported.
  • Time to first occurrence of infection reported as cumulative incidence of infection with CTCAE grade 3 - 5 at 3 years after randomization [ Time Frame: from randomization to 3 years after randomization, an average of 3 years ]
    The severity and/or intensity of an adverse event will be graded based upon the patient's symptoms according to the current active version of National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE). Patients will be observed from randomization until database lock for final analysis and cumulative incidence of any infectious complication with CTCAE grade 3 - 5 at 3 years after randomization is reported.
  • Time to first occurrence of infection reported as cumulative incidence of infection with CTCAE grade 3 - 5 at 5 years after randomization [ Time Frame: from randomization to 5 years after randomization, an average of 5 years ]
    The severity and/or intensity of an adverse event will be graded based upon the patient's symptoms according to the current active version of National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE). Patients will be observed from randomization until database lock for final analysis and cumulative incidence of any infectious complication with CTCAE grade 3 - 5 at 5 years after randomization is reported.
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures
 (submitted: January 5, 2023)
  • Event-free survival at 3 and 5 years after randomization [ Time Frame: from randomization to 3 and 5 years after randomization ]
    Patients will be observed from randomization until database lock for interim analysis and the event-free survival (EFS) rate is calculated at 3 and 5 years after randomization. Events are defined as:
    • Progression or
    • Relapse or
    • Engraftment Failure or
    • Death of any cause
  • Change from baseline in total EORTC score (Summary Score) at 3 and 5 years after randomization [ Time Frame: at visit Screening,at the end of cycle 3 (84 days, each cycle is 28 days) of salvage therapy, 6 months, 1, 2, 3, 4 and 5 years after randomization, an average at 3 and 5 years after randomization ]
    The aim of the quality of life questionnaires (QLQ) is to provide a comparison between the two treatment arms. Quality of life according EORTC (European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) & Quality of Life Questionnaire - Multiple Myeloma Module (EORTC QLQ-MY20)) will be assessed in both groups. A high score for a functional scale represents a high/ healthy level of functioning whereas a high score for a symptom scale or item represents a high level of symptomatology/ sickness. Patients will be observed from baseline until database lock for interim analysis and adjusted mean is calculated at 3 and 5 years after randomization.
  • Non-relapse mortality at 1, 3 and 5 years after randomization [ Time Frame: from randomization to 1, 3 and 5 years after randomization, an average of 1, 3 and 5 years ]
    Patients will be observed from randomization until database lock for interim analysis and cumulative incidence of death before any relapse at 1, 3 and 5 years after randomization is reported
  • Cumulative incidence of acute GvHD after allogeneic stem cell transplantation at 1, 3 and 5 years after randomization [ Time Frame: at 30 days, 100 days, 6 months, 1 year, 18 months and 2 years, 30 months, 3, 4 and 5 years after randomization, an average of 1, 3 and 5 years ]
    Patients will be observed from randomization until database lock for interim analysis and cumulative incidence of any acute GvHD (according to Przepiorka et al.) at 1, 3 and 5 years after randomization is reported
  • Cumulative incidence of chronic GvHD after allogeneic stem cell transplantation at 1, 3 and 5 years after randomization [ Time Frame: at 30 days, 100 days, 6 months, 1 year, 18 months and 2 years, 30 months, 3, 4 and 5 years after randomization, an average of 1, 3 and 5 years ]
    Patients will be observed from randomization until database lock for interim analysis and cumulative incidence of any chronic GvHD (according to Jagasia et al.) at 1, 3 and 5 years after randomization is reported
  • Time to first occurrence of Minimal Residual Disease (MRD) [ Time Frame: at 30 days, 100 days, 6 months, 1 and 2 years after randomization, rate of occurence at 6 months, 1 and 2 years after randomization ]
    Patient observed from randomization until database lock for interim analysis and until database lock for final and rate of occurrence calculated at 6 months, 1 year and 2 years after randomization
  • Time to first occurrence of progression [ Time Frame: from randomization to 1, 3, and 5 years after randomization ]
    Patients will be observed from randomization until database lock for interim analysis and rates at 3 and 5 years after randomization are calculated; and patients will be observed from randomization until database lock for final analysis and rates at 1, 3, and 5 years after randomization are calculated
  • Time to first recurrence of relapse [ Time Frame: at 1, 3, and 5 years after randomization ]
    Patients will be followed from randomization to database lock for interim analysis and rates at 3 and 5 years after randomization are calculated; and patients will be followed from randomization to database lock for final analysis and rates at 1, 3, and 5 years after randomization are calculated.
  • Time to first occurrence of graft failure after stem cell transplatation [ Time Frame: at day 30 after after randomization ]
    Patients are followed from randomization until database lock for interim analysis and rates at 3 and 5 years post-randomization are calculated; and patients are followed from randomization until database lock for final analysis and rates at 1, 3, and 5 years post-randomization are calculated. A graft failure is defined as no stable neutrophil count > 0.5 x 10^9/l at day 28 post-SCT.
Original Other Pre-specified Outcome Measures Same as current
 
