Multiple Myeloma Clinical Trial
— MagnetisMM-7Official title:
A RANDOMIZED, 2-ARM, PHASE 3 STUDY OF ELRANATAMAB (PF-06863135) VERSUS LENALIDOMIDE IN PATIENTS WITH NEWLY DIAGNOSED MULTIPLE MYELOMA AFTER UNDERGOING AUTOLOGOUS STEM-CELL TRANSPLANTATION
The purpose of this study is to evaluate whether elranatamab monotherapy can provide clinical benefit compared to lenalidomide monotherapy (control) in participants with newly diagnosed multiple myeloma after undergoing autologous stem cell transplant. In Part 1 and Part 2 of the study, participants in the study will either receive elranatamab (arm A and C) as an injection under the skin at the study clinic or lenalidomide orally once daily at home (arm B). Participation in the study will be approximately five years
Status | Recruiting |
Enrollment | 760 |
Est. completion date | October 31, 2029 |
Est. primary completion date | August 4, 2027 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Diagnosis of MM as defined according to IMWG criteria (Rajkumar, 2014) with measurable disease at diagnosis - Part 1 patients must be MRD positive, Part 2 patients can be MRD negative or MRD positive - History of induction therapy for newly diagnosed MM, followed by high dose therapy and autologous stem cell transplant. Randomization must occur within 120 days from the stem cell transplant. For participants who receive consolidation therapy after ASCT, randomization must occur within 60 days of consolidation and within 7 months from ASCT. - Partial Response or better according to IMWG criteria at the time of randomization - Must have an archival bone marrow aspirate sample(s) to identify the dominant malignant (index) clone by central laboratory NGS test (ClonoSEQ assay) that is used to track MRD status. This sample should preferably be collected before induction treatment (eg, at diagnosis) or before transplant. - ECOG performance status =1 - Resolved acute effects of any prior therapy to baseline severity or CTCAE Grade = 1 - Not pregnant and willing to use contraception Exclusion Criteria: - Plasma cell leukemia - Amyloidosis, Waldenström's macroglobulinemia - POEMS syndrome - Known active CNS involvement or clinical signs of myelomatous meningeal involvement - Previous MM maintenance treatment - Prior treatment with BCMA targeted therapy - Any other active malignancy within 3 years prior to enrollment, except for adequately treated basal cell or squamous cell skin cancer, or carcinoma in situ - Active, uncontrolled bacterial, fungal, or viral infection, including (but not limited to) HBV, HCV, and known HIV or AIDS-related illness - Previous administration with an investigational drug or vaccine within 30 days (or as determined by the local requirement) or 5 half-lives preceding the first dose of study intervention used in this study (whichever is longer) |
Country | Name | City | State |
---|---|---|---|
Australia | Pindara Private Hospital | Benowa | Queensland |
Australia | QScan Radiology Clinics | Clayfield | Queensland |
Australia | Epworth Healthcare | East Melbourne | Victoria |
Australia | Precision Haematology | East Melbourne | Victoria |
Australia | St Vincent's Hospital (Melbourne) | Fitzroy | Victoria |
Australia | Slade Pharmacy | Richmond | |
Australia | Princess Alexandra Hospital | Woolloongabba | Queensland |
Austria | Hanusch-Krankenhaus | Vienna | |
Austria | Medizinische Universität Wien | Vienna | Wien |
Austria | Medizinische Universität Wien | Wien | |
Belgium | Institut Jules Bordet | Anderlecht | Bruxelles-capitale, Région DE |
Belgium | Zna Cadix | Antwerpen | |
Belgium | Zna Cadix | Antwerpen | |
Belgium | ZNA Middelheim | Antwerpen | |
