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    Clinical Trial Results:
    A Phase 2 Multi-Arm Study of Magrolimab Combinations in Patients with Relapsed/Refractory Multiple Myeloma

    Summary
    EudraCT number
    2021-001798-21
    Trial protocol
    CZ  
    Global end of trial date
    25 Apr 2024

    Results information
    Results version number
    v1(current)
    This version publication date
    01 May 2025
    First version publication date
    01 May 2025
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    GS-US-558-5915
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT04892446
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Gilead Sciences
    Sponsor organisation address
    333 Lakeside Drive, Foster City, CA, United States, 94404
    Public contact
    Gilead Clinical Study Information Center, Gilead Sciences, GileadClinicalTrials@gilead.com
    Scientific contact
    Gilead Clinical Study Information Center, Gilead Sciences, GileadClinicalTrials@gilead.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    25 Apr 2024
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    25 Apr 2024
    Global end of trial reached?
    Yes
    Global end of trial date
    25 Apr 2024
    Was the trial ended prematurely?
    Yes
    General information about the trial
    Main objective of the trial
    The goal of this clinical study was to learn more about the safety and dosing of the study drug, magrolimab, in combination with other anticancer therapies in participants with relapsed/refractory multiple myeloma.
    Protection of trial subjects
    The protocol and consent/assent forms were submitted by each investigator to a duly constituted Independent Ethics Committee (IEC) or Institutional Review Board (IRB) for review and approval before study initiation. All revisions to the consent/assent forms (if applicable) after initial IEC/IRB approval were submitted by the investigator to the IEC/IRB for review and approval before implementation in accordance with regulatory requirements. This study was conducted in accordance with recognized international scientific and ethical standards, including but not limited to the International Conference on Harmonization guideline for Good Clinical Practice (ICH GCP) and the original principles embodied in the Declaration of Helsinki.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    09 Nov 2021
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety
    Long term follow-up duration
    1 Months
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Canada: 7
    Country: Number of subjects enrolled
    Czechia: 9
    Country: Number of subjects enrolled
    United States: 20
    Worldwide total number of subjects
    36
    EEA total number of subjects
    9
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    0
    From 65 to 84 years
    19
    85 years and over
    17

    Subject disposition

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    Recruitment
    Recruitment details
    43 participants were screened. As all participants were dosed with same dose of magrolimab, per prespecified analysis, data for Safety Run-in and corresponding Dose-expansion cohorts were combined except for dose limiting toxicity outcome measure, for which data was collected only in Safety Run-in Cohorts.

    Pre-assignment
    Screening details
    Participants were enrolled at study sites in the United States, Czech Republic, and Canada. Magrolimab in combination with bortezomib and dexamethasone cohort was not initiated due to early closure of study.

    Period 1
    Period 1 title
    Overall Study (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Magrolimab+Daratumumab
    Arm description
    Participants in Safety Run-in and Dose-expansion period with relapsed/refractory multiple myeloma who have had 3 or more prior therapies including an immunomodulatory drug (IMiD) and a proteasome inhibitor (PI) received magrolimab intravenously (IV) 1 milligrams per kilogram (mg/kg) on Day 1 and 30 mg/kg on Days 8, 15, 22, 29 of Cycle 1; 30 mg/kg every week on Days 1, 8, 15, 22 of Cycle 2; 30 mg/kg on Days 1, 15 from Cycle 3 onwards. Participants also received daratumumab 1800 mg subcutaneously (SC) or 16 mg/kg IV on Days 8, 15, 22, 29 of Cycle 1; Days 1, 8, 15, 22 of Cycle 2; and Days 1, 15 (every 2 weeks) until Cycle 6 (total of 8 doses) followed by Day 1 (every 4 weeks) for subsequent cycles. (Cycle 1=35 days, All other Cycles=28 days).
    Arm type
    Experimental

    Investigational medicinal product name
    Daratumumab
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Solution for infusion
    Routes of administration
    Intravenous use, Subcutaneous use
    Dosage and administration details
    Administered either subcutaneously or intravenously

    Investigational medicinal product name
    Magrolimab
    Investigational medicinal product code
    Other name
    GS-4721
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Administered intravenously

    Arm title
    Magrolimab+Pomalidomide+Dexamethasone
    Arm description
    Participants in Safety Run-in and Dose-expansion period with relapsed/refractory multiple myeloma who have had 3 or more prior therapies including an IMiD and a PI received magrolimab IV 1 mg/kg on Day 1 and 30 mg/kg on Days 8, 15, 22, 29 of Cycle 1; 30 mg/kg every week on Days 1, 8, 15, 22 of Cycle 2; 30 mg/kg on Days 1, 15 from Cycle 3 onwards. Participants also received pomalidomide orally 4 mg on Days 1 to 21 (daily) of Cycle 1 and onward and dexamethasone orally 40 mg on Days 1, 8, 15, 22, 29 of Cycle 1; Days 1, 8, 15, 22 of Cycle 2 and onward. (Cycle 1=35 days, All other Cycles=28 days).
    Arm type
    Experimental

    Investigational medicinal product name
    Pomalidomide
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Capsule, hard
    Routes of administration
    Oral use
    Dosage and administration details
    Administered orally

    Investigational medicinal product name
    Dexamethasone
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Administered orally

    Investigational medicinal product name
    Magrolimab
    Investigational medicinal product code
    Other name
    GS-4721
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Administered intravenously

    Arm title
    Magrolimab+Carfilzomib+Dexamethasone
    Arm description
    Participants in Safety Run-in and Dose-expansion period with relapsed/refractory multiple myeloma who have had 3 or more prior therapies including an IMiD and a PI received magrolimab IV 1 mg/kg on Day 1 and 30 mg/kg on Days 8, 15, 22, 29 of Cycle 1; 30 mg/kg every week on Days 1, 8, 15, 22 of Cycle 2; 30 mg/kg on Days 1, 15 from Cycle 3 onwards. Participants also received carfilzomib IV 20 milligrams per square meter (mg/m^2) on Days 8, 15, 22 of Cycle 1; Days 1, 8, 15 of Cycle 2 and onward (if the carfilzomib starting dose of 20 mg/m^2 was tolerated after Cycle 1, Day 8, the dose was escalated to 70 mg/m^2 on Cycle 1, Day 15 and thereafter) and dexamethasone orally or IV 40 mg on Days 8, 15, 22, 29 of Cycle 1; Days 1, 8, 15, 22 of Cycles 2 to 9 and then Days 1, 8, 15 from Cycle 10 and onward. (Cycle 1=35 days, All other Cycles=28 days).
    Arm type
    Experimental

    Investigational medicinal product name
    Carfilzomib
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Powder for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Administered intravenously

    Investigational medicinal product name
    Magrolimab
    Investigational medicinal product code
    Other name
    GS-4721
    Pharmaceutical forms
    Concentrate for solution for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    Administered intravenously

    Investigational medicinal product name
    Dexamethasone
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Tablet
    Routes of administration
    Oral use
    Dosage and administration details
    Administered orally

    Number of subjects in period 1 [1]
    Magrolimab+Daratumumab Magrolimab+Pomalidomide+Dexamethasone Magrolimab+Carfilzomib+Dexamethasone
    Started
    14
    10
    11
    Completed
    7
    5
    8
    Not completed
    7
    5
    3
         Death
    4
    4
    -
         Study terminated by sponsor
    -
    -
    2
         Withdrew consent
    3
    -
    1
         Investigator's discretion
    -
    1
    -
    Notes
    [1] - The number of subjects reported to be in the baseline period are not the same as the worldwide number enrolled in the trial. It is expected that these numbers will be the same.
    Justification: One participant was enrolled but did not receive study drug in Magrolimab+Daratumumab cohort.

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Magrolimab+Daratumumab
    Reporting group description
    Participants in Safety Run-in and Dose-expansion period with relapsed/refractory multiple myeloma who have had 3 or more prior therapies including an immunomodulatory drug (IMiD) and a proteasome inhibitor (PI) received magrolimab intravenously (IV) 1 milligrams per kilogram (mg/kg) on Day 1 and 30 mg/kg on Days 8, 15, 22, 29 of Cycle 1; 30 mg/kg every week on Days 1, 8, 15, 22 of Cycle 2; 30 mg/kg on Days 1, 15 from Cycle 3 onwards. Participants also received daratumumab 1800 mg subcutaneously (SC) or 16 mg/kg IV on Days 8, 15, 22, 29 of Cycle 1; Days 1, 8, 15, 22 of Cycle 2; and Days 1, 15 (every 2 weeks) until Cycle 6 (total of 8 doses) followed by Day 1 (every 4 weeks) for subsequent cycles. (Cycle 1=35 days, All other Cycles=28 days).

    Reporting group title
    Magrolimab+Pomalidomide+Dexamethasone
    Reporting group description
    Participants in Safety Run-in and Dose-expansion period with relapsed/refractory multiple myeloma who have had 3 or more prior therapies including an IMiD and a PI received magrolimab IV 1 mg/kg on Day 1 and 30 mg/kg on Days 8, 15, 22, 29 of Cycle 1; 30 mg/kg every week on Days 1, 8, 15, 22 of Cycle 2; 30 mg/kg on Days 1, 15 from Cycle 3 onwards. Participants also received pomalidomide orally 4 mg on Days 1 to 21 (daily) of Cycle 1 and onward and dexamethasone orally 40 mg on Days 1, 8, 15, 22, 29 of Cycle 1; Days 1, 8, 15, 22 of Cycle 2 and onward. (Cycle 1=35 days, All other Cycles=28 days).

    Reporting group title
    Magrolimab+Carfilzomib+Dexamethasone
    Reporting group description
    Participants in Safety Run-in and Dose-expansion period with relapsed/refractory multiple myeloma who have had 3 or more prior therapies including an IMiD and a PI received magrolimab IV 1 mg/kg on Day 1 and 30 mg/kg on Days 8, 15, 22, 29 of Cycle 1; 30 mg/kg every week on Days 1, 8, 15, 22 of Cycle 2; 30 mg/kg on Days 1, 15 from Cycle 3 onwards. Participants also received carfilzomib IV 20 milligrams per square meter (mg/m^2) on Days 8, 15, 22 of Cycle 1; Days 1, 8, 15 of Cycle 2 and onward (if the carfilzomib starting dose of 20 mg/m^2 was tolerated after Cycle 1, Day 8, the dose was escalated to 70 mg/m^2 on Cycle 1, Day 15 and thereafter) and dexamethasone orally or IV 40 mg on Days 8, 15, 22, 29 of Cycle 1; Days 1, 8, 15, 22 of Cycles 2 to 9 and then Days 1, 8, 15 from Cycle 10 and onward. (Cycle 1=35 days, All other Cycles=28 days).

    Reporting group values
    Magrolimab+Daratumumab Magrolimab+Pomalidomide+Dexamethasone Magrolimab+Carfilzomib+Dexamethasone Total
    Number of subjects
    14 10 11 35
    Age categorical
    Units: Subjects
    Age continuous
    Units: years
        arithmetic mean (standard deviation)
    65 ( 9.5 ) 66 ( 10.2 ) 68 ( 8.0 ) -
    Gender categorical
    Units: Subjects
        Female
    10 2 5 17
        Male
    4 8 6 18
    Race
    Units: Subjects
        American Indian or Alaska Native
    0 0 0 0
        Asian
    1 0 0 1
        Native Hawaiian or Other Pacific Islander
    1 0 0 1
        Black or African American
    1 1 1 3
        White
    11 9 10 30
        More than one race
    0 0 0 0
    Ethnicity
    Units: Subjects
        Hispanic or Latino
    0 0 0 0
        Not Hispanic or Latino
    14 10 11 35
        Unknown or Not Reported
    0 0 0 0

    End points

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    End points reporting groups
    Reporting group title
    Magrolimab+Daratumumab
    Reporting group description
    Participants in Safety Run-in and Dose-expansion period with relapsed/refractory multiple myeloma who have had 3 or more prior therapies including an immunomodulatory drug (IMiD) and a proteasome inhibitor (PI) received magrolimab intravenously (IV) 1 milligrams per kilogram (mg/kg) on Day 1 and 30 mg/kg on Days 8, 15, 22, 29 of Cycle 1; 30 mg/kg every week on Days 1, 8, 15, 22 of Cycle 2; 30 mg/kg on Days 1, 15 from Cycle 3 onwards. Participants also received daratumumab 1800 mg subcutaneously (SC) or 16 mg/kg IV on Days 8, 15, 22, 29 of Cycle 1; Days 1, 8, 15, 22 of Cycle 2; and Days 1, 15 (every 2 weeks) until Cycle 6 (total of 8 doses) followed by Day 1 (every 4 weeks) for subsequent cycles. (Cycle 1=35 days, All other Cycles=28 days).

    Reporting group title
    Magrolimab+Pomalidomide+Dexamethasone
    Reporting group description
    Participants in Safety Run-in and Dose-expansion period with relapsed/refractory multiple myeloma who have had 3 or more prior therapies including an IMiD and a PI received magrolimab IV 1 mg/kg on Day 1 and 30 mg/kg on Days 8, 15, 22, 29 of Cycle 1; 30 mg/kg every week on Days 1, 8, 15, 22 of Cycle 2; 30 mg/kg on Days 1, 15 from Cycle 3 onwards. Participants also received pomalidomide orally 4 mg on Days 1 to 21 (daily) of Cycle 1 and onward and dexamethasone orally 40 mg on Days 1, 8, 15, 22, 29 of Cycle 1; Days 1, 8, 15, 22 of Cycle 2 and onward. (Cycle 1=35 days, All other Cycles=28 days).

    Reporting group title
    Magrolimab+Carfilzomib+Dexamethasone
    Reporting group description
    Participants in Safety Run-in and Dose-expansion period with relapsed/refractory multiple myeloma who have had 3 or more prior therapies including an IMiD and a PI received magrolimab IV 1 mg/kg on Day 1 and 30 mg/kg on Days 8, 15, 22, 29 of Cycle 1; 30 mg/kg every week on Days 1, 8, 15, 22 of Cycle 2; 30 mg/kg on Days 1, 15 from Cycle 3 onwards. Participants also received carfilzomib IV 20 milligrams per square meter (mg/m^2) on Days 8, 15, 22 of Cycle 1; Days 1, 8, 15 of Cycle 2 and onward (if the carfilzomib starting dose of 20 mg/m^2 was tolerated after Cycle 1, Day 8, the dose was escalated to 70 mg/m^2 on Cycle 1, Day 15 and thereafter) and dexamethasone orally or IV 40 mg on Days 8, 15, 22, 29 of Cycle 1; Days 1, 8, 15, 22 of Cycles 2 to 9 and then Days 1, 8, 15 from Cycle 10 and onward. (Cycle 1=35 days, All other Cycles=28 days).

    Primary: Percentage of Participants Experiencing Dose-limiting Toxicities (DLTs) According to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0

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    End point title
    Percentage of Participants Experiencing Dose-limiting Toxicities (DLTs) According to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 [1]
    End point description
    A DLT is defined as any Grade 3 or higher hematologic toxicity or Grade 3 or higher nonhematologic toxicity, that has worsened in severity from pretreatment baseline during the DLT assessment period and, in the opinion of the investigator, the adverse event (AE) is at least possibly related to magrolimab. The DLT-Evaluable Analysis Set included all participants in the Safety Analysis Set who are enrolled in the Safety Run-in cohorts and fulfil the criteria for evaluation for DLT specified in the protocol. As all participants were dosed with same dose of magrolimab, per prespecified analysis, data for Safety Run-in and corresponding Dose-expansion cohorts were combined except for dose limiting toxicity endpoint, for which data was collected only in Safety Run-in Cohorts. Percentages are rounded off.
    End point type
    Primary
    End point timeframe
    Up to 35 days
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: As prespecified only descriptive analysis was planned.
    End point values
    Magrolimab+Daratumumab Magrolimab+Pomalidomide+Dexamethasone Magrolimab+Carfilzomib+Dexamethasone
    Number of subjects analysed
    6
    6
    6
    Units: percentage of participants
        number (not applicable)
    16.7
    16.7
    0
    No statistical analyses for this end point

    Primary: Percentage of Participants Experiencing Treatment-emergent Adverse Events (TEAE’s) According to the NCI CTCAE Version 5.0

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    End point title
    Percentage of Participants Experiencing Treatment-emergent Adverse Events (TEAE’s) According to the NCI CTCAE Version 5.0 [2]
    End point description
    An AE is any untoward medical occurrence in a clinical study participant administered a study drug that does not necessarily have a causal relationship with the treatment. An AE can therefore be any unfavorable and/or unintended sign, symptom, or disease temporally associated with the use of a study drug, whether or not the AE is considered related to the study drug. A treatment-emergent AE was defined as any AE that began on or after the date of first dose of any study drug up to the date of last dose of any study drug plus 70 days. The Safety Analysis Set included all participants who received at least 1 dose of study treatment with treatment group designated according to the actual treatment received. As all participants were dosed with same dose of magrolimab, per prespecified analysis, data for Safety Run-in and corresponding Dose-expansion cohorts were combined for all 3 arms.
    End point type
    Primary
    End point timeframe
    Up to 1.3 years plus 70 days
    Notes
    [2] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: As prespecified only descriptive analysis was planned.
    End point values
    Magrolimab+Daratumumab Magrolimab+Pomalidomide+Dexamethasone Magrolimab+Carfilzomib+Dexamethasone
    Number of subjects analysed
    14
    10
    11
    Units: percentage of participants
        number (not applicable)
    100
    100
    100
    No statistical analyses for this end point

    Primary: Percentage of Participants Experiencing Treatment-emergent Laboratory Abnormalities According to the NCI CTCAE Version 5.0

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    End point title
    Percentage of Participants Experiencing Treatment-emergent Laboratory Abnormalities According to the NCI CTCAE Version 5.0 [3]
    End point description
    Treatment-emergent laboratory abnormalities were defined as values that increase at least 1 toxicity grade from baseline at any postbaseline time point, up to and included the date of last dose of study drug plus 70 days for participants who permanently discontinued study drug, or the day before initiation of new anticancer therapy including stem cell transplant (SCT) (whichever was earlier). If the relevant baseline laboratory value was missing, any abnormality of at least Grade 1 observed within the time frame specified above was considered treatment emergent. Participants in the Safety Analysis Set were analysed. As all participants were dosed with same dose of magrolimab, per prespecified analysis, data for Safety Run-in and corresponding Dose-expansion cohorts were combined for all 3 arms. Percentages are rounded off.
    End point type
    Primary
    End point timeframe
    Up to 1.3 years plus 70 days
    Notes
    [3] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: As prespecified only descriptive analysis was planned.
    End point values
    Magrolimab+Daratumumab Magrolimab+Pomalidomide+Dexamethasone Magrolimab+Carfilzomib+Dexamethasone
    Number of subjects analysed
    14
    10
    11
    Units: percentage of participants
    number (not applicable)
        Hematology: Any Grade 1 or Higher
    92.9
    100
    100
        Chemistry: Any Grade 1 or Higher
    92.9
    100
    100
    No statistical analyses for this end point

    Primary: Objective Response Rate (ORR)