Descriptive Information
Brief Title  ICMJE Allogeneic Stem Cell Transplantation vs. Conventional Therapy as Salvage Therapy for Relapsed / Progressive Patients With Multiple Myeloma After First-line Therapy
Official Title  ICMJE Allogeneic Stem Cell Transplantation vs. Conventional Therapy as Salvage Therapy for Relapsed / Progressive Patients With Multiple Myeloma After First-line Therapy
Brief Summary

Allogeneic stem cell (allo SCT) transplantation for multiple myeloma is a potential curative treatment, but is associated with morbidity and treatment related mortality. Approved drug combinations or another autologous stem cell transplantation (auto-SCT) can be used for relapsed patients resulting in a median progression free survival up to 2-3 years.

In the current trial after first-line treatment relapsed or progressed myeloma patients with an HLA compatible donor will be randomized after 3 cycles of salvage therapy to allogeneic stem cell transplantation or to continuous conventional salvage therapy.

Detailed Description

The primary objective of the present clinical study aims to demonstrate the superiority of allogeneic stem cell transplantation (allo SCT) compared to conventional therapy for the difference in overall survival (OS) at 5 years in patients with multiple myeloma who have relapsed or progressed after first-line autologous hematopoietic stem cell therapy.

The secondary objectives are to show an improvement of progression free survival and relapse free survival after allo SCT compared to conventional therapy.

In addition, quality of life, toxicities, recurrence rates, non-relapse mortality (NRM), remission rates including minimal residual disease (MRD) and incidence of severe or life-threatening infection between the two arms are compared. Acute and chronic graft-versus-host disease (GvHD) after allo SCT are evaluated.

Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 3
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE Multiple Myeloma
Intervention  ICMJE
  • Drug: Allogeneic Stem Cells
    Allogeneic Stem Cell Transplantation
  • Drug: carfilzomib/lenalidomide/dexamethasone (KRD)
    triple regimen for first relapse should be applied according to latest Summary of Product Characteristics (SmPC) version
  • Drug: elotuzumab/lenalidomide/dexamethasone (ERD)
    triple regimen for first relapse should be applied according to latest SmPC version
  • Drug: daratumumab/bortezomib/dexamethasone (DVD)
    triple regimen for first relapse should be applied according to latest SmPC version
  • Drug: daratumumab/lenalidomide/dexamethasone (DRD)
    triple regimen for first relapse should be applied according to latest SmPC version
  • Drug: ixazomib/lenalidomide/dexamethasone (IRD)
    triple regimen for first relapse should be applied according to latest SmPC version
  • Drug: pomalidomide/bortezomib/dexamethasone (PVD)
    triple regimen for first relapse should be applied according to latest SmPC version
  • Drug: carfilzomib/daratumumab/dexamethasone (KDD)
    triple regimen for first relapse should be applied according to latest SmPC version
  • Drug: Autologous Stem Cells
    Autologous Stem Cell Transplantation
Study Arms  ICMJE
  • Experimental: Arm A (allo SCT)
    Allogeneic stem cell transplantation
    Intervention: Drug: Allogeneic Stem Cells
  • Active Comparator: Arm B (conventional therapy)

