Clinical trial NCT02728102: Dendritic Cell/Myeloma Fusion Vaccine for Multiple Myeloma (BMT CTN 1401)
Official title: Phase II Multicenter Trial of Single Autologous Hematopoietic Cell Transplant Followed by Lenalidomide Maintenance for Multiple Myeloma With or Without Vaccination With Dendritic Cell/Myeloma Fusions (BMT CTN 1401)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Multiple Myeloma
Keywords: Multiple Myeloma
Lenalidomide
Maintenance Therapy
Hematologic Disorders
Vaccine
GM-CSF
Transplant
Anti-Myeloma Agents
Lead sponsor: National Heart, Lung, and Blood Institute (NHLBI)
Sponsor class: NIH
Collaborators: name: Blood and Marrow Transplant Clinical Trials Network
name: National Cancer Institute (NCI)
name: National Marrow Donor Program
First posted: 2016-04-05
Enrollment: 203
Sex: ALL
Minimum age (years): 18
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The study is designed as a Phase II, multicenter trial of vaccination with Dendritic cell/myeloma fusions with granulocyte macrophage colony-stimulating factor (GM-CSF) adjuvant plus lenalidomide maintenance therapy versus maintenance therapy alone or with GM-CSF following autologous transplant as part of upfront treatment of multiple myeloma (MM). It is hypothesized that the dendritic cell myeloma vaccine will result in improved response in patients with multiple myeloma after autologous Hematopoietic Cell Transplant (HCT).

Detailed description: The study is a three-arm, phase II randomized, open-labeled clinical trial that randomizes patients to vaccination with Dendritic Cell (DC)/myeloma fusions/GM-CSF plus lenalidomide maintenance therapy or lenalidomide maintenance therapy with or without GM-CSF following autologous transplant as part of upfront treatment for patients diagnosed with multiple myeloma. Patients are randomized approximately 2 months post transplant and will begin maintenance lenalidomide between day 90 and 100. The primary objective of this randomized trial is to compare the proportion of patients alive and in complete response (defined as CR or sCR) at one year post transplant between patients receiving DC/myeloma vaccine/GM-CSF with lenalidomide maintenance therapy to those receiving lenalidomide maintenance therapy with or without GM-CSF.

Eligibility criteria: Initial Inclusion Criteria:

1. Patients must be considered transplant eligible by the treating physician at time of study entry.
2. Patients must meet the criteria for symptomatic multiple myeloma prior to initiating systemic anti-myeloma treatment.
3. Age \>18 years and ≤ 70 years at the time of enrollment
4. Karnofsky Performance status of ≥ 70%
5. Patients must have \> 20% plasma cells in the bone marrow aspirate differential \<60 days prior to enrollment. The required bone marrow evaluation will need to be repeated for patients who received more than 1 cycle of anti-myeloma therapy (corticosteroid with or without other anti-myeloma agents)
6. Patients must have received ≤ 1 cycles of systemic anti-myeloma therapy.
7. Renal: Creatinine clearance of ≥ 40 mL/min, estimated or calculated.

Initial Exclusion Criteria:

