²¹¹At-OKT10-B10 and Fludarabine Alone or in Combination With Cyclophosphamide and Low-Dose TBI Before Donor Stem Cell Transplant for the Treatment of Newly Diagnosed, Recurrent, or Refractory High-Risk Multiple Myeloma

Studies

Study First Submitted Date 2020-09-23
Study First Posted Date 2020-10-08
Last Update Posted Date 2023-05-06
Start Month Year November 1, 2023
Primary Completion Month Year December 31, 2027
Verification Month Year May 2023
Verification Date 2023-05-31
Last Update Posted Date 2023-05-06

Detailed Descriptions

Sequence: 20718591
Description OUTLINE: This is a dose-escalation study of ²¹¹At-OKT10-B10. Patients are assigned to 1 of 2 arms. ARM A: Patients with HLA-matched related or unrelated donors receive ²¹¹At-OKT10-B10 intravenously (IV) on day -7 (day -10 to -5) and fludarabine IV over 30 minutes on days -4 to -2. Patients then undergo TBI and allogeneic HCT on day 0. ARM B: Patients with HLA-matched haploidentical donors receive ²¹¹At-OKT10-B10 IV on day -8 (day -14 to -7), fludarabine IV over 30 minutes on days -6 to -2, and cyclophosphamide IV over 1 hour on day -6 and -5. Patients then undergo TBI on day -1 and allogeneic HCT on day 0.

Facilities

Sequence: 200073846
Name Fred Hutch/University of Washington Cancer Consortium
City Seattle
State Washington
Zip 98109
Country United States

Facility Contacts

Sequence: 28100329
Facility Id 200073846
Contact Type primary
Name Damian Green
Email dgreen@fredhutch.org
Phone 206-667-5398

Facility Investigators

Sequence: 18327872
Facility Id 200073846
Role Principal Investigator
Name Damian Green

Browse Interventions

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Mesh Term Immunologic Factors Mesh Term Cyclophosphamide Mesh Term Fludarabine Mesh Term Fludarabine phosphate Mesh Term Daratumumab Mesh Term Antineoplastic Agents, Immunological Mesh Term Antibodies Mesh Term Immunoglobulins Mesh Term Antibodies, Monoclonal Mesh Term Immunosuppressive Agents Mesh Term Physiological Effects of Drugs Mesh Term Antirheumatic Agents Mesh Term Antineoplastic Agents, Alkylating Mesh Term Alkylating Agents Mesh Term Molecular Mechanisms of Pharmacological Action Mesh Term Antineoplastic Agents Mesh Term Myeloablative Agonists Mesh Term Antimetabolites, Antineoplastic Mesh Term Antimetabolites
Downcase Mesh Term immunologic factors Downcase Mesh Term cyclophosphamide Downcase Mesh Term fludarabine Downcase Mesh Term fludarabine phosphate Downcase Mesh Term daratumumab Downcase Mesh Term antineoplastic agents, immunological Downcase Mesh Term antibodies Downcase Mesh Term immunoglobulins Downcase Mesh Term antibodies, monoclonal Downcase Mesh Term immunosuppressive agents Downcase Mesh Term physiological effects of drugs Downcase Mesh Term antirheumatic agents Downcase Mesh Term antineoplastic agents, alkylating Downcase Mesh Term alkylating agents Downcase Mesh Term molecular mechanisms of pharmacological action Downcase Mesh Term antineoplastic agents Downcase Mesh Term myeloablative agonists Downcase Mesh Term antimetabolites, antineoplastic Downcase Mesh Term antimetabolites
Mesh Type mesh-ancestor Mesh Type mesh-list Mesh Type mesh-list Mesh Type mesh-list Mesh Type mesh-list Mesh Type mesh-list Mesh Type mesh-list Mesh Type mesh-list Mesh Type mesh-list Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor

Conditions

Sequence: 52162495 Sequence: 52162496 Sequence: 52162497
Name Plasma Cell Myeloma Name Recurrent Plasma Cell Myeloma Name Refractory Plasma Cell Myeloma
Downcase Name plasma cell myeloma Downcase Name recurrent plasma cell myeloma Downcase Name refractory plasma cell myeloma

