Using Carfilzomib to help collect stem cells for multiple myeloma treatment

Phase I Study of Carfilzomib-based Chemotherapy Mobilization for Autologous Stem Cell Transplantation in Multiple Myeloma

This study is testing if a combination of Carfilzomib, Cyclophosphamide, and Dexamethasone can help collect stem cells from patients with multiple myeloma before they have a stem cell transplant.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 18 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Hackensack Meridian Health (Academic / other)
• Drugs / interventions: radiation, Cyclophosphamide
• Locations: 1 site (Hackensack, New Jersey)
• Trial ID: NCT03909412 on ClinicalTrials.gov

What this trial studies

This phase I study investigates the use of Carfilzomib in combination with Cyclophosphamide and Dexamethasone to mobilize peripheral blood stem cells in patients with multiple myeloma. The study employs a 3+3 design with escalating doses of Carfilzomib administered to cohorts of subjects, followed by high-dose G-CSF injections to facilitate stem cell collection. Patients will undergo screening and receive treatment before proceeding to an autologous stem cell transplant. Monthly assessments will be conducted post-transplant to monitor disease parameters.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older with a confirmed diagnosis of multiple myeloma and measurable disease.

Not a fit: Patients who have not been diagnosed with multiple myeloma or those who are not eligible for stem cell transplantation may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could improve the efficiency of stem cell mobilization for patients undergoing treatment for multiple myeloma.

How similar studies have performed: Other studies have shown promise in using similar chemotherapy regimens for stem cell mobilization, indicating potential for success in this approach.

Eligibility criteria

INCLUSION CRITERIA Subject has voluntarily agreed to participate by giving written informed consent before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care. Informed Consent must be obtained prior to mobilization.

* Subject has a confirmed diagnosis of multiple myeloma as specified by the International Myeloma Working Group criteria and must have measurable disease as defined by at least one of the following criteria:
* Serum monoclonal protein ≥ 0.5 g/dL
* ≥200 mg of monoclonal protein in the urine on 24-hour electrophoresis
* Serum immunoglobulin free light chain: involved FLC ≥ 10 mg/dL (≥ 100 mg/L) AND abnormal serum immunoglobulin kappa to lambda free light chain ratio
* MRD positivity in peripheral blood by flow cytometry.
* Subject previously received treatment with Carfilzomib.
* Subject is ≥18 years of age at the time of signing the informed consent form.
* Subject has an ECOG performance status of \< 2.
* Subjects must have completed any "induction therapy" and have achieved less than a CR.
* Subject has a life expectancy of \>12 weeks.

  * Absolute neutrophil count (ANC) ≥1000 cells/mm3 (≥500 for patients with bone marrow biopsy displaying \>50% involvement by myeloma)
  * Platelets count ≥ 50,000/mm3 (≥ 30,000 for patients with bone marrow biopsy displaying \>50% involvement by myeloma)
  * Hemoglobin \> 9.0 g/dL
  * Serum SGOT/AST \<3.0 x upper limits of normal (ULN)
  * Serum SGPT/ALT \<3.0 x upper limits of normal (ULN)
  * Serum total bilirubin \<1.5 x ULN
* Subject must have a MUGA scan or echo with LVEF ≥40% within 6 months of enrollment.
* Females of childbearing potential (FCBP) must have a negative serum pregnancy test should be done within 7 days of treatment initiation and a negative urine pregnancy test within the 24 hours prior to the first study drug administration
* FCBP and male subjects who are sexually active with FCBP must agree to use 2 highly effective concomitant methods of contraception including a male condom during the study and for 90 days following the last dose of study treatment
* Male subjects must agree to not donate sperm while taking carfilzomib and for 90 days after the last dose of carfilzomib.

EXCLUSION CRITERIA

* Subject has a history of allergic reactions to compounds containing captisol, or Carfilzomib
* Subject has a NYHA Class III or IV heart disease and/or a history of active unstable angina, congestive heart disease, severe uncontrolled cardiac arrhythmia, electrocardiographic evidence of acute ischemia, active conduction system abnormalities or myocardial infarction within 6 months prior to enrollment. Prior to study entry, any ECG abnormality at Screening has to be documented by the investigator as not medically relevant.
* Uncontrolled hypertension.
* Pulmonary hypertension.
* Known HIV infection, hepatitis C infection (subjects with hepatitis C that achieve a sustained virologic response after antiviral therapy are allowed), or hepatitis B infection (subjects with hepatitis B surface antigen or core antibody that achieve sustained virologic response with antiviral therapy are permitted with a requirement for regular monitoring for reactivation for the duration of treatment on the study).
* Subject has active viral or bacterial infections or any coexisting medical problem that would significantly increase the risks of this treatment program.
* Subject has concurrent, uncontrolled medical condition, laboratory abnormality, or psychiatric illness which could place him/her at unacceptable risk, including, but not limited to, uncontrolled hypertension, uncontrolled diabetes, active uncontrolled infection, and/or acute chronic liver disease (i.e., hepatitis, cirrhosis).
* Subject has ≥Grade 2 peripheral neuropathy.
* Subject has been diagnosed or treated for another malignancy within 3 years of enrollment, with the exception of complete resection of basal cell carcinoma or squamous cell carcinoma of the skin, an in situ malignancy, or low-risk prostate cancer after curative therapy.
* Subject has received radiation therapy within 3 weeks of enrollment. Enrollment of subjects who require concurrent radiotherapy (which must be localized in its field size) should be deferred until the radiotherapy is completed and 3 weeks have elapsed since the last date of therapy.
* Subject has had prior mobilization or stem cell transplant.

Where this trial is running

Hackensack, New Jersey

• Hackensack Meridian Health - John Theurer Cancer Center — Hackensack, New Jersey, United States (Recruiting)

Study contacts

• Study coordinator: Mariefel Vendivil

Conditions Multiple Myeloma