Eligibility |
Inclusion Criteria:
-Risk factors for progression to multiple myeloma in patients with smoldering multiple
myeloma (SMM) have been identified and include: percentage of bone marrow involvement by
plasma cells, monoclonal spike in blood, serum free light chains in blood, presence or
absence of immunoparesis in blood, percentage of normal versus abnormal plasma cells in the
bone marrow compartment by using standard flow cytometry techniques and gene expression
profiling of plasma cells obtained from a bone marrow aspirate.
Patients must have histologically confirmed SMM based on the following criteria. Both
criteria must be met:
1. Serum monoclonal protein (IgG or IgA) = 3 g/dL or urinary monoclonal protein = 500 mg
per 24 hours and/or clonal bone marrow plasma cells 10-60%
2. Absence of myeloma defining events or amyloidosis
Additionally, patients must meet criteria for high risk of progression to multiple myeloma
by PETHEMA criteria (patients must have at least 2 risk factors present) (11):
- =95% abnormal plasma cells/total plasma cells in bone marrow compartment. (This is
measured as a percentage of the total abnormal versus normal plasma cells in the bone
marrow compartment using standard flow cytometry of the bone marrow aspirate. Having
=95% abnormal plasma cells/total plasma cells constitutes a risk factor for
progression to multiple myeloma by PETHEMA criteria)
- Immunoparesis (This term refers to the patient having low uninvolved immunoglobulins
in peripheral blood, for example if a patient has IgA smoldering multiple myeloma,
then either having a low IgM and/or low IgG will qualify as a risk factor for
progression to multiple myeloma)
*2 of 2 risk factors: high risk for progression at a rate of 72% at 5 years
- Creatinine clearance (CrCl) = 40 ml/min. CrCl will be calculated using the
Modification of Diet in Renal Disease (MDRD) equation.
- Age = 18 years. Because no dosing or adverse event data are currently available on the
use of isatuximab in patients <18 years of age, children are excluded from this study.
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2
- Absolute neutrophil count (ANC) = 1.0 x 109 /L, hemoglobin more or equal than 2 grams
below the institutional level of normal and platelet count = 90 x 109/L. Platelet and
blood transfusions are allowed on protocol. Growth factors, including granulocyte
colony stimulating factors and erythropoietin are allowed.
- Adequate hepatic function, with bilirubin < 1.5 x the ULN, and AST and ALT < 3.0 x
ULN.
- Females of childbearing potential and male subjects with female partners of
childbearing potential must agree to avoid pregnancy by using an adequate method of
contraception (2 barrier method or 1 barrier method with a spermicide or intrauterine
device for 10-14 days prior to screening, during and 5 months after the last dose of
isatuximab. Adequate methods of contraception are provided as examples. Other
acceptable and effective methods of birth control are also permitted (eg, abstinence).
- Men must agree to not donate sperm while on the study and for at least 5 months after
the last dose of isatuximab. Women of child bearing potential must have a negative
serum/urine pregnancy test result within 10-14 days prior to the first administration
of isatuximab and at the end of treatment visit. A negative urine pregnancy test is
required prior to each subsequent isatuximab dose administration.
- Subjects must be able to give informed consent.
Exclusion Criteria:
- Evidence of myeloma defining events or biomarkers of malignancy due to underlying
plasma cell proliferative disorder meeting at least one of the following(14)
1. Hypercalcemia: serum calcium >0.25 mmol/L (>1 mg/dL) higher than the upper limit
of normal or > 2.75 mmol/L (> 11 mg/dL)
2. Renal Insufficiency: creatinine clearance < 50 ml/min or serum creatinine > 2
mg/dL
3. Anemia: hemoglobin value <10 g/dL or 2 g/dL < normal reference
4. Bone lesions: one or more osteolytic lesions on skeletal radiography,
computerized tomography (CT) or 2-deoxy-2[F-18] fluoro-D-glucose positron
emission tomography CT (PET-CT).
5. Clonal bone marrow plasma cell percentage = 60%
6. Involved: uninvolved serum free light chain ratio =100 measured by Freelite assay
(The Binding Site Group, Birmingham, UK)
7. >1 focal lesions on MRI studies (each focal lesion must be 5 mm or more in size)
- Bisphosphonates are permitted, including pamidronate, zoledronic acid, alendronate,
ibandronate, risedronate.
- Treatment with corticosteroids is not permitted, unless the patient is on a stable
chronic dose of inhaled steroids to treat respiratory diseases or on stable chronic
steroid replacement therapy for endocrinology disorders.
- Radiotherapy is not permitted.
- Prior or concurrent treatment for smoldering multiple myeloma with chemotherapy agents
approved for the treatment of smoldering multiple myeloma or CD38 drugs is not
permitted.
- Plasma cell leukemia
- Pregnant or lactating females. Because there is a potential risk for adverse events in
nursing infants secondary to treatment of the mother with isatuximab, breastfeeding
should be discontinued if the mother is treated with isatuximab. These potential risks
may also apply to other agents used in this study.
- Active hepatitis B or C infection
- Known HIV infection
- Intolerance to infused protein products, sucrose, histidine or polysorbate 80
- Concurrent treatment with other anti-cancer therapy is not permitted
- Patients must not have uncontrolled intercurrent illness including hypertension,
symptomatic congestive heart failure, unstable angina, uncontrolled cardiac
arrhythmia. Patients should not have New York Heart Association classification III or
IV heart failure at baseline.
- Uncontrolled intercurrent illness including but not limited to active infection or
psychiatric illness/social situations that would compromise compliance with study
requirements
- Contraindication to any concomitant medication, including pre-medications or hydration
given prior to therapy
- Major surgery within 1 month prior to enrollment
- Patients with pre-existing pulmonary uncontrolled disease will be excluded.
Uncontrolled refers to patients having had at least one hospitalization due to
pulmonary disease (for example, asthma, chronic obstructive pulmonary disease) within
the 6 months prior to enrollment in the study. Patients with previous history of
pneumonitis will be excluded.
- Recruitment Strategies
- Patients that are seen in clinic at MD Anderson, Memorial Sloan Kettering Cancer
Center and Mount Sinai meeting eligibility criteria will be screened for the protocol
- Other participant sources will be from outside physician referrals.
- Our outside physician referral network has a high representation of minorities.
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