Belgium | ZNA Stuivenberg | Antwerpen | |
Belgium | ZNA Stuivenberg | Antwerpen | |
Belgium | UZ Brussel | Brussel | |
Belgium | Grand Hôpital de Charleroi | Charleroi | Hainaut |
Belgium | Université Catholique de Louvain-Namur - Centre Hospitalier Universitaire Dinant-Godinne - Site Godi | Yvoir | Namur |
Brazil | Ambulatório de QT Convênio | Jaú | SÃO Paulo |
Brazil | Fundação Doutor Amaral Carvalho | Jaú | |
Brazil | Hospital Amaral Carvalho | Jaú | SÃO Paulo |
Brazil | Centro de Pesquisa Clínica - Área Administrativa | Porto Alegre | RIO Grande DO SUL |
Brazil | Centro Gaucho Integrado De Oncologia, Hematologia, Ensino E Pesquisa | Porto Alegre | RIO Grande DO SUL |
Brazil | Hospital Mae de Deus | Porto Alegre | RIO Grande DO SUL |
Brazil | Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (USP | Ribeirão Preto | SÃO Paulo |
Brazil | Américas Medical City | Rio de Janeiro | |
Brazil | Instituto de Educação, Pesquisa e Gestão em Saúde | Rio de Janeiro | |
Brazil | Instituto D'Or de Pesquisa e Ensino (IDOR) - Filial Salvador | Salvador, | Bahia |
Brazil | BP - A Beneficencia Portuguesa de São Paulo | Sao Paulo | SÃO Paulo |
Brazil | Clínica Médica São Germano S/S Ltda | São Paulo | |
Brazil | ESHO Empresa de Serviços Hospitalares S.A/ Hospital Samaritano de Higienópolis | São Paulo | |
Brazil | Hospital Japonês Santa Cruz | São Paulo | |
Brazil | HU UNIFESP / SPDM - Hospital São Paulo | São Paulo | |
Brazil | Universidade Federal de Sao Paulo | São Paulo | |
Brazil | Clínica Médica São Germano LTDA | SP | SÃO Paulo |
Canada | Tom Baker Cancer Center | Calgary | Alberta |
Canada | Dr. Everett Chalmers Regional Hospital | Fredericton | New Brunswick |
Canada | Hamilton Health Sciences Corporation | Hamilton | Ontario |
Canada | Centre Integre Universitaire de la Santé et de Services Sociaux de l'Est-de-l'ile-de-Montreal, | Montreal | Quebec |
Canada | Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSS | Montreal | Quebec |
Canada | McGill University Health Centre | Montreal | Quebec |
Canada | Saint John Regional Hospital | Saint John | New Brunswick |
Canada | Princess Margaret Cancer Centre | Toronto | Ontario |
Canada | Windsor Regional Hospital Cancer Program | Windsor | Ontario |
China | Sun Yat-sen University Cancer Center | Guangzhou | Guangdong |
China | Shanghai Fourth People's Hospital | Shanghai | |
China | Institute of hematology&blood disease hospital | Tianjin | Tianjin |
China | The First Affiliated Hospital of Wenzhou Medical University | Wenzhou | Zhejiang |
China | Tongji Hospital; Tongji Medical college; Huazhong University of Science and Technonogy | Wuhan | Hubei |
Czechia | Fakultní nemocnice Brno Bohunice | Brno | Brno-mesto |
Czechia | Fakultni nemocnice Hradec Kralove | Hradec Kralove | Hradec Králové |
Czechia | Fakultni nemocnice Olomouc | Olomouc | |
Czechia | Fakultni nemocnice Ostrava | Ostrava | Moravskoslezský KRAJ |
Czechia | Fakultni nemocnice Ostrava | Ostrava-Poruba | Moravskoslezský KRAJ |
Czechia | Vseobecna fakultni nemocnice v Praze | Praha 2 | |
Finland | Helsinki University Hospital - Comprehensive Cancer Center (HYKS - Syöpäkeskus) | Helsinki | Uusimaa |
Finland | Oulun yliopistollinen sairaala | Oulu | Pohjois-pohjanmaa |
Finland | Turku University Hospital | Turku | Varsinais-suomi |
France | Chu Grenoble Alpes | La Tronche | |
France | Hopital Claude Huriez - CHU de Lille | Lille | |
France | Hopital Claude Huriez - CHU de Lille | Lille | Nord |
France | Hôpital Saint Antoine | Paris | Île-de-france |
France | Pitie Salpetriere University Hospital | Paris | Orne |
France | Hôpital Saint Antoine | Paris Cedex 12 | |
France | Hopital Lyon Sud | Pierre Benite | |
France | Centre Hospitalier Universitaire de Poitiers | Poitiers | Vienne |
France | Institut Universitaire du Cancer Toulouse - Oncopole - CHU de TOULOUSE | Toulouse | Haute-garonne |
France | Centre Hospitalier Régional Universitaire de Tours - Hôpital Bretonneau | Tours | |
France | Gustave Roussy | Villejuif | Val-de-marne |
Germany | Charite Universitätsmedizin Berlin Campus Benjamin Franklin | Berlin | |
Germany | Charite Universitätsmedizin Berlin Campus Benjamin Franklin | Berlin | |
Germany | Klinikum Chemnitz gGMbH | Chemnitz | |
Germany | Universitätsklinikum Essen | Essen | |
Germany | Universitaetsklinikum Schleswig-Holstein Campus Kiel | Kiel | Schleswig-holstein |
Germany | Universitaetsklinikum Koeln | Köln | Nordrhein-westfalen |
Germany | Universitätsklinikum Leipzig | Leipzig | Sachsen |
Germany | Universitätsmedizin Johannes Gutenberg Universität Mainz | Mainz | Rheinland-pfalz |
Germany | Klinikum rechts der Isar der Technischen Universität München | München | |
Germany | Universitätsklinikum Würzburg | Würzburg | Bayern |
Greece | Alexandra General Hospital of Athens | Athens | Attikí |
Greece | Evangelismos General Hospital of Athens | Athens | Attikí |
Greece | Evangelismos Hospital | Athens | |
Greece | University Hospital of Ioannina | Ioannina | Ípeiros |
Greece | Theageneio Cancer Hospital of Thessaloniki | Thessaloniki | Kentrikí Makedonía |
Hungary | Dél-Pesti Centrumkórház | Budapest | |
Hungary | Semmelweis University | Budapest | |
Hungary | Debreceni Egyetem Klinikai Kozpont | Debrecen | |
Hungary | Somogy Megyei Kaposi Mór Oktató Kórház | Kaposvár | Somogy |
Hungary | Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház, Jósa András Oktatókórház | Nyíregyháza | |
India | Himalayan Institute Hospital Trust University | Dehradun | Uttarakhand |
India | Rajiv Gandhi Cancer Institute And Research Centre | Delhi | |
India | Artemis hospital | Gurugram | Haryana |
India | Fortis Memorial Research Institute | Gurugram | Haryana |
India | Medanta-The Medicity | Gurugram | Haryana |
India | Tata Medical Center | Kolkata | WEST Bengal |
India | Christian Medical College Vellore | Ranipet | Tamil NADU |
Israel | Soroka Medical Center | Be'er Sheva | Hadarom |
Israel | Rambam Health Care Campus | Haifa | Hatsafon |
Israel | Hadassah Medical Center | Jerusalem | Yerushalayim |
Israel | Hadassah Mount Scopus Medical Center | Jerusalem | Yerushalayim |
Israel | Shaare Zedek Medical Center | Jerusalem | |
Israel | Shaare Zedek Medical Center | Jerusalem | |
Israel | Shaare Zedek Medical Center | Jerusalem | Yerushalayim |
Israel | Rabin Medical Center | Petah-Tikva | Hamerkaz |
Israel | Sheba Medical Center | Ramat Gan | Hamerkaz |
Israel | Tel-Aviv Sourasky Medical Center Dana-Dwek Children's Hospital | Tel Aviv | Tell Abib |
Italy | Azienda Ospedaliero Universitaria Ospedali Riuniti Umberto I - G.M. Lancisi - G. Salesi | Ancona | |
Italy | IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola | Bologna | |
Italy | Policlinico "G. Rodolico" | Catania | Sicilia |
Italy | IRCCS - Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori" | Meldola | Emilia-romagna |
Italy | Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico | Milano | Lombardia |
Italy | AOU Policlinico Umberto I | Roma | |
Italy | Fondazione Policlinico Universitario Agostino Gemelli | Roma | Lazio |
Italy | Azienda Ospedaliero Universitaria Senese | Siena | Toscana |
Italy | Universita di Siena -Azienda Ospedaliera Universitaria Senese-Policlincio Santa Maria Alle Scotte | Siena | Toscana |
Japan | Hamamatsu University Hospital | Hamamatsu-shi | Shizuoka |
