A Phase 2, Multicohort Study of Daratumumab-Based Therapies in Participants with Amyloid Light Chain (AL) Amyloidosis
- Conditions
- Amyloid Light Chain AmyloidosisMedDRA version: 23.0Level: LLTClassification code 10083938Term: Amyloid light-chain amyloidosisSystem Organ Class: 100000004870Therapeutic area: Diseases [C] - Immune System Diseases [C20]
- Registration Number
- EUCTR2021-002639-48-ES
- Lead Sponsor
- Janssen-Cilag International N.V.
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Authorised-recruitment may be ongoing or finished
- Sex
- All
- Target Recruitment
- 150
- >/= 18 years of age.
- New diagnosis of systemic AL amyloidosis based on both: (a) tissue deposition of amyloid in any organ other than bone marrow and (b) an underlying clonal plasma cell disorder as demonstrated by any one of the following:
• Clonal plasma cells in the bone marrow
• Monoclonal gammopathy in the serum or urine
• Abnormal free light chain ratio
- Measurable disease at screening defined by difference between iFLC and uninvolved FLC (dFLC) >/= 40mg/L per central laboratory
- Cohort 1: Cardiac involvement (AL amyloidosis Mayo Cardiac Stage II and Stage IIIa; see Appendix 6) with or without other organ(s) involved
- Cohort 2: One or more organs impacted by systemic AL amyloidosis according to consensus guidelines
- Eastern Cooperative Oncology Group (ECOG) Performance Status score of 0, 1 or 2.
- Pre-treatment clinical laboratory values meeting the following criteria during the Screening Phase:
• Hemoglobin >/= 8.0 g/dL (>/= 5 mmol/L); red blood cell transfusion allowed until 7 days before randomization/enrollment
• Platelets >/= 50×109/L; platelet transfusions are allowed until 7 days before randomization/enrollment
• Absolute Neutrophil count >/= 1.0×109/L
• Aspartate aminotransferase and alanine aminotransferase • Total bilirubin • Estimated glomerular filtration rate >/= 20 mL/min/1.73 m2
- A female participant of childbearing potential must have a negative serum or urine test at screening and within 72 hours of the first dose of study treatment and must agree to further serum or urine pregnancy tests during the study.
- A female participant must be either of the following:
a. Not of childbearing potential
b. Of childbearing potential and practicing true abstinence or have a sole partner who is vasectomized or practicing at least 1 highly effective user independent method of contraception
Contraception must begin 4 weeks prior to dosing and continue for 1 year after discontinuation of cyclophosphamide or 3 months after discontinuation of daratumumab, whichever is longer.
- A male participant must wear a condom (with or without spermicidal foam/gel/film/cream/suppository) when engaging in any activity that allows for passage of ejaculate to another person during the study and for 6 months after discontinuation of cyclophosphamide or 3 months after discontinuation of daratumumab, whichever is longer. His female partner, if of childbearing potential, must also be practicing a highly effective method of contraception.
If the male participant is vasectomized, he still must wear a condom (with or without spermicidal foam/gel/film/cream/suppository), but his female partner is not required to use contraception.
- A female participant must agree not to donate eggs (ova, oocytes) or freeze for future use, for the purposes of assisted reproduction during the study and for a period of least 1 year after the last dose of cyclophosphamide or 3 months after discontinuation of daratumumab, whichever is longer.
- A male participant must agree not to donate sperm for the purpose of reproduction during the study and for a minimum of 6 months after receiving the last dose of cyclophosphamide or 3 months after discontinuation of daratumumab, whichever is longer.
- Signed an informed consent form (ICF).
Cohort 2 only: self-identified racial and ethnic minorities, including Blac
- Prior therapy for systemic AL amyloidosis or multiple myeloma including medications that target CD38, with the exception of 160 mg dexamethasone or equivalent corticosteroid maximum exposure prior to randomization/enrollment.
- Previous or current diagnosis of symptomatic multiple myeloma per International Myeloma Working Group (IMWG) Criteria.
- Participant received any of the following therapies:
a. treatment with an investigational drug or used an invasive investigational medical device within 14 days or at least 5 half-lives, whichever is less.
b. vaccinated with an investigational vaccine (except for COVID-19, live attenuated or replicating viral vector vaccines within 4 weeks prior to randomization/enrollment.
- Stem cell transplantation – Planned stem cell transplant during the first 9 cycles of protocol therapy are excluded. Stem cell collection during the first 9 cycles of protocol therapy is permitted.
- Grade 2 sensory or Grade 1 painful peripheral neuropathy.
- Evidence of significant cardiovascular conditions (as specified in protocol)
- History of malignancy (other than AL amyloidosis) within 3 years before the date of randomization
- Contraindications or life-threatening allergies, hypersensitivity, or intolerance to any study treatment or its excipients, including bortezomib, boron, mannitol, or cyclophosphamide or any of its metabolites
- Known allergies, hypersensitivity, or intolerance to monoclonal antibodies, hyaluronidase, human proteins, or their excipients, or known sensitivity to mammalian-derived products
- Pregnant or breastfeeding or planning to become pregnant while enrolled in this study or within 1 year after discontinuation of cyclophosphamide or 100 days after the last dose of daratumumab, whichever is longer
- Plans to father a child while enrolled in this study or within 100 days after the last dose of study treatment
- Chronic obstructive pulmonary disease (COPD) with a Forced Expiratory Volume in 1 second (FEV1) <50% of predicted normal
- Moderate or severe persistent asthma within the past 2 years, or currently has uncontrolled asthma of any classification
- Participant is known to be positive for human immunodeficiency virus (HIV), with 1 or more of the following:
• Not receiving highly active antiretroviral therapy (ART)
• Had a change in ART within 6 months of the start of screening
• Receiving ART that may interfere with study treatment (consult Sponsor for review of medication prior to enrollment)
• CD4 count <350 at screening
• Acquired immunodeficiency syndrome (AIDS)-defining opportunistic infection within 6 months of start of screening
• Not agreeing to start ART and be on ART >4 weeks plus having HIV viral load <400 copies/mL at end of 4-week period (to ensure ART is tolerated and HIV controlled)
- Seropositive for hepatitis B (defined by a positive test for hepatitis B surface antigen [HbsAg]). (Conditions for resolved infection are specified in protocol)
- Known to be seropositive for hepatitis C (except in the setting of a sustained virologic response [SVR], defined as aviremia at least 12 weeks after completion of antiviral therapy).
- Any serious underlying medical or psychiatric condition or disease, that is likely to interfere with study procedures or results, or that in the opinion of the investigator would constitute a hazard for participating in this study, such as:
• Evidence of serious active viral or bacterial infection, requiring systemic antimicrobial therapy, or uncontr
Study & Design
- Study Type
- Interventional clinical trial of medicinal product
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method
- Secondary Outcome Measures
Name Time Method