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    End point title
    Objective Response Rate (ORR) [4]
    End point description
    ORR=percentage of participants who achieve confirmed stringent complete response (sCR), complete response (CR), very good partial response (VGPR), or partial response (PR), as assessed by investigator per International Myeloma Working Group (IMWG) 2016 criteria. CR=negative immunofixation on serum and urine & disappearance of any soft tissue plasmacytomas &< 5% plasma cells in bone marrow (BM) aspirates; sCR=CR as above plus normal serum free light-chain (FLC) assay ratio & absence of clonal cells in BM biopsy by immunohistochemistry; VGPR=serum and urine M-protein detectable by immunofixation but not on electrophoresis or ≥ 90% reduction in serum M-protein plus urine M-protein <100 mg/24 h; PR=≥50% reduction of serum M-protein and reduction in 24-hour urinary M-protein by ≥90% or to <200 mg/24 h. The Full Analysis Set included all participants who took ≥ 1 dose of study drugs with arm designated according to the planned treatment at enrollment. Percentages are rounded off.
    End point type
    Primary
    End point timeframe
    Up to 1.5 years
    Notes
    [4] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: As prespecified only descriptive analysis was planned.
    End point values
    Magrolimab+Daratumumab Magrolimab+Pomalidomide+Dexamethasone Magrolimab+Carfilzomib+Dexamethasone
    Number of subjects analysed
    14
    10
    11
    Units: percentage of participants
        number (confidence interval 95%)
    14.3 (1.8 to 42.8)
    20.0 (2.5 to 55.6)
    36.4 (10.9 to 69.2)
    No statistical analyses for this end point

    Secondary: Duration of Response (DoR)

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    End point title
    Duration of Response (DoR)
    End point description
    DoR: earliest date of sCR, CR, VGPR, or PR, until earliest date of documented progression disease (PD), documented relapse, or death from any cause, whichever occurred first. sCR, CR, VGPR, or PR as defined in endpoint#4. PD: increase of 25% from lowest confirmed response value/appearance of new lesion, ≥ 50% increase in sum of products of 2 longest perpendicular diameters of >1 lesion, or ≥ 50% increase in longest diameter of previous lesion >1 cm in short axis; ≥ 50% increase in circulating plasma cells. Relapse=direct indicators of increasing disease/increase in size of existing or new soft tissue plasmacytomas or bone lesions/hypercalcemia (> 11 mg/dL)/decrease in hemoglobin of ≥ 2 g/dL/rise in serum creatinine by 2mg/dL/hyperviscosity. Participants in FAS who had objective response were analysed. 9999:Median, lower & upper limit (UL) of CI not estimable due to low number of participants with event;99999:Median & UL were not estimable due to low number of participants with events.
    End point type
    Secondary
    End point timeframe
    Up to 1.5 years
    End point values
    Magrolimab+Daratumumab Magrolimab+Pomalidomide+Dexamethasone Magrolimab+Carfilzomib+Dexamethasone
    Number of subjects analysed
    2
    2
    4
    Units: months
        median (confidence interval 95%)
    9999 (9999 to 9999)
    99999 (3.9 to 99999)
    9999 (9999 to 9999)
    No statistical analyses for this end point

    Secondary: Serum Concentration of Magrolimab

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    End point title
    Serum Concentration of Magrolimab
    End point description
    Arm 1: Magrolimab+Daratumumab; Arm 2: Magrolimab+Pomalidomide+Dexamethasone; Arm 3: Magrolimab+Carfilzomib+Dexamethasone; D=Day. The PK Analysis Set included all participants who received ≥ 1 dose of magro and had ≥ 1 measurable posttreatment serum concentration of magrolimab. Participants with available data were analyzed. As all participants were dosed with same dose of magrolimab, per prespecified analysis, data for Safety Run-in and corresponding Dose-expansion cohorts were combined for all 3 arms. 9999: Mean and standard deviation were not calculable as the values were below the limit of quantitation. 99999: Standard deviation was not calculable due to less than 3 participants available for analysis. 999999: As no sample was collected, mean and standard deviation were not calculated.
    End point type
    Secondary
    End point timeframe
    Arm 1, 2, 3: Predose: Days 1 and 22 of Cycle 1, Day 1 of Cycles 2, 3, 4, 5, 7, and on last sample collection day (anytime; up to Day 358); Arm 1 and 3: Predose: Day 1 of Cycles 10 and 13
    End point values
    Magrolimab+Daratumumab Magrolimab+Pomalidomide+Dexamethasone Magrolimab+Carfilzomib+Dexamethasone
    Number of subjects analysed
    10
    10
    10
    Units: ng/mL
    arithmetic mean (standard deviation)
        Predose: Cycle 1 D 1 N=10,10,10
    9999 ( 9999 )
    9999 ( 9999 )
    9999 ( 9999 )
        Predose: Cycle 1 D 22 N=8,8,7
    435000 ( 245000 )
    303000 ( 182000 )
    421000 ( 115000 )
        Predose: Cycle 2 D 1 N=7,5,8
    621000 ( 233000 )
    713000 ( 293000 )
    675000 ( 274000 )
        Predose: Cycle 3 D 1 N=4,6,8
    853000 ( 399000 )
    739000 ( 365000 )
    847000 ( 238000 )
        Predose: Cycle 4 D 1 N=2,1,2
    694000 ( 82700 )
    5540 ( 99999 )
    459000 ( 161000 )
        Predose: Cycle 5 D 1 N=3,5,5
    517000 ( 186000 )
    373000 ( 142000 )
    448000 ( 90700 )
        Predose: Cycle 7 D 1 N=1,3,4
    332000 ( 99999 )
    307000 ( 153000 )
    376000 ( 140000 )
        Predose: Cycle 10 D 1 N=1,0,2
    336000 ( 99999 )
    999999 ( 999999 )
    361000 ( 345000 )
        Predose: Cycle 13 D 1 N=1,0,1
    295000 ( 99999 )
    999999 ( 999999 )
    624000 ( 99999 )
        Anytime: Up to D 358 N=9,6,2
    445000 ( 337000 )
    179000 ( 131000 )
    86000 ( 34000 )
    No statistical analyses for this end point

    Secondary: Percentage of Participants With Positive Anti-magrolimab Antibodies

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    End point title
    Percentage of Participants With Positive Anti-magrolimab Antibodies
    End point description
    Percentage of participants who had treatment induced or treatment-boosted anti-drug antibody (ADA) based on participants who had non-missing baseline ADA sample and at least one post-treatment ADA result reported in Immunogenicity Analysis Set. Treatment-Induced ADA: participants who had negative baseline ADA sample and at least one positive post-treatment ADA sample based on participants who had both non-missing baseline and at least one post-treatment ADA result reported. Treatment-Boosted ADA: participants who had positive baseline ADA sample and at least one positive post-treatment ADA sample and the (max titer of the posttreatment ADA)/(titer of baseline ADA) >= 4. The Immunogenicity Analysis Set included all enrolled participants who received at least 1 dose of magrolimab and have at least 1 evaluable anti-magrolimab antibody test result. As prespecified analysis, data for Safety Run-in and corresponding Dose-expansion cohorts were combined for all 3 arms.
    End point type
    Secondary
    End point timeframe
    Up to Day 358
    End point values
    Magrolimab+Daratumumab Magrolimab+Pomalidomide+Dexamethasone Magrolimab+Carfilzomib+Dexamethasone
    Number of subjects analysed
    10
    8
    10
    Units: percentage of participants
        number (not applicable)
    0
    0
    0
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    All-cause mortality (ACM): Up to 1.5 years; Adverse events (AE): Up to 1.3 years plus 70 days
    Adverse event reporting additional description
    ACM: The All Enrolled Analysis Set included all participants who received a study patient identification number after screening. AE: Participants in the Safety Analysis Set were analyzed. As prespecified analysis, data for Safety Run-in and corresponding Dose-expansion cohorts were combined for all 3 arms.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    27
    Reporting groups
    Reporting group title
    Magrolimab+Daratumumab
    Reporting group description
    Participants in Safety Run-in and Dose-expansion period with relapsed/refractory multiple myeloma who have had 3 or more prior therapies including an IMiD and a PI received magrolimab IV 1 mg/kg on Day 1 and 30 mg/ kg on Days 8, 15, 22, 29 of Cycle 1; 30 mg/kg every week on Days 1, 8, 15, 22 of Cycle 2; 30 mg/kg on Days 1, 15 from Cycle 3 onwards. Participants also received daratumumab 1800 mg SC or 16 mg/kg IV on Days 8, 15, 22, 29 of Cycle 1; Days 1, 8, 15, 22 of Cycle 2; and Days 1, 15 (every 2 weeks) until Cycle 6 (total of 8 doses) followed by Day 1 (every 4 weeks) for subsequent cycles. (Cycle 1=35 days, All other Cycles=28 days).

    Reporting group title
    Magrolimab+Carfilzomib +Dexamethasone
    Reporting group description
    Participants in Safety Run-in and Dose-expansion period with relapsed/refractory multiple myeloma who have had 3 or more prior therapies including an IMiD and a PI received magrolimab IV 1 mg/kg on Day 1 and 30 mg/ kg on Days 8, 15, 22, 29 of Cycle 1; 30 mg/kg every week on Days 1, 8, 15, 22 of Cycle 2; 30 mg/kg on Days 1, 15 from Cycle 3 onwards. Participants also received carfilzomib IV 20 mg/m^2 on Days 8, 15, 22 of Cycle 1; Days 1, 8, 15 of Cycle 2 and onward (if the carfilzomib starting dose of 20 mg/m^2 was tolerated after Cycle 1, Day 8, the dose was escalated to 70 mg/m^2 on Cycle 1, Day 15 and thereafter) and dexamethasone orally or IV 40 mg on Days 8, 15, 22, 29 of Cycle 1; Days 1, 8, 15, 22 of Cycles 2 to 9 and then Days 1, 8, 15 from Cycle 10 and onward. (Cycle 1=35 days, All other Cycles=28 days).

    Reporting group title
    Magrolimab+Pomalidomide +Dexamethasone
    Reporting group description
    Participants in Safety Run-in and Dose-expansion period with relapsed/refractory multiple myeloma who have had 3 or more prior therapies including an IMiD and a PI received magrolimab IV 1 mg/kg on Day 1 and 30 mg/ kg on Days 8, 15, 22, 29 of Cycle 1; 30 mg/kg every week on Days 1, 8, 15, 22 of Cycle 2; 30 mg/kg on Days 1, 15 from Cycle 3 onwards. Participants also received pomalidomide orally 4 mg on Days 1 to 21 (daily) of Cycle 1 and onward and dexamethasone orally 40 mg on Days 1, 8, 15, 22, 29 of Cycle 1; Days 1, 8, 15, 22 of Cycle 2 and onward. (Cycle 1=35 days, All other Cycles=28 days).

    Serious adverse events
    Magrolimab+Daratumumab Magrolimab+Carfilzomib +Dexamethasone Magrolimab+Pomalidomide +Dexamethasone
    Total subjects affected by serious adverse events
         subjects affected / exposed
    5 / 14 (35.71%)
    4 / 11 (36.36%)
    5 / 10 (50.00%)
         number of deaths (all causes)
    4
    0
    4
         number of deaths resulting from adverse events
    0
    0
    0
    Injury, poisoning and procedural complications
    Hip fracture
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infusion related reaction
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Vascular disorders
    Deep vein thrombosis
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Surgical and medical procedures
    Assisted suicide
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
    Blood and lymphatic system disorders
    Febrile neutropenia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Anaemia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    2 / 2
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Musculoskeletal and connective tissue disorders
    Pathological fracture
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Infections and infestations
    Pneumonia
         subjects affected / exposed
    0 / 14 (0.00%)
    2 / 11 (18.18%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    2 / 2
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Acute sinusitis
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Bacteraemia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Covid-19 pneumonia
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Febrile infection
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Klebsiella urinary tract infection
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 1
    Sepsis
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Upper respiratory tract infection
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Metabolism and nutrition disorders
    Hyponatraemia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Magrolimab+Daratumumab Magrolimab+Carfilzomib +Dexamethasone Magrolimab+Pomalidomide +Dexamethasone
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    14 / 14 (100.00%)
    11 / 11 (100.00%)
    10 / 10 (100.00%)
    Vascular disorders
    Hypertension
         subjects affected / exposed
    2 / 14 (14.29%)
    1 / 11 (9.09%)
    2 / 10 (20.00%)
         occurrences all number
    2
    1
    2
    Hypotension
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    1
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    6 / 14 (42.86%)
    6 / 11 (54.55%)
    3 / 10 (30.00%)
         occurrences all number
    8
    6
    3
    Oedema peripheral
         subjects affected / exposed
    1 / 14 (7.14%)
    3 / 11 (27.27%)
    1 / 10 (10.00%)
         occurrences all number
    1
    3
    1
    Pyrexia
         subjects affected / exposed
    2 / 14 (14.29%)
    2 / 11 (18.18%)
    1 / 10 (10.00%)
         occurrences all number
    3
    2
    1
    Chills
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Peripheral swelling
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    1
    Influenza like illness
         subjects affected / exposed
    1 / 14 (7.14%)
    2 / 11 (18.18%)
    0 / 10 (0.00%)
         occurrences all number
    1
    2
    0
    Asthenia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    2 / 10 (20.00%)
         occurrences all number
    1
    0
    2
    Non-cardiac chest pain
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Gait disturbance
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Immune system disorders
    Hypogammaglobulinaemia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    3 / 14 (21.43%)
    4 / 11 (36.36%)
    3 / 10 (30.00%)
         occurrences all number
    3
    5
    3
    Cough
         subjects affected / exposed
    1 / 14 (7.14%)
    4 / 11 (36.36%)
    2 / 10 (20.00%)
         occurrences all number
    1
    5
    2
    Nasal congestion
         subjects affected / exposed
    3 / 14 (21.43%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    4
    1
    1
    Dysphonia
         subjects affected / exposed
    1 / 14 (7.14%)
    2 / 11 (18.18%)
    0 / 10 (0.00%)
         occurrences all number
    1
    2
    0
    Epistaxis
         subjects affected / exposed
    0 / 14 (0.00%)
    2 / 11 (18.18%)
    0 / 10 (0.00%)
         occurrences all number
    0
    2
    0
    Oropharyngeal pain
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    1
    0
    1
    Upper-airway cough syndrome
         subjects affected / exposed
    0 / 14 (0.00%)
    2 / 11 (18.18%)
    0 / 10 (0.00%)
         occurrences all number
    0
    2
    0
    Wheezing
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    1
    1
    0
    Rhinorrhoea
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    2
    0
    Dyspnoea exertional
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Psychiatric disorders
    Depression
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Anxiety
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Insomnia
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 11 (9.09%)
    3 / 10 (30.00%)
         occurrences all number
    1
    1
    3
    Product issues
    Device breakage
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Investigations
    Platelet count decreased
         subjects affected / exposed
    2 / 14 (14.29%)
    7 / 11 (63.64%)
    3 / 10 (30.00%)
         occurrences all number
    2
    8
    3
    Neutrophil count decreased
         subjects affected / exposed
    2 / 14 (14.29%)
    2 / 11 (18.18%)
    4 / 10 (40.00%)
         occurrences all number
    2
    4
    7
    White blood cell count decreased
         subjects affected / exposed
    2 / 14 (14.29%)
    3 / 11 (27.27%)
    2 / 10 (20.00%)
         occurrences all number
    2
    5
    2
    Lymphocyte count decreased
         subjects affected / exposed
    0 / 14 (0.00%)
    2 / 11 (18.18%)
    2 / 10 (20.00%)
         occurrences all number
    0
    2
    2
    Blood creatinine increased
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 11 (9.09%)
    3 / 10 (30.00%)
         occurrences all number
    1
    4
    3
    Blood bilirubin increased
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    1
    C-reactive protein increased
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    2 / 10 (20.00%)
         occurrences all number
    0
    0
    2
    Alanine aminotransferase increased
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Blood lactate dehydrogenase increased
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    2
    0
    Blood calcium increased
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Blood uric acid increased
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Weight decreased
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Injury, poisoning and procedural complications
    Fall
         subjects affected / exposed
    1 / 14 (7.14%)
    2 / 11 (18.18%)
    1 / 10 (10.00%)
         occurrences all number
    1
    3
    1
    Contusion
         subjects affected / exposed
    1 / 14 (7.14%)
    3 / 11 (27.27%)
    0 / 10 (0.00%)
         occurrences all number
    1
    4
    0
    Infusion related reaction
         subjects affected / exposed
    4 / 14 (28.57%)
    2 / 11 (18.18%)
    0 / 10 (0.00%)
         occurrences all number
    4
    2
    0
    Rib fracture
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Humerus fracture
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Fracture
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Cardiac disorders
    Palpitations
         subjects affected / exposed
    0 / 14 (0.00%)
    2 / 11 (18.18%)
    1 / 10 (10.00%)
         occurrences all number
    0
    2
    1
    Atrial fibrillation
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Sinus tachycardia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Cardiac failure congestive
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Tachycardia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Nervous system disorders
    Headache
         subjects affected / exposed
    5 / 14 (35.71%)
    3 / 11 (27.27%)
    2 / 10 (20.00%)
         occurrences all number
    6
    4
    3
    Coordination abnormal