Japan | National Hospital Organization Kumamoto Medical Center | Kumamoto | |
Japan | University Hospital,Kyoto Prefectural University of Medicine | Kyoto | |
Japan | University Hospital,Kyoto Prefectural University of Medicine | Kyoto-shi | Kyoto |
Japan | Gunma University Hospital | Maebashi | Gunma |
Japan | Nagoya City University Hospital | Nagoya | Aichi |
Japan | National Hospital Organization Okayama Medical Center | Okayama | |
Japan | Osaka Metropolitan University Hospital | Osaka | |
Japan | Tohoku University Hospital | Sendai | Miyagi |
Japan | Shizuoka Cancer Center | Sunto-gun | Shizuoka |
Japan | Japanese Red Cross Medical Center | Tokyo | |
Japan | Iwate Medical University Hospital | Yahaba-cho, Shiwa-gun | Iwate |
Japan | Yamagata University Hospital | Yamagata | |
Korea, Republic of | Pusan National University Hospital | Busan | Pusan-kwangyokshi |
Korea, Republic of | Kyungpook National University | Daegu | Taegu-kwangyokshi |
Korea, Republic of | Chonnam National University Hwasun Hospital | Hwasun Gun | Jeonranamdo |
Korea, Republic of | Kyungpook National University Hospital | Jung-gu | Taegu-kwangyokshi |
Korea, Republic of | Gachon University Gil Medical Center | Namdong-gu | Incheon-gwangyeoksi [incheon] |
Korea, Republic of | Seoul National University Bundang Hospital | Seongnam | Kyonggi-do |
Korea, Republic of | Samsung Medical Center | Seoul | Seoul-teukbyeolsi [seoul] |
Korea, Republic of | Seoul National University Hospital | Seoul | Seoul-teukbyeolsi [seoul] |
Korea, Republic of | The Catholic Univ. of Korea Seoul St. Mary's Hospital | Seoul | Seoul-teukbyeolsi [seoul] |
Korea, Republic of | The Catholic Univ. of Korea Seoul St. Mary's Hospital(Seoul St. Mary's Hospital) | Seoul | Seoul-teukbyeolsi [seoul] |
Netherlands | HagaZiekenhuis | Den Haag | Zuid-holland |
Netherlands | Maastricht Universitair Medisch Centrum | Maastricht | |
Netherlands | Isala | Zwolle | |
Norway | Haukeland Universitetssjukehus | Bergen | Hordaland |
Norway | Oslo Universitetssykehus Ullevål | Oslo | |
Norway | Stavanger Universitetssykehus | Stavanger | |
Poland | Uniwersyteckie Centrum Kliniczne, | Gdansk | |
Poland | Pratia Onkologia Katowice | Katowice | Slaskie |
Poland | Uniwersytecki Szpital Kliniczny w Poznaniu | Poznan | |
Poland | Centrum Medyczne Pratia Poznan | Skorzewo | Wielkopolskie |
Poland | Narodowy Instytut Onkologii im. Marii Sklodowskiej-Curie - Panstwowy Instytut Badawczy | Warszawa | |
Poland | Uniwersyteckie Centrum Kliniczne WUM Centralny Szpital Kliniczny | Warszawa | |
Poland | Klinika Hematologii, Nowotworow Krwi i Transplantacji Szpiku | Wroclaw | |
Spain | Institut Catala d' Oncologia. Hospital Germans Trias i Pujol | Badalona | Barcelona |
Spain | Hospital Clínic de Barcelona | Barcelona | Catalunya [cataluña] |
Spain | Hospital Universitari Vall d'Hebron | Barcelona | Barcelona [barcelona] |
Spain | Institut Catala Oncologia - Hospital Universitari de Girona Dr Josep Trueta | Gerona | |
Spain | Institut Català d'Oncologia - L'Hospitalet | L'Hospitalet Del Llobregat | Barcelona [barcelona] |
Spain | Clinica Universidad de Navarra | Madrid | Madrid, Comunidad DE |
Spain | Hospital General Universitario Gregorio Marañon | Madrid | |
Spain | Hospital La Princesa | Madrid | |
Spain | Hospital Universitario 12 de Octubre | Madrid | |
Spain | Hospital Universitario HM Sanchinarro | Madrid | |
Spain | Clinica Universidad de Navarra | Pamplona | Navarra |
Spain | Hospital Universitario Quironsalud Madrid | Pozuelo de Alarcon | Madrid |
Spain | Hospital Universitario de Salamanca | Salamanca | Castilla Y LEÓN |
Spain | Hospital Universitario de Salamanca - Complejo Asistencial Universitario de Salamanca | Salamanca | |
