Treating relapse of minimal residual disease in multiple myeloma patients

The Relapse from MRD Negativity As Indication for Treatment (REMNANT) Study

This study tests if starting treatment sooner for minimal residual disease can help people with multiple myeloma live longer and feel better compared to waiting until their disease gets worse.

Quick facts

• Phase: Phase2; Phase3
• Study type: Interventional
• Enrollment: 176 (estimated)
• Ages: 18 Years to 75 Years
• Sex: All
• Sponsor: Oslo University Hospital (Academic / other)
• Drugs / interventions: daratumumab
• Locations: 13 sites (Ålesund and 12 other locations)
• Trial ID: NCT04513639 on ClinicalTrials.gov

What this trial studies

The REMNANT study evaluates the effectiveness of early treatment for minimal residual disease (MRD) relapse in multiple myeloma patients compared to standard treatment at progressive disease. Initially, 391 patients will receive standard first-line treatment and undergo autologous stem cell transplantation. Those achieving MRD negativity will be randomized to receive second-line treatment either upon MRD reappearance or at progressive disease. The study aims to determine if early intervention can prolong progression-free and overall survival.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 to 75 with newly diagnosed multiple myeloma eligible for high-dose therapy and autologous stem cell transplantation.

Not a fit: Patients with advanced disease or those who do not meet the eligibility criteria for high-dose therapy may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could significantly improve survival outcomes for multiple myeloma patients by allowing earlier intervention at MRD relapse.

How similar studies have performed: Other studies have shown promising results with early intervention strategies in multiple myeloma, suggesting potential for success in this approach.

Eligibility criteria

Inclusion Criteria part one:

* Each patient must meet all of the following inclusion criteria to be enrolled in the study:

  1. Patient with newly diagnosed multiple myeloma (IMWG criteria) eligible for high-dose therapy and ASCT.
  2. Patient must be \>18 and \< 75 years of age at the time of signing the informed consent
  3. Must have measurable disease as defined by the International Myeloma Working Group; serum monoclonal paraprotein (M-protein) level \> 10 g/L or light chain multiple myeloma without measurable disease in the serum; serum immunoglobulin FLC \> 100 mg/L and abnormal serum immunoglobulin kappa lambda FLC ratio.
  4. Voluntary written informed consent
  5. Eastern Cooperative Oncology Group (ECOG) performance status score of 0, 1, or 2. ECOG 3 can be enrolled if caused by myeloma.
  6. Patient must be willing and able to adhere to the study protocol visit schedule and other protocol requirements.
  7. Female of childbearing potential (FCBP) must have a confirmed negative serum pregnancy test within 7 days prior to inclusion.
  8. FCBP and male subject who are sexually active with FCBP must agree to use highly effective concomitant methods of contraceptive during the study and for at least 28 days following the last study drug dose. Male subjects must use contraception and refrain from donating sperm for at least 28 days after the last dose of lenalidomide according to Pregnancy Prevention Plan (Appendix 4: Contraceptive Guidance and Collection of Pregnancy Information).

     Inclusion Criteria part two:
* Each patient must meet all of the following inclusion criteria to be enrolled in the study

  1. Patient must be MRD negative measured by Euroflow NGF after 1.L therapy. The cutoff for inclusion into part 2 will be 100 PC per 10 mill. nucleated cells monitored in BM.
  2. Has received 1.L treatment in part 1 of the study.
  3. ECOG performance status score 0, 1 or 2

Exclusion Criteria part one:

1. Received more than one cycle of induction treatment for multiple myeloma.
2. Patient with ongoing or active systemic infection, active hepatitis B or C virus infection or known human immunodeficiency virus (HIV) positive
3. Concurrent medical or psychiatric condition or disease that is incompatible to HDM and ASCT or that will likely result in reduced study compliance and reduce ability to follow study procedures, or that in the opinion of the investigator, would constitute a hazard for participating in this study.
4. No active malignancy with a lower life expectancy than myeloma
5. Female patient who have a positive serum pregnancy test during the screening period.
6. Female patient who is lactating during the screening period but are not willing to stop lactating prior to the first treatment cycle starts.
7. Known allergy to any of the study medications, their analogues, or excipients in the various formulations of any agent.

Exclusion Criteria part two:

1. No active malignancy with a lower life expectancy than myeloma
2. Known allergy to any of the study medications, their analogues, or excipients in the various formulations of any agent

Where this trial is running

Ålesund and 12 other locations

• Ålesund Hospital — Ålesund, Norway (Recruiting)
• Haukeland University Hospital — Bergen, Norway (Recruiting)
• Nordland Hospital Bodø — Bodø, Norway (Recruiting)
• Sykehuset Ostfold — Fredrikstad, Norway (Recruiting)
• Førde Central Hospital — Førde, Norway (Recruiting)
• Sørlandet Hospital Kristiansand — Kristiansand, Norway (Recruiting)
• Levanger Hospital — Levanger, Norway (Recruiting)
• Akershus University Hospital — Lørenskog, Norway (Recruiting)
• Oslo University Hospital — Oslo, Norway (Recruiting)
• Helse Stavanger HF — Stavanger, Norway (Recruiting)
• University Hospital North Norway — Tromsø, Norway (Recruiting)
• St. Olavs Hospital — Trondheim, Norway (Recruiting)
• The Hospital of Vestfold — Tønsberg, Norway (Recruiting)

Study contacts

• Principal investigator: Fredrik Schjesvold, MD, PhD — Oslo University Hospital
• Study coordinator: Anne-Marie Rasmussen, PhD

Conditions Multiple Myeloma