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Paraesthesia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    2
    0
    1
    Dizziness
         subjects affected / exposed
    1 / 14 (7.14%)
    2 / 11 (18.18%)
    0 / 10 (0.00%)
         occurrences all number
    1
    2
    0
    Presyncope
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Peripheral sensory neuropathy
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Dysgeusia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Dysaesthesia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Disturbance in attention
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    7 / 14 (50.00%)
    6 / 11 (54.55%)
    6 / 10 (60.00%)
         occurrences all number
    7
    11
    6
    Thrombocytopenia
         subjects affected / exposed
    2 / 14 (14.29%)
    3 / 11 (27.27%)
    2 / 10 (20.00%)
         occurrences all number
    2
    4
    6
    Neutropenia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    2 / 10 (20.00%)
         occurrences all number
    0
    1
    4
    Haemolysis
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Ear and labyrinth disorders
    Vertigo
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    2
    Eye disorders
    Vision blurred
         subjects affected / exposed
    2 / 14 (14.29%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    3
    0
    0
    Dry eye
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Eyelid oedema
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Eye pain
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    4 / 14 (28.57%)
    4 / 11 (36.36%)
    3 / 10 (30.00%)
         occurrences all number
    4
    7
    3
    Nausea
         subjects affected / exposed
    5 / 14 (35.71%)
    3 / 11 (27.27%)
    3 / 10 (30.00%)
         occurrences all number
    5
    3
    4
    Constipation
         subjects affected / exposed
    2 / 14 (14.29%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    2
    1
    0
    Abdominal pain
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    2
    1
    1
    Vomiting
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    2
    1
    1
    Dental caries
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    1
    1
    0
    Abdominal discomfort
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Dry mouth
         subjects affected / exposed
    2 / 14 (14.29%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    0
    Abdominal distension
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Gastrooesophageal reflux disease
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Dyspepsia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Gingival pain
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Stomatitis
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Mouth haemorrhage
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Skin and subcutaneous tissue disorders
    Pruritus
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    1
    Dermal cyst
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Erythema
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Hyperhidrosis
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Purpura
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    2
    0
    Rash
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Rash maculo-papular
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Renal and urinary disorders
    Acute kidney injury
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    2 / 10 (20.00%)
         occurrences all number
    0
    0
    2
    Haematuria
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    1
    Chronic kidney disease
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    0
    Proteinuria
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Renal failure
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Musculoskeletal and connective tissue disorders
    Arthralgia
         subjects affected / exposed
    2 / 14 (14.29%)
    2 / 11 (18.18%)
    2 / 10 (20.00%)
         occurrences all number
    2
    2
    2
    Spinal pain
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    2 / 10 (20.00%)
         occurrences all number
    0
    1
    2
    Bone pain
         subjects affected / exposed
    2 / 14 (14.29%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    2
    1
    1
    Muscle spasms
         subjects affected / exposed
    0 / 14 (0.00%)
    3 / 11 (27.27%)
    0 / 10 (0.00%)
         occurrences all number
    0
    3
    0
    Muscular weakness
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    2 / 10 (20.00%)
         occurrences all number
    0
    1
    2
    Back pain
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    1
    Pain in extremity
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Musculoskeletal stiffness
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Joint swelling
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    2
    0
    Musculoskeletal chest pain
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    1
    Pathological fracture
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Infections and infestations
    Urinary tract infection
         subjects affected / exposed
    1 / 14 (7.14%)
    2 / 11 (18.18%)
    2 / 10 (20.00%)
         occurrences all number
    2
    3
    3
    Respiratory tract infection
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    3 / 10 (30.00%)
         occurrences all number
    1
    0
    3
    Sinusitis
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 11 (9.09%)
    2 / 10 (20.00%)
         occurrences all number
    1
    1
    2
    Upper respiratory tract infection
         subjects affected / exposed
    2 / 14 (14.29%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    2
    1
    1
    Bronchitis
         subjects affected / exposed
    0 / 14 (0.00%)
    3 / 11 (27.27%)
    0 / 10 (0.00%)
         occurrences all number
    0
    3
    0
    Covid-19
         subjects affected / exposed
    1 / 14 (7.14%)
    2 / 11 (18.18%)
    0 / 10 (0.00%)
         occurrences all number
    1
    2
    0
    Pneumonia
         subjects affected / exposed
    1 / 14 (7.14%)
    2 / 11 (18.18%)
    0 / 10 (0.00%)
         occurrences all number
    1
    2
    0
    Enterocolitis infectious
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Candida infection
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    2
    0
    0
    Bacteraemia
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Influenza
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Skin infection
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Lower respiratory tract infection
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Viral infection
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Tonsillitis
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Metabolism and nutrition disorders
    Hyperkalaemia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    1
    Hypomagnesaemia
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 11 (9.09%)
    2 / 10 (20.00%)
         occurrences all number
    1
    1
    3
    Hypoalbuminaemia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    1 / 10 (10.00%)
         occurrences all number
    0
    1
    1
    Decreased appetite
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    1
    0
    0
    Hyponatraemia
         subjects affected / exposed
    1 / 14 (7.14%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    1
    2
    0
    Hypokalaemia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    4
    0
    1
    Dehydration
         subjects affected / exposed
    0 / 14 (0.00%)
    0 / 11 (0.00%)
    1 / 10 (10.00%)
         occurrences all number
    0
    0
    1
    Hypocalcaemia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    7
    0
    Hypophosphataemia
         subjects affected / exposed
    1 / 14 (7.14%)
    0 / 11 (0.00%)
    0 / 10 (0.00%)
         occurrences all number
    4
    0
    0
    Hypercalcaemia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    1
    0
    Hyperglycaemia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    7
    0
    Hyperuricaemia
         subjects affected / exposed
    0 / 14 (0.00%)
    1 / 11 (9.09%)
    0 / 10 (0.00%)
         occurrences all number
    0
    2
    0