    Currently approved triple regimens for first relapse:

    • carfilzomib/lenalidomide/dexamethasone (KRD) or
    • elotuzumab/lenalidomide/dexamethasone (ERD) or
    • daratumumab/bortezomib/dexamethasone DVD) or
    • daratumumab/lenalidomide/dexamethasone (DRD) or
    • ixazomib/lenalidomide/dexamethasone (IRD) or
    • pomalidomide/bortezomib/dexamethasone (PVD) or
    • carfilzomib/daratumumab/dexamethasone (KDD)

    Alternatively, autologous stem cell transplantation may also be performed, if sufficient stem cells are still cryopreserved.

    Interventions:
    • Drug: carfilzomib/lenalidomide/dexamethasone (KRD)
    • Drug: elotuzumab/lenalidomide/dexamethasone (ERD)
    • Drug: daratumumab/bortezomib/dexamethasone (DVD)
    • Drug: daratumumab/lenalidomide/dexamethasone (DRD)
    • Drug: ixazomib/lenalidomide/dexamethasone (IRD)
    • Drug: pomalidomide/bortezomib/dexamethasone (PVD)
    • Drug: carfilzomib/daratumumab/dexamethasone (KDD)
    • Drug: Autologous Stem Cells
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Recruiting
Estimated Enrollment  ICMJE
 (submitted: January 5, 2023)
482
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE March 2033
Estimated Primary Completion Date March 2028   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

Patients eligible for study inclusion must meet criteria 1- 7 at registration and all of the following criteria before randomization:

  1. Multiple Myeloma
  2. Age 18 - 65 years
  3. A signed informed consent form must be obtained before participation in the study
  4. Age 66 - 70 years, if comorbidity index according to Sorror score = 0 and ECOG ≤ 1
  5. 1st relapse/ progression according to IMWG criteria after first-line therapy (consisting of induction therapy followed by autologous transplantation once or twice and maintenance therapy), Additionally: meeting the need for treatment based on the SLiM criteria
  6. Negative pregnancy test in female patients
  7. Maximum of 1 cycle salvage therapy prior to study inclusion
  8. Availability of a fully compatible stem cell donor (HLA-ident. Sibling or 10/10 MUD or 9/10 MMUD if mismatch affects DQB) after 3 cycles salvage therapy
  9. CR/PR or SD according to IMWG-criteria after 3 cycles salvage therapy within the study

Exclusion Criteria:

Patients are excluded from the study if any one of criteria 1-6 are met at registration and if criterion 7 is met before randomization:

  1. Non-sufficient organ function defined as:

    Bilirubin (in the absence of Meulengracht's disease), SGPT or SGOT ≥3 higher than normal values Cardiac ejection fraction ≤ 50% GFR < 30 ml/min DLCO < 50% and/or continuous oxygen dependency

  2. Active hepatitis B or C infection or uncontrolled HIV infection
  3. Other, active malignant disease
  4. Prior treatment with allogeneic stem cells
  5. Participation in a clinical trial or taking an IMP within 30 days or five times the half-life of the IMP, whichever is longer, prior to registration
  6. Positive serum pregnancy test at screening and before first treatment or breastfeeding
  7. PD under salvage therapy
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 70 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Nicolaus Kröger, Prof. Dr. +4940741054851 n.kroeger@uke.de
Listed Location Countries  ICMJE Germany
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT05675319
Other Study ID Numbers  ICMJE AlloRelapseMMStudy
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Current Responsible Party Universitätsklinikum Hamburg-Eppendorf
Original Responsible Party Same as current
Current Study Sponsor  ICMJE Universitätsklinikum Hamburg-Eppendorf
Original Study Sponsor  ICMJE Same as current
Collaborators  ICMJE
  • Gemeinsamer Bundesausschuss (G-BA)
  • Staburo GmbH
Investigators  ICMJE
Principal Investigator: Nicolaus Kröger, Prof. Dr. University Medical Center Hamburg-Eppendorf, Department of Stem Cell Transplantation
PRS Account Universitätsklinikum Hamburg-Eppendorf
Verification Date April 2023

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP