Clinical Trials /

The Relapse From MRD Negativity as Indication for Treatment (REMNANT) Study

NCT04513639

Description:

The REMNANT study will evaluate whether treating minimal residual disease (MRD) relapse after first line treatment prolongs progression free survival and overall survival for myeloma patients versus treating relapse after first line treatment at progressive disease. To establish a homogenous group of MRD negative patients after first line treatment including autologous stem cell transplantation, patients are enrolled at diagnosis and treated with Norwegian standard of care first line treatment. MRD negative patients will move on to the randomized part.

Related Conditions:
  • Multiple Myeloma
Recruiting Status:

Recruiting

Phase:

Phase 2/Phase 3

Trial Eligibility

Document

Title

  • Brief Title: The Relapse From MRD Negativity as Indication for Treatment (REMNANT) Study
  • Official Title: The Relapse From MRD Negativity as Indication for Treatment (REMNANT) Study

Clinical Trial IDs

  • ORG STUDY ID: OMC01/19
  • NCT ID: NCT04513639

Conditions

  • Multiple Myeloma

Interventions

DrugSynonymsArms
Early treatment of relapse with carfilzomib, dexamethasone, daratumumabDKdArm A
Standard treatment of relapse with carfilzomib, dexamethasone, daratumumabDKdArm B

Purpose

The REMNANT study will evaluate whether treating minimal residual disease (MRD) relapse after first line treatment prolongs progression free survival and overall survival for myeloma patients versus treating relapse after first line treatment at progressive disease. To establish a homogenous group of MRD negative patients after first line treatment including autologous stem cell transplantation, patients are enrolled at diagnosis and treated with Norwegian standard of care first line treatment. MRD negative patients will move on to the randomized part.

Detailed Description

      391 patients with newly diagnosed multiple myeloma eligible for high dose therapy with
      autologous stem cell support will be included in the phase II part of the study and receive
      standard of care first line treatment according to Norwegian national guidelines; bortezomib-
      lenalidomide - dexamethasone for 4 pre-transplant induction and 4 post-transplant
      consolidation cycles (all 21-d cycles). After induction patients will undergo tandem or
      single ASCT, depending on toxicity and response to first ASCT. The primary endpoint of the
      phase 2 part of the study is the number of patients who achieve MRD negative (Euroflow NGF 10
      -5 ) complete response 30-45 days post consolidation. Patients (176) achieving MRD negative
      complete response will be randomly assigned in a 1:1 ratio to receive second line treatment
      at MRD reappearance (arm A) or at progressive disease as defined by the IMWG criteria (arm
      B). Randomization will be stratified by R-ISS stage at diagnosis and single vs tandem ASCT.
      Patients in arm A will be followed with MRD assessment every 4 month and start second line
      treatment at loss of MRD negative CR. Patients in arm B will be followed up by standard
      criteria and start second line treatment at progressive disease. Both arms will receive the
      same 2.L treatment; carfilzomib - dexamethasone - daratumumab. (all 28-d cycles) Second line
      treatment will continue until disease progression, unacceptable AEs or patient withdrawal. In
      arm A MRD Euroflow will be assessed after 6 and 18 months of 2L therapy. In arm B MRD
      Euroflow will be assessed if >CR is achieved but not before 6 months of 2 L therapy, and
      again after 12 consecutive months.
    

Trial Arms

NameTypeDescriptionInterventions
Arm AExperimentalPatients will be followed with MRD assessment every 4 month and start 2.L treatment at loss of MRD negative complete response.
  • Early treatment of relapse with carfilzomib, dexamethasone, daratumumab
Arm BActive ComparatorPatients will be followed up by standard criteria and start 2.L treatment at progressive disease.
  • Standard treatment of relapse with carfilzomib, dexamethasone, daratumumab

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
      
Maximum Eligible Age:75 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Progression Free Survival (PFS)
Time Frame:10 years
Safety Issue:
Description:Median PFS of Arm A (MRD guided) vs Arm B (PD guided) defined as the time from randomization to disease progression or death due to any cause following 2.L treatment.

Secondary Outcome Measures

Measure:Time-to-next treatment
Time Frame:10 years
Safety Issue:
Description:Time from end of first line treatment to start of 3.L therapy
Measure:Minimal residual disease negativity during second line treatment
Time Frame:6 months after starting second line treatment
Safety Issue:
Description:The proportion of patients who achieve MRD negativity during 2.L treatment, monitored by MRD Euroflow NGF at 6 and 18 months in arm A and after achieving CR in arm B (first MRD testing after 6 months).
Measure:Health-related quality of life (HRQOL)
Time Frame:10 years
Safety Issue:
Description:Patient reported outcome HRQOL forms will be filled out by patients at defined time points during the study and finally at relapse after 2.L therapy.

Details

Phase:Phase 2/Phase 3
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Oslo University Hospital

Last Updated

June 18, 2021