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    18 Mar 2021
    Amendment 1: • Address changes based on feedback from the Food and Drug Administration (FDA). • Target population was amended per FDA request. • Eligibility criteria was amended per FDA request. • The information related to dose limiting toxicity was amended per FDA request. • Study stopping rules based on a specified rate of unacceptable toxicity were added per FDA recommendation. • Inclusion criteria pertaining to previous lines of therapy for MM were amended per FDA request. • Exclusion criteria pertaining to dose of prednisone was amended per FDA request. • The information on route of administration of daratumumab was modified to provide clarity. • The information on dose modification and delays of magrolimab was modified to provide more clarity. • The information on bone marrow assessments was modified to provide more clarity. • The text on management of infusion related reactions was modified to provide more clarity. • New section on ‘Management of Pneumonitis’ was added per FDA request. • New section on ‘Management of Other Non-hematologic Adverse Events’ was added per FDA request. • The text on formulations of daratumumab was modified to provide more clarity. • The text toxicity management of pomalidomide was modified to provide more clarity. • The text for referring applicable product’s label for bortezomib was added. • New references were added for ‘Treatment-Related Toxicity monitoring’. • X added to line for Urine Immunofixation (UIFE), for consistency with Section 6.5.1 of the protocol. • The schedule of assessments (SOA) table was updated to specify peripheral smear separately. • Antidrug antibody sampling once in 12 weeks (Q12W) was removed from table.
    05 May 2021
    Amendment 2: • Changes to inclusion criteria #11: Updated to mitigate against a drop in hemoglobin with the initial dosing of magrolimab. Changes to inclusion criteria #22 and #25, and removal of inclusion criteria #21, #24, and #28: Updated based on feedback from external experts in the field of multiple myeloma in order to select appropriate patients for the study. Addition of inclusion criteria #21: Updated to ensure consistency with inclusion criteria for other combination arms. • Study Schema was updated to include 3 prior therapies, in line with Amendment 1. • Information related to time interval between completion of magrolimab infusion/injection and the initiation of daratumumab was removed. Daratumumab should be given before magrolimab with a 1 hour observation period in between. • Information on magrolimab discontinuation was amended per FDA request. • Corrected an error. Updated dosing duration in line with USPI for dosing days and cycle length for dose reductions.
    12 Oct 2021
    Amendment 3: • Text was added to allow use of approved generic or a biosimilar for combination agents. • New section was added to provide a description and summary of clinical data for carfilzomib. • The description of bortezomib was updated to remove redundant text that was added to a previous section. • Text was added to add a rationale for carfilzomib as the preferred proteasome inhibitor. • Study schema was updated to add carfilzomib as the preferred proteasome inhibitor. • The section 3.1.1. Safety Run-in Cohorts was updated to remove the need for additional safety follow-up evaluation based on the updated Cycle 3 dose for magrolimab. • Text updated to section 3.8.2. Pharmacokinetics/Biomarker Samples for Optional Future Research to include buccal samples. • Inclusion criteria was updated to indicate requirements for previous lines of therapy for patients. • Inclusion criteria were updated to add requirements for previous lines of therapy for patients who will receive magrolimab in combination with daratumumab. • Inclusion criteria were updated to add requirements for previous lines of therapy for patients who will receive magrolimab in combination with pomalidomide and dexamethasone. • Inclusion criteria were updated to add requirements for previous lines of therapy for patients who will receive magrolimab in combination with carfilzomib and dexamethasone. • Inclusion criteria were updated to add criteria for patients who will receive magrolimab in combination with bortezomib and dexamethasone. • Exclusion criteria was added to exclude patients who received any live vaccine within 4 weeks prior to treatment. • Text was updated to expand description of physical appearance of magrolimab. • New section was added to include a description of the formulation, packaging and labeling, and storage and handling of carfilzomib. • Text was updated to add a window for magrolimab dosing.
    12 Oct 2021
    Amendment 3: • New section was added to give instructions for dosage and administration of carfilzomib and dexamethasone. • Text was added to Magrolimab section to give guidance regarding dose delays and interruptions for the combination drugs. • Table 11 was updated to reflect new dosing regimen for magrolimab from Cycle 3 onwards. • Text was deleted to update guidance regarding dose delays and interruptions of daratumumab. • Text was updated to add recommendations for carfilzomib dose modifications and delays based on toxicity. • Text was added to clarify that live vaccines are prohibited before and during the study. • Table was updated to clarify prohibited prior medications for drug combinations with magrolimab. • Text added to clarify allowance of COVID-19 vaccines. • Text was revised to clarify type and screen procedures. • Text was updated to give instructions for toxicity management for carfilzomib. • The section was added to give instructions for toxicity management for carfilzomib. • The appendix was updated to include guidance for pregnancy and contraception for carfilzomib.
    31 Mar 2022
    Amendment 4: • Inclusion Criterion #10 (Section 4.2) was updated to indicate that hemoglobin level must be ≥ 9 g/dL prior to initial dose of study treatment. • Inclusion Criterion #11 (Section 4.2) was removed as there is no added clinical advantage of necessitating a hemoglobin threshold of 9.5 g/dL or more in patients with cardiac comorbidities. • Inclusion Criterion #20 (Section 4.2) was updated to remove the requirement for patients to have CD38-positive multiple myeloma. • Additional clarification on timing of magrolimab premedication was added to Section 5.3.1. • Type and Screen and Direct Antiglobulin Test (Section 6.2.2) was updated to remove details from this section and refer to Section 7.8.1.1. • Dosage and Administration of Magrolimab (Section 5.3.1) and Laboratory Assessments (Section 6.4.2) were updated to link to the hemoglobin monitoring and testing requirements detailed in Section 7.8.1.1. • Anemia management described in Anemia, Blood Cross-matching, and Packed Red Blood Cell Transfusion Procedures (Section 7.8.1.1) and its subsections was updated to clarify the risk of anemia in the first 2 weeks of treatment and provide additional guidance for enhanced anemia management. Updates include adding the requirement to confirm hemoglobin level prior to magrolimab dosing and within 24 hours after the first 2 doses of magrolimab. • Thromboembolic Events (Section 7.8.1.3) text was added to match the investigator’s brochure (IB) Edition 9. • Hemagglutination and Microangiopathy text was deleted from Section 7.8.1.3 Toxicity Management to match the IB Edition 9. • Text was updated to align the publications language in the clinical trial agreement (Section 9.2.2).
    31 Mar 2022
    Amendment 4: • Appendix 10 was added to include the Myeloma Frailty Score Calculator Additional change(s) to the protocol include the following: • Administrative, editorial, and formatting updates, changes, corrections, and clarifications were made throughout, where appropriate, including section numbering and references. • Changes in the body of the protocol were also updated in the synopsis and study procedures tables, as appropriate.
    31 May 2022
    Amendment 5: • Lowered the stopping boundary due to toxicity from greater than 33% to greater than 25% of patients experiencing a Grade 4 or higher treatment related AE (Section 3.1.3; Table 3) in order to increase patient safety during the dose expansion phase of the study. • Clarified the process for analyzing bone marrow samples during screening. (Section 6.2). • Clarified the processes for investigator evaluation of disease response assessments by providing additional detail regarding which assessments would be analyzed at the central laboratory versus locally (Section 6.5.2 and 6.5.4).
    02 Nov 2023
    Amendment 6: • Removal of posttreatment follow-up for disease progression and survival follow-up assessments and secondary endpoints for progression-free survival (PFS) and overall (OS) as efficacy data will no longer be collected after the end-of-treatment (EOT) visit. • Removal of exploratory endpoint for minimal residual disease (MRD) negativity rate as central laboratory assessment of MRD is no longer required. • Removal of exploratory endpoints/analyses to evaluate the association of each biomarker or combination of biomarkers with clinical outcomes as there are no plans to perform these analyses anymore. • Guidance for the use of corticosteroids as premedication for the first few infusions of magrolimab has been incorporated to align with the information in Edition 12 of the Investigator’s Brochure. • Clarification of standard of care procedure language incorporated from Administrative Amendment 1 for Protocol Amendment 5. • Removal of receptor occupancy assessment. • Removal of the requirement for multiple myeloma, tumor response, and bone marrow assessments to be performed by a central laboratory. These assessments may now be performed by a central or local laboratory based on investigator preference. • Removal of FACT-MM questionnaire assessment as patient-reported outcome data are no longer required. • Guidance for the management of infusion-related reactions has been updated to incorporate the use of corticosteroids as premedication during the first few infusions of magrolimab, and to incorporate guidance for discontinuation of magrolimab in certain cases. This was done to align with the information in Edition 12 of the Investigator’s Brochure. • Toxicity management section for magrolimab has been updated to include guidelines for dose delay and discontinuation in case of severe neutropenia and serious infections to align with the information in Edition 12 of the Investigator’s Brochure.
    02 Nov 2023
    Amendment 6: • Clarification that assessment of quantitative Ig levels is to be performed for patients with IgA and IgD myelomas to align with Section 6.5.1. • Contraception appendix has been updated to reflect the latest nonclinical embryo-fetal development toxicity data. • Global Patient Safety (GLPS) has been updated to Patient Safety (PS) to reflect the new department name.

    Interruptions (globally)

    Were there any global interruptions to the trial? Yes
    Date
    Interruption
    Restart date
    25 Apr 2024
    The study was terminated early due to the Sponsor's decision to discontinue development of the investigational drug and program closure.
    -

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/36779512
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