Spain | Complejo Hospitalario Universitario de Santiago | Santiago de Compostela | A Coruna |
Spain | Hospital Universitari Mutua Terrassa | Terrassa | Barcelona [barcelona] |
Spain | Hospital Universitari Mutua Terrassa | Terrassa | Barcelona |
Spain | Hospital Universitari i Politecnic La Fe | València | |
Sweden | Södra Älvsborgs Sjukhus Borås | Borås | Västra Götalands LÄN [se-14] |
Sweden | Falu Lasarett | Falun | |
Sweden | Helsingborgs Lasarett | Helsingborg | Skåne LÄN [se-12] |
Sweden | Universitetssjukhuset i Linköping | Linköping | Östergötlands LÄN [se-05] |
Sweden | Universitetssjukhuset Örebro | Örebro | Örebro LÄN [se-18] |
Sweden | Karolinska Universitetssjukhuset Huddinge | Stockholm | Stockholms LÄN [se-01] |
Taiwan | China Medical University Hospital | Taichung | |
Taiwan | Taichung Veterans General Hospital | Taichung | |
Taiwan | National Taiwan University Hospital | Taipei | |
Taiwan | Taipei Veterans General Hospital | Taipei | |
Taiwan | Chang Gung Medical Foundation-Linkou Branch | Taoyuan | |
Turkey | Ankara Universitesi Tip Fakultesi Hastanesi | Ankara | |
Turkey | Dr. Abdurrahman Yurtaslan Ankara Onkoloji Egitim ve Arastirma Hastanesi | Ankara | |
Turkey | Gazi Universitesi | Ankara | |
Turkey | Akdeniz Universitesi Hastanesi | Antalya | |
Turkey | Aydin Adnan Menderes Universitesi Hastanesi | Aydin | |
Turkey | Medipol Mega Universite Hastanesi | Istanbul | I?stanbul |
Turkey | Sisli Florence Nightingale Hastanesi | Istanbul | I?stanbul |
Turkey | Dokuz Eylul Universitesi Hastanesi | Izmir | I?zmir |
Turkey | Dokuz Eylul Universitesi Hastanesi | Izmir | I?zmir |
Turkey | Ege Universitesi Hastanesi | Izmir | I?zmir |
Turkey | Erciyes Universitesi Tip Fakultesi Hastaneleri | Kayseri | |
Turkey | Özel Anadolu Saglik Merkezi | Kocaeli | |
United Kingdom | The Beatson West of Scotland Cancer Centre | Glasgow | |
United States | University of Michigan | Ann Arbor | Michigan |
United States | Emory University Hospital | Atlanta | Georgia |
United States | Emory University Hospital Midtown | Atlanta | Georgia |
United States | Investigational Drug Service, Emory University Clinic | Atlanta | Georgia |
United States | Winship Cancer Institute, Emory University | Atlanta | Georgia |
United States | Cleveland Clinic | Cleveland | Ohio |
United States | OhioHealth Arthur G.H. Bing, MD, Cancer Center | Columbus | Ohio |
United States | OhioHealth Research Institute | Columbus | Ohio |
United States | OhioHealth Riverside Methodist Hospital | Columbus | Ohio |
United States | OhioHealth Riverside Methodist Hospital | Columbus | Ohio |
United States | Baylor University Medical Center | Dallas | Texas |
United States | Banner Gateway Medical Center | Gilbert | Arizona |
United States | Banner MD Anderson Cancer Center | Gilbert | Arizona |
United States | University Of Mississippi Medical Center | Jackson | Mississippi |
United States | University of Mississippi Medical Center | Jackson | Mississippi |
United States | Ronald Reagan UCLA Medical Center | Los Angeles | California |
United States | UCLA Hematology/Oncology - Westwood (Building 200 Suite 120) | Los Angeles | California |
United States | Alliance for Multispecialty Research, LLC | Merriam | Kansas |
United States | Miami Cancer Institute at Baptist Health, Inc. | Miami | Florida |
United States | Baylor Scott & White Medical Center - Temple | Temple | Texas |
United States | Georgetown University Medical Center | Washington | District of Columbia |
Lead Sponsor | Collaborator |
---|---|
Pfizer |
