E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Patients, 18-65 years, inclusive, multiple myeloma with a first relapse or progression after first line therapy (with a HLA- identical sibling or unrelated donor completely matched (10/10)) |
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E.1.1.1 | Medical condition in easily understood language |
Patients, 18-65 years, inclusive, myeloma with a first relapse or progression after first line therapy (with an appropriate sibling or unrelated donor) |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10028228 |
E.1.2 | Term | Multiple myeloma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Assessment of feasibility and toxicity of T cell depleted NMA Allo-SCT followed by lenalidomide or lenalidomide combined with bortezomib,and subsequent DLI; as treatment of relapsed multiple myeloma after first line therapy who are at least in PR after reinduction therapy |
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E.2.2 | Secondary objectives of the trial |
• To assess the efficacy of early consolidation as determined by response and number of patients that receive subsequent DLI.
• To assess the overall efficacy of the regimen as determined by response rate (especially CR), progression free survival and overall survival.
• To evaluate quality of life with these regimens. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
• Patients with multiple myeloma with a first relapse or with progression after first line therapy;
• Relapsed or progressive patients have received reinduction therapy before entering this trial;
• At least PR after reinduction treatment;
• 18-65 years,inclusive;
• HLA-identical sibling or unrelated donor completely matched (10/10) (excluding identical twins);
• WHO-performance status 0-2;
• Written informed consent.
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E.4 | Principal exclusion criteria |
• No previous Allo-SCT;
• Severe pulmonary dysfunction (CTCAE grade III-IV, see appendix D);
• Severe neurological or psychiatric disease;
• Patients with neuropathy, CTC grade 3 or higher;
• Significant hepatic dysfunction (serum bilirubin or transaminases ≥ 3 times upper limit of normal);
• Significant renal dysfunction (creatinine clearance < 30 ml/min after rehydration);
• Concurrent severe and/or uncontrolled medical condition (e.g. uncontrolled diabetes, infection, hypertension, cancer, etc.);
• History of active malignancy during the past 5 years with the exception of basal carcinoma of the skin or or carcinoma “in situ” of the cervix or breast;
• Patient known to be HIV-positive;
• Patients with brain disease with the exception of those patients whose brain disease has been treated with either radiotherapy or surgery and remains asymptomatic, with no active brain disease, as shown by CT scan or MRI, for at least 6 months;
• The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide, lenalidomide or borium;
• Pregnant or breast-feeding female patients. Negative pregnancy test at study is mandatory for female patients of childbearing potential;
• Not able and not willing to use adequate contraception during therapy;
• Any psychological, familial, sociological and geographical condition potentially hampering compliance with the study protocol and follow-up schedule;
• Severe cardiac dysfunction (NYHA classification II-IV, see appendix E).
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E.5 End points |
E.5.1 | Primary end point(s) |
Failure free duration (FFD) at 9 months post-transplant. Patients count as a failure (= event) at the earliest time point at which any of the following events occurs within 9 months after Allo-SCT :
- Onset of acute GvHD grade 3-4 without prior DLI;
- Onset of extensive chronic GvHD without prior DLI;
- Non-hematological toxicity CTCAE grade 4;
- Systemic therapy for uncontrolled myeloma other than the assigned study treatment of lenalidomide or lenalidomide/bortezomib and DLI;
- Death not due to (progression of) MM, which is in fact TRM.
Patients without a failure within 9 months post Allo-SCT will be censored at 9 months, at the date of progression, or when they go off protocol treatment, whichever comes first.
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
If the trial was not discontinued early, the final analysis will be performed when complete information is available for all eligible patients in a treatment arm. |
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E.5.2 | Secondary end point(s) |
• Toxicity profile and compliance related to each treatment step and intervals between treatment steps (Allo-SCT, consolidation chemotherapy as well as pre-emptive DLI);
• Percentage of patients with a pre-emptive DLI within 6-9 months from the date of Allo-SCT;
• Response, improvement of response and conversion to full donor chimerism during the separate treatment phases (i.e. from Allo-SCT until consolidation; from consolidation to DLI; and after DLI);
• CR rate;
• Progression-free survival (PFS; i.e. time from registration until progression, relapse or death, whichever comes first);
• PFS from Allo-SCT;
• Overall survival (OS) measured from time of registration;
• OS from Allo-SCT;
• The poportion of patients that complete 1, 2 resp. 3 induction cycles;
• Quality of life as defined by the EORTC QLQ-C30 and QLQ-MY20
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
If the trial was not discontinued early, the final analysis will be performed when complete information is available for all eligible patients in a treatment arm. |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | Yes |
E.8.2.3.1 | Comparator description |
The treatment arms will not be compared |
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E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 9 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |