This phase II trial test whether combination chemotherapy works to improve blood test results in patients with high-risk multiple myeloma. Chemotherapy drugs, such as carfilzomib, daratumumab, lenalidomide, and dexamethasone, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. This trial may help determine if patients who have a small amount of cancer left after the initial treatment, called minimal residual disease, will benefit from the drug combination.
PRIMARY OBJECTIVE: I. To estimate the rate of sustained minimal residual disease (MRD) negativity (MRD negative status at any point, with a repeated MRD negative status one year later) in subjects with high-risk multiple myeloma. SECONDARY OBJECTIVES: I. To describe the toxicities associated with this treatment approach in subjects with high-risk multiple myeloma (MM). II. To estimate the overall response rate, very good partial response (VGPR) or better rate and complete response (CR) rate at the end of induction, end of consolidation, end of maintenance and at two years after the completion of treatment. III. To estimate the progression-free survival and overall survival rate. CORRELATIVE RESEARCH OBJECTIVES: I. To describe the clonal architecture through a combination of genomic, epigenomic, proteomic and metabolomic studies before and after treatment, in subjects with high-risk MM. II. To describe the bone marrow microenvironment through various stages of treatment and the time of MRD negative state and at time of relapse. OUTLINE: INDUCTION: Patients receive carfilzomib intravenously (IV) on days 1, 2, 8, and 15 of cycle 1 and days 1, 8, and 15 of cycles 2-12, lenalidomide orally (PO) days 1-21 of each cycle, daratumumab subcutaneously (SC) days 1, 8, 15, and 22 of cycles 1 and 2, days 1 and 15 of cycles 3-6, and day 1 of subsequent cycles, and dexamethasone PO or IV on days 1, 8, 15, and 22 of each cycle. Treatment repeats every 28 days for 12 cycles in the absence of disease progression or unacceptable toxicity. CONSOLIDATION: Patients receive carfilzomib IV on days 1, 8, and 15, lenalidomide PO days 1-21, daratumumab SC day 1 of each cycle. Treatment repeats every 28 days for 12 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE: Patients receive carfilzomib IV on day 1, lenalidomide PO days 1-21, daratumumab SC day 1 of each cycle. Treatment repeats every 28 days for 12 cycles in the absence of disease progression or unacceptable toxicity. Additionally, patients undergo bone marrow aspirate and biopsy, blood sample collection, echocardiography (ECHO) or multigated acquisition (MUGA) scan, and magnetic resonance imaging (MRI), computed tomography (CT), or positron emission tomography (PET)/CT throughout the study. Patients also undergo chest radiography (x-ray) during screening. After completion of study treatment, patients are followed up every 6 months for up to 10 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
17
Undergo bone marrow aspiration and biopsy
Given IV
Undergo CT or PET/CT
Given SC
Given IV/PO
Given PO
Undergo MRI
Undergo PET/CT
Undergo MUGA scan
Undergo blood sample collection
Undergo ECHO
Undergo chest x-ray
Mayo Clinic in Arizona
Scottsdale, Arizona, United States
Mayo Clinic
Jacksonville, Florida, United States
Mayo Clinic in Rochester
Rochester, Minnesota, United States
Rate of sustained minimal residual disease (MRD) negativity
MRD negative status at any point, with a repeated MRD negative status one year later. All subjects meeting the eligibility criteria who have signed a consent form and have begun treatment will be evaluable, with the exception of subjects determined to be a major violation.
Time frame: At 1 year
Overall response rate (>= confirmed very good partial response ([VGPR])
Exact binomial 95% confidence intervals for the true response proportion at each time point will be calculated.
Time frame: End of induction, end of consolidation, and every 3 cycles of maintenance, up to two years or 24. One cycle is 28 days. after treatmentmonths
Overall survival
Defined as the time from registration to death due to any cause. The distribution of overall survival will be estimated using the method of Kaplan-Meier.
Time frame: Up to 10 years
Progression-free survival
Defined as the time from registration to the earliest date of documentation of disease progression or death due to any cause. The distribution of progression-free survival will be estimated using the method of Kaplan-Meier.
Time frame: Up to 10 years
Incidence of adverse events
Adverse Events: All eligible subjects that have initiated treatment will be considered evaluable for assessing adverse event rate(s). The maximum grade for each type of adverse event will be recorded for each subject, and frequency tables will be reviewed to determine patterns. Additionally, the relationship of the adverse event(s) to the trial treatment will be taken into consideration. AEs will be summarized overall, as well as by treatment phase (induction, consolidation, maintenance with carfilzomib and lenalidomide and daratumumab).
Time frame: Up to 30 days after administration of study therapy
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