Id Information

Sequence: 40152582 Sequence: 40152583 Sequence: 40152584 Sequence: 40152585
Id Source org_study_id Id Source secondary_id Id Source secondary_id Id Source secondary_id
Id Value RG1121028 Id Value NCI-2020-06835 Id Value 10467 Id Value P01CA078902
Id Type Registry Identifier Id Type Other Identifier Id Type U.S. NIH Grant/Contract
Id Type Description CTRP (Clinical Trial Reporting Program) Id Type Description Fred Hutch/University of Washington Cancer Consortium
Id Link https://reporter.nih.gov/quickSearch/P01CA078902

Countries

Sequence: 42561999
Name United States
Removed False

Design Groups

Sequence: 55584610 Sequence: 55584611
Group Type Experimental Group Type Experimental
Title Arm A (²¹¹At-OKT10-B10, fludarabine, TBI, HCT) Title Arm B (²¹¹At-OKT10-B10, chemotherapy, TBI, HCT)
Description Patients with HLA-matched related or unrelated donors receive ²¹¹At-OKT10-B10 IV on day -7 (day -10 to -5) and fludarabine IV over 30 minutes on days -4 to -2. Patients then undergo TBI and allogeneic HCT on day 0. Description Patients with HLA-matched haploidentical donors receive ²¹¹At-OKT10-B10 IV on day -8 (day -14 to -7), fludarabine IV over 30 minutes on days -6 to -2, and cyclophosphamide IV over 1 hour on day -6 and -5. Patients then undergo TBI on day -1 and allogeneic HCT on day 0.

Interventions

Sequence: 52477762 Sequence: 52477758 Sequence: 52477759 Sequence: 52477760 Sequence: 52477761
Intervention Type Radiation Intervention Type Procedure Intervention Type Biological Intervention Type Drug Intervention Type Drug
Name Total-Body Irradiation Name Allogeneic Hematopoietic Stem Cell Transplantation Name Astatine At 211 Anti-CD38 Monoclonal Antibody OKT10-B10 Name Cyclophosphamide Name Fludarabine Phosphate
Description Undergo TBI Description Undergo HCT Description Given IV Description Given IV Description Given IV

Design Outcomes

Sequence: 177349466 Sequence: 177349465 Sequence: 177349467 Sequence: 177349468 Sequence: 177349469 Sequence: 177349470
Outcome Type secondary Outcome Type primary Outcome Type secondary Outcome Type secondary Outcome Type secondary Outcome Type secondary
Measure Disease response Measure Maximum tolerated dose (MTD) of radiation delivered via ²¹¹At-OKT10-B10 Measure Duration of response Measure Minimal residual disease (MRD) Measure One-year disease -free survival Measure One-year overall survival (OS)
Time Frame Between days 70 to 90 post-transplant Time Frame Up to 100 days following HCT Time Frame From date of response assessment (days +70-90 following allogeneic HCT) until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 2 years Time Frame Between days 70 to 90 post-transplant Time Frame From allogeneic hematopoietic cell transplantation to disease progression, relapse or death, assessed at 1 year Time Frame From transplantation to death or last patient contact, assessed at 1 year
Description Definition of disease status will be performed using the established International Myeloma Working Group (IMWG) response criteria for stringent complete response, complete response, partial response (PR) and no response. Relapse is defined per IMWG criteria. The response rates (PR or better) will be estimated along with the exact 95% confidence interval. Description MTD is defined as the dose of ²¹¹At-OKT10-B10 associated with a true dose limiting toxicity (DLT) rate of 25%, where DLT is defined as grade III/IV regimen-related toxicity according to the Bearman Scale. Description Duration of response will be estimated using Kaplan-Meier methodology. Description MRD will be assessed in the comprehensive response evaluation/restaging. The proportion who achieve MRD will be estimated along with an exact 95% confidence interval. Description Kaplan-Meier methodology will be used to estimate the 1-year disease-free survival. Description Kaplan-Meier methodology will be used to estimate the 1-year OS.

Browse Conditions

Sequence: 193455179 Sequence: 193455170 Sequence: 193455171 Sequence: 193455172 Sequence: 193455173 Sequence: 193455174 Sequence: 193455175 Sequence: 193455176 Sequence: 193455177 Sequence: 193455178 Sequence: 193455180 Sequence: 193455181 Sequence: 193455182 Sequence: 193455183
Mesh Term Hematologic Diseases Mesh Term Multiple Myeloma Mesh Term Neoplasms, Plasma Cell Mesh Term Neoplasms by Histologic Type Mesh Term Neoplasms Mesh Term Hemostatic Disorders Mesh Term Vascular Diseases Mesh Term Cardiovascular Diseases Mesh Term Paraproteinemias Mesh Term Blood Protein Disorders Mesh Term Hemorrhagic Disorders Mesh Term Lymphoproliferative Disorders Mesh Term Immunoproliferative Disorders Mesh Term Immune System Diseases
Downcase Mesh Term hematologic diseases Downcase Mesh Term multiple myeloma Downcase Mesh Term neoplasms, plasma cell Downcase Mesh Term neoplasms by histologic type Downcase Mesh Term neoplasms Downcase Mesh Term hemostatic disorders Downcase Mesh Term vascular diseases Downcase Mesh Term cardiovascular diseases Downcase Mesh Term paraproteinemias Downcase Mesh Term blood protein disorders Downcase Mesh Term hemorrhagic disorders Downcase Mesh Term lymphoproliferative disorders Downcase Mesh Term immunoproliferative disorders Downcase Mesh Term immune system diseases
Mesh Type mesh-ancestor Mesh Type mesh-list Mesh Type mesh-list Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor Mesh Type mesh-ancestor

Sponsors

Sequence: 48311667 Sequence: 48311668
Agency Class OTHER Agency Class NIH
Lead Or Collaborator lead Lead Or Collaborator collaborator
Name Fred Hutchinson Cancer Center Name National Cancer Institute (NCI)

Overall Officials

Sequence: 29281131
Role Principal Investigator
Name Damian Green
Affiliation Fred Hutch/University of Washington Cancer Consortium

Central Contacts

Sequence: 12006463
Contact Type primary
Name Damian Green
Phone 206.667.5398
Email dgreen@fredhutch.org
Role Contact

Design Group Interventions

Sequence: 68138713 Sequence: 68138714 Sequence: 68138715 Sequence: 68138716 Sequence: 68138717 Sequence: 68138718 Sequence: 68138719 Sequence: 68138720 Sequence: 68138721
Design Group Id 55584610 Design Group Id 55584611 Design Group Id 55584610 Design Group Id 55584611 Design Group Id 55584611 Design Group Id 55584610 Design Group Id 55584611 Design Group Id 55584610 Design Group Id 55584611
Intervention Id 52477758 Intervention Id 52477758 Intervention Id 52477759 Intervention Id 52477759 Intervention Id 52477760 Intervention Id 52477761 Intervention Id 52477761 Intervention Id 52477762 Intervention Id 52477762

Eligibilities

Sequence: 30760826
Gender All
Minimum Age 18 Years
Maximum Age 70 Years
Healthy Volunteers No
Criteria Inclusion Criteria: Patients with newly diagnosed or relapsed/refractory multiple myeloma Patients with multiple myeloma must have at least one of the following high-risk features: t(4;14), t(14;16), t(14;20) or deletion 17p, gain in chromosome 1q (> 3 copies of CKS1b) by fluorescence in situ hybridization (FISH); hypodiploidy; complex karyotype Revised International Staging System III Plasmablastic morphology History of primary or secondary plasma cell leukemia Patients must start ²¹¹At-OKT10-B10 within 40-180 days of autologous stem cell transplant (either as part of their induction, or as salvage) Patients must have an estimated creatinine clearance greater than 50/ml per minute measured by 24-hour urine collection Total bilirubin < 2 times the upper limit of normal Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 2 times the upper limit of normal) Patients must have an Eastern Cooperative Oncology Group (ECOG) =< 2 or Karnofsky >= 70 Patients must have CD38+ myeloma cells as demonstrated by either flow cytometry or immunohistochemistry in most recent bone marrow that had evidence of clonal plasma cells For patients of childbearing potential, must have a negative urinary pregnancy test on the day of and prior to infusion of ²¹¹At-OKT10-B10 Ability to provide informed consent Patients must have an HLA-matched related donor or an HLA-matched unrelated donor who meets standard Seattle Cancer Care Alliance (SCCA) and/or National Marrow Donor Program (NMDP) or other donor center criteria for peripheral blood stem cell (PBSC) or bone marrow donation, as follows: Related donor: related to the patient and genotypically or phenotypically identical for HLA-A, B, C, DRB1 and DQB1. Phenotypic identity must be confirmed by high-resolution typing Unrelated donor: Matched for HLA-A, B, C, DRB1 and DQB1 by high resolution typing; OR Mismatched for a single allele without antigen mismatching at HLA-A, B, or C as defined by high resolution typing but otherwise matched for HLA-A, B, C, DRB1 and DQB1 by high resolution typing Donors are excluded when preexisting immunoreactivity is identified that would jeopardize donor hematopoietic cell engraftment. The recommended procedure for patients with 10 of 10 HLA allele level (phenotypic) match is to obtain panel reactive antibody (PRA) screens to class I and class II antigens for all patients before HCT. If the PRA shows > 10% activity, then flow cytometric or B and T cell cytotoxic cross matches should be obtained. The donor should be excluded if any of the cytotoxic cross match assays are positive. For those patients with an HLA class I allele mismatch, flow cytometric or B and T cell cytotoxic cross matches should be obtained regardless of the PRA results. A positive anti-donor cytotoxic crossmatch is an absolute donor exclusion Patient and donor pairs homozygous at a mismatched allele in the graft rejection vector are considered a two-allele mismatch, i.e., the patient is A*0101 and the donor is A*0102, and this type of mismatch is not allowed Patients without an HLA-matched related or unrelated donor available must have a related donor who is identical for one HLA haplotype and mismatched at the HLA-A, -B or DRB1 loci of the unshared haplotype with the exception of single HLA-A, -B or DRB1 mismatches Exclusion Criteria: History of central nervous system involvement by multiple myeloma Presence of circulating plasma cells in the peripheral blood of 5% or more by flow cytometry or morphology Prior radioimmunotherapy or radiation of > 20 Gy to pelvis or at maximally tolerated levels to any critical normal organ Prior allogeneic HCT More than two prior autologous HCTs Patients with plasmacytomas > 1 cm in bone marrow or any extramedullary plasmacytoma. Previously fludeoxyglucose F-18 (FDG) avid mass lesions by positron emission tomography (PET) that are no longer hypermetabolic following the most recent cycle of therapy are exempt, as are plasmacytomas irradiated with curative intent (>= 35 Gy) Patients with symptomatic coronary artery disease defined as having angina or anginal equivalent, and/or arrhythmias requiring anti-arrhythmics for rhythm control History of reactive airway disease and clinically significant asthma requiring ongoing treatment Patients with the following organ dysfunction: Left ventricular ejection fraction < 40% in patients with HLA-matched or unrelated donor or < 45% in patients with an HLA-haploidentical donor New York Heart Association (NYHA) class > 1 heart failure Corrected diffusing capacity of the lungs for carbon monoxide (DLCO) < 50% or receiving supplemental continuous oxygen. When pulmonary function tests cannot be obtained, the 6-minute walk test (6MWT, also known as exercise oximetry) will be used: Any patient with oxygen saturation on room air of < 90% during a 6MWT will be excluded Liver abnormalities: fulminant liver failure, cirrhosis of the liver with evidence of portal hypertension, alcoholic hepatitis, esophageal varices, hepatic encephalopathy, uncorrectable hepatic synthetic dysfunction as evidenced by prolongation of the prothrombin time, ascites related to portal hypertension, bacterial or fungal liver abscess, biliary obstruction, chronic viral hepatitis, or symptomatic biliary disease Patients who are known to be seropositive for human immunodeficiency virus (HIV) Perceived inability to tolerate diagnostic or therapeutic procedures Women of childbearing potential who are pregnant (beta-human chorionic gonadotropin [HCG]+) or breast feeding Fertile men and women unwilling to use contraceptives during and for 12 months post-transplant Uncontrolled or untreated active infection Patients with known AL subtype amyloidosis Inability to understand or give an informed consent Known allergy to murine-based monoclonal antibodies Known contraindications to radiotherapy History of another primary malignancy that has not been in remission for at least 2 years. The following are exempt from the 2-year-limit: nonmelanoma skin cancer, curatively treated localized prostate cancer, or cervical carcinoma in situ or squamous intraepithelial lesion on papanicolaou (PAP) smear Therapy with anti-CD38 monoclonal antibody within 3 months of ²¹¹At-OKT10-B10 infusion Prior therapy with radiolabeled monoclonal antibodies Any history of treatment with checkpoint inhibitor/s
Adult True
Child False
Older Adult True

Calculated Values

Sequence: 254304485
Number Of Facilities 1
Registered In Calendar Year 2020
Were Results Reported False
Has Us Facility True
Has Single Facility True
Minimum Age Num 18
Maximum Age Num 70
Minimum Age Unit Years
Maximum Age Unit Years
Number Of Primary Outcomes To Measure 1
Number Of Secondary Outcomes To Measure 5

Designs

Sequence: 30507028
Allocation Non-Randomized
Intervention Model Parallel Assignment
Observational Model
Primary Purpose Treatment
Time Perspective
Masking None (Open Label)

Intervention Other Names

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Intervention Id 52477758 Intervention Id 52477758 Intervention Id 52477758 Intervention Id 52477758 Intervention Id 52477758 Intervention Id 52477758 Intervention Id 52477759 Intervention Id 52477759 Intervention Id 52477759 Intervention Id 52477759 Intervention Id 52477759 Intervention Id 52477759 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477760 Intervention Id 52477761 Intervention Id 52477761 Intervention Id 52477761 Intervention Id 52477761 Intervention Id 52477761 Intervention Id 52477762 Intervention Id 52477762 Intervention Id 52477762 Intervention Id 52477762 Intervention Id 52477762
Name Allogeneic Name Allogeneic Hematopoietic Cell Transplantation Name Allogeneic Stem Cell Transplantation Name HSC Name HSCT Name Stem Cell Transplantation, Allogeneic Name ²¹¹At-OKT10-B10 Name [²¹¹At]OKT10-B10 Name Astatine 211-labeled Anti-CD38 Monoclonal Antibody OKT10-B10 Name Astatine At 211 Anti-CD38 MoAb OKT10-B10 Name Astatine-211-OKT10-B10 Name At211-OKT10-B10 Name (-)-Cyclophosphamide Name 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate Name Carloxan Name Ciclofosfamida Name Ciclofosfamide Name Cicloxal Name Clafen Name Claphene Name CP monohydrate Name CTX Name CYCLO-cell Name Cycloblastin Name Cycloblastine Name Cyclophospham Name Cyclophosphamid monohydrate Name Cyclophosphamide Monohydrate Name Cyclophosphamidum Name Cyclophosphan Name Cyclophosphane Name Cyclophosphanum Name Cyclostin Name Cyclostine Name Cytophosphan Name Cytophosphane Name Cytoxan Name Fosfaseron Name Genoxal Name Genuxal Name Ledoxina Name Mitoxan Name Neosar Name Revimmune Name Syklofosfamid Name WR- 138719 Name 2-F-ara-AMP Name 9H-Purin-6-amine, 2-fluoro-9-(5-O-phosphono-.beta.-D-arabinofuranosyl)- Name Beneflur Name Fludara Name SH T 586 Name SCT_TBI Name TBI Name Total Body Irradiation Name Whole Body Irradiation Name Whole-Body Irradiation

Responsible Parties

Sequence: 28873307
Responsible Party Type Sponsor