This phase II trial studies how well carfilzomib, lenalidomide, and dexamethasone before and after stem cell transplant works in treating patients with newly diagnosed multiple myeloma. Carfilzomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Biological therapies, such as lenalidomide, may stimulate the immune system in different ways and stop cancer cells from growing. Drugs used in chemotherapy, such as dexamethasone, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from diving. Giving carfilzomib, lenalidomide, and dexamethasone before and after stem cell transplant may kill more cancer cells
PRIMARY OBJECTIVES: I. To determine the rate of stringent complete response (CR) (sCR) after 8 cycles of CRd (4 cycles of induction + autologous stem cell transplant \[ASCT\] + 4 cycles of carfilzomib, lenalidomide, and low dose dexamethasone \[CRd\] consolidation). SECONDARY OBJECTIVES: I. Overall response rate defined as partial response or better (\>= partial response \[PR\]) including the rate of very good partial response (VGPR) or better (\>= VGPR) and near complete response or better (sCR/CR/nCR) across entire treatment in high risk and low risk patients. II. Duration of response (DOR), progression free survival (PFS), time to progression (TTP), and overall survival (OS). TERTIARY OBJECTIVES: I. Determination of the rate of minimal residual disease in patients who achieved CR. II. Prospective evaluation of candidate markers of response to CRd established in the completed CRd trial. III. Evaluation of markers of response and duration of response to treatment strategy using CRd with or without transplant. OUTLINE: INDUCTION THERAPY: Patients receive dexamethasone intravenously (IV) or orally (PO) once daily (QD) on days 1, 8, 15 and 22; carfilzomib IV over 10-30 minutes on days 1, 2, 8, 9, 15, and 16; and lenalidomide PO QD on days 1-21. Treatment repeats every 28 days for 4 courses in the absence of disease progression or unacceptable toxicity.. TRANSPLANT: Patients undergo autologous stem cell transplant. CONSOLIDATION THERAPY: Patients receive dexamethasone, carfilzomib, and lenalidomide as in induction. Treatment repeats every 28 days for 4 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive dexamethasone and lenalidomide as in induction therapy and carfilzomib IV over 30 minutes on days 1, 2, 15, and 16. Treatment repeats every 28 days for 10 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 2 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
76
Given IV or PO
Given IV
Given PO
Undergo autologous hematopoietic stem cell transplant
Correlative studies
University of Chicago Comprehensive Cancer Center
Chicago, Illinois, United States
Dana Farber
Boston, Massachusetts, United States
Washington University in St Louis
St Louis, Missouri, United States
Sarah Cannon Cancer Center
Nashville, Tennessee, United States
Princess Margaret
Toronto, Ontario, Canada
Percentage of Patients Achieving sCR
The percentage of stringent complete response (CR) (sCR) will be reported along with 95% confidence intervals, adjusted for the two-stage nature of the trial design.
Time frame: Day 224
Overall Response Rate, Defined as at Least a Partial Response to Therapy (> PR), at Least Very Good Partial Response (VGPR) and at Least Near Complete Response (nCR) Rate
Reported along with its exact 95% binomial confidence interval.
Time frame: Up to 5 years
Time to Progression
Estimated using the product-limit method of Kaplan and Meier.
Time frame: Up to 5 years
Duration of Response
Reported along with its exact 95% binomial confidence interval. Estimated using the product-limit method of Kaplan and Meier.
Time frame: Up to 5 years
Percentage of Participants With Progression-free Survival (PFS)
Progression-free Survival rate was estimated at months 12, 24, 36, 48, and 60, by the product-limit method of Kaplan and Meier.
Time frame: Up to 5 years
Percentage of Participants With Overall Survival (OS)
Overall survival rate was estimated at months 12, 24, 36, 48, and 60, by the product-limit method of Kaplan and Meier.
Time frame: Up to 5 years
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