1. Patients with a prior autologous or allogeneic HCT
2. Patients with purely non-secretory MM \[absence of a monoclonal protein (M protein) in serum as measured by electrophoresis and immunofixation and the absence of Bence Jones protein in the urine defined by use of conventional electrophoresis and immunofixation techniques and the absence of involved serum free light chain \>100 mg/L\]. Patients with light chain MM detected in the serum by free light chain assay are eligible.
3. Patients with Plasma Cell Leukemia
4. Patients with disease progression prior to enrollment
5. Patients seropositive for the human immunodeficiency virus (HIV).
6. Myocardial infarction within 6 months prior to enrollment or New York Heart Association (NYHA) Class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities. Prior to study entry, any ECG abnormality at screening will be documented by the investigator as not medically relevant.
7. Patients with active clinically significant autoimmune disease, defined as a history of requiring systemic immunosuppressive therapy and at ongoing risk for potential disease exacerbation. Patients with a history of autoimmune thyroid disease, asthma, or limited skin manifestations are potentially eligible.
8. Patients receiving other investigational immunotherapy or anti-myeloma drugs within 14 days before enrollment.
9. Patients with prior malignancies except resected basal cell carcinoma or treated cervical carcinoma in situ. Cancer treated with curative intent \< 5 years prior to enrollment will not be allowed unless approved by the Protocol Officer or one of the Protocol Chairs. Cancer treated with curative intent \> 5 years prior to enrollment is allowed.
10. Female patients who are pregnant (positive beta-HCG) or breastfeeding.
11. Females of childbearing potential (FCBP) or men who have sexual contact with FCBP unwilling to use contraceptive techniques (Appendix D) during the length of lenalidomide maintenance therapy.
12. Patients who have received mid-intensity melphalan (\>50 mg IV) as part of prior therapy.
13. Prior organ transplant requiring immunosuppressive therapy.
14. Patients who previously received lenalidomide and have experienced toxicities resulting in treatment discontinuation.
15. Patients who experienced thromboembolic events while on full anticoagulation during prior therapy with lenalidomide or thalidomide.
16. Patients unwilling to take deep vein thrombosis (DVT) prophylaxis.
17. Patients unable or unwilling to provide informed consent.
18. Patients unable or unwilling to return to the transplant center for their assigned treatments.

Randomization Inclusion Criteria:

1. Patient received transplant \< 12 months of enrollment onto BMT CTN 1401.
2. No disease progression since initiation of systemic anti-myeloma therapy as determined within seven days of randomization/enrollment.
3. Received an autologous cell transplant with melphalan 200mg/m\^2 with a minimum cell dose of 2x10\^6 CD34+ cells/kg (actual body weight).
4. Mucositis and gastrointestinal symptoms resolved, off hyperalimentation and intravenous hydration.
5. No evidence of uncontrolled infection requiring systemic therapy. Patients who completed treatment for an infection but are continuing antibiotics, anti-viral, or anti-fungal therapy for prophylaxis are eligible to continue on protocol.
6. Platelet count ≥75,000/mm\^3 (without transfusion in previous 7 days).
7. Absolute neutrophil count (ANC) ≥ 1,500/mm\^3 without filgrastim administration within 7 days, or pegfilgrastim within 14 days of measurement.
8. Hepatic: bilirubin \< 2x the upper limit of normal and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) \< 2.5x the upper limit of normal. (Patients who have been diagnosed with Gilbert's Disease are allowed to exceed the defined bilirubin value of 2x the upper limit of normal)
9. Renal: Creatinine clearance of ≥ 40 mL/min, estimated or calculated. Patients with creatinine clearance ≥30 but \<40 will be considered with review/approval from the protocol chairs or officer if the cause of renal insufficiency is associated with multiple myeloma.
10. All study participants must be registered into the mandatory Revlimid REMs program, and be willing and able to comply with the requirements.
11. Females of childbearing potential (FCBP) as defined in section 2.7.1.1 must have a negative serum pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again within 24 hours of prescribing lenalidomide (prescriptions must be filled within 7 days)
12. FCBP must either commit to abstain continuously from sexual intercourse or use TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 4 weeks before she starts taking lenalidomide, during therapy, during dose interruptions, and continuing for 4 weeks following discontinuation of lenalidomide.
13. FCBP must agree to ongoing pregnancy testing as required by the Revlimid REMs program.
14. Men must agree to use a latex condom during sexual contact with females of child bearing potential even if they have had a successful vasectomy while taking lenalidomide, during dose interruptions and for 28 days after discontinuing lenalidomide.
15. Patients must be willing to receive DVT prophylaxis.

Primary outcomes:
measure: Percentage of Participants With 1-year Response Rate of CR/sCR
timeFrame: 1 year
Secondary outcomes:
measure: Participants Response to Treatment
timeFrame: 6 months, 1 year, and 2 years post-transplant and at Cycles 3(Day 57), 6(Day 141), 9(Day 225), 12(Day 309), 15 (Day 393), 18(Day 477), 21(Day 561) and 24(Day 654) of maintenance therapy
measure: Percentage of Participants With Myeloma Progression of Vaccine and Non-vaccine Arms
timeFrame: 2 years
measure: Percentage of Participants With Myeloma Progression in Pairwise Analysis
timeFrame: 2 years
measure: Percentage of Participants With Treatment-related Mortality (TRM)
timeFrame: 2 years
measure: Percentage of Participants With Progression-Free Survival
timeFrame: 2 years
measure: Percentage of Participants With Progression-Free Survival in Pairwise Analysis
timeFrame: 2 year
measure: Percentage of Participants With Overall Survival
timeFrame: 2 years
measure: Percentage of Participants With Overall Survival in Pairwise Analysis
timeFrame: 2 years
measure: Number of Grade ≥ 3 Toxicities
timeFrame: 2 years
measure: Participants With Grade ≥ 3 Toxicities
timeFrame: 2 years
measure: Number of Grade 2 and 3 Infections
timeFrame: 2years
measure: Percentage of Participants With Grade 2 and 3 Infections
timeFrame: 2 years
measure: Percentage of Participants With Grade 2 and 3 Infections in Pairwise Analysis
timeFrame: 2 years
measure: Number of Participants With Minimal Residual Disease (MRD)
timeFrame: Pre-randomization, Post-randomization at Cycle 9
Other outcomes:
Locations:
city: San Francisco
country: United States
facility: University of California, San Francisco
state: California
city: Atlanta
country: United States
facility: Emory University
state: Georgia
city: Baltimore
country: United States
facility: University of Maryland/Greenebaum Cancer Center
state: Maryland
city: Boston
country: United States
facility: Beth Israel Deaconess Medical Center/Dana Farber Cancer Institute
state: Massachusetts
city: Minneapolis
country: United States
facility: University of Minnesota
state: Minnesota
city: Omaha
country: United States
facility: University of Nebraska Medical Center
state: Nebraska
city: Buffalo
country: United States
facility: Roswell Park Cancer Institute
state: New York
city: New York
country: United States
facility: Mount Sinai Medical Center
state: New York
city: New York
country: United States
facility: Memorial Sloan-Kettering Cancer Center
state: New York
city: Cleveland
country: United States
facility: University Hospitals of Cleveland/Case Western
state: Ohio
city: Columbus
country: United States
facility: Ohio State University/Arthur G. James Cancer Hospital
state: Ohio
city: Houston
country: United States
facility: University of Texas/MD Anderson Cancer Center
state: Texas
city: Seattle
country: United States
facility: Fred Hutchinson Cancer Research Center
state: Washington
city: Madison
country: United States
facility: University of Wisconsin Hospital & Clinics
state: Wisconsin
city: Milwaukee
country: United States
facility: Medical College of Wisconsin
state: Wisconsin
Study officials:
affiliation: Center for International Blood and Marrow Transplant Research
name: Mary Horowitz, MD
role: STUDY_DIRECTOR
References:
citation: Chung DJ, Shah N, Wu J, Logan B, Bisharat L, Callander N, Cheloni G, Anderson K, Chodon T, Dhakal B, Devine S, Somaiya Dutt P, Efebera Y, Geller N, Ghiasuddin H, Hematti P, Holmberg L, Howard A, Johnson B, Karagkouni D, Lazarus HM, Malek E, McCarthy P, McKenna D, Mendizabal A, Nooka A, Munshi N, O'Donnell L, Rapoport AP, Reese J, Rosenblatt J, Soiffer R, Stroopinsky D, Uhl L, Vlachos IS, Waller EK, Young JW, Pasquini MC, Avigan D. Randomized Phase II Trial of Dendritic Cell/Myeloma Fusion Vaccine with Lenalidomide Maintenance after Upfront Autologous Hematopoietic Cell Transplantation for Multiple Myeloma: BMT CTN 1401. Clin Cancer Res. 2023 Dec 1;29(23):4784-4796. doi: 10.1158/1078-0432.CCR-23-0235.