United States, Australia, Austria, Belgium, Brazil, Canada, China, Czechia, Finland, France, Germany, Greece, Hungary, India, Israel, Italy, Japan, Korea, Republic of, Netherlands, Norway, Poland, Spain, Sweden, Taiwan, Turkey, United Kingdom,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Progression Free Survival | Progression Free Survival assessed by Blinded Independent Central review per IMWG response criteria | Assessed for up to approximately 5 years | |
Secondary | Overall Survival | Defined as the time from randomization until death due to any cause | Assessed for up to approximately 5 years | |
Secondary | Minimal Residual Disease negativity rate | Minimal Residual Disease negativity rate per IMWG criteria as assessed via Next Generation Sequencing | 12 months after randomization | |
Secondary | Sustained MRD negativity rate | Sustained Minimal Residual Disease negativity rate per IMWG criteria as assessed via Next Generation Sequencing | 24 months after randomization | |
Secondary | Progression Free Survival | Progression Free Survival by investigator per IMWG response criteria | Assessed for up to approximately 5 years | |
Secondary | Overall minimal residual disease negativity rate | Minimal residual disease negativity rate per IMWG criteria | Assessed for up to approximately 5 years | |
Secondary | Duration of minimal residual disease negativity | Minimal residual disease negativity per IMWG criteria | Assessed for up to approximately 5 years | |
Secondary | Sustained minimal residual disease negativity rate | Minimal residual disease negativity per IMWG criteria that has lasted a minimum of 12 months | Assessed for up to approximately 5 years | |
Secondary | Complete response rate | Complete response rate by blinded independent central review and by investigator per IMWG criteria | Assessed for up to approximately 5 years | |
Secondary | Duration of complete response | Duration of complete response by blinded independent central review and by investigator per IMWG criteria | Assessed for up to approximately 5 years | |
Secondary | Frequency of adverse events | Adverse event as characterized by type, frequency, severity per the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5, seriousness and relationship to the study intervention | Up to 90 days after last dose | |
Secondary | Frequency of laboratory abnormalities | Assessed for up to approximately 5 years | ||
Secondary | Pre-dose concentrations of elranatamab | Pharmacokinetics of elranatamab (trough concentrations of elranatamab) | Assessed for up to approximately 5 years | |
Secondary | Post-dose concentrations of elranatamab | Pharmacokinetics of elranatamab (Post-dose serum concentrations of elranatamab)" | Assessed for up to approximately 5 years | |
Secondary | Incidence and titers of Anti-Drug Antibody and Neutralizing Antibody against elranatamab | Immunogenicity of elranatamab | Assessed for up to approximately 5 years | |
Secondary | Health-related quality of life by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 | Higher scores on the functional scales represent higher levels of functioning. Higher scores on the global health status/quality of life scale represent higher health status/quality of life. Higher scores on symptom scales/items represent a greater presence of symptoms | Assessed for up to approximately 5 years | |
Secondary | Health-related quality of life by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Myeloma 20 | Higher scores on the functioning subscales (body image, future perspective) represent higher levels of functioning, whereas higher scores on the symptom subscales (disease symptoms, side effects) represent a greater presence of symptoms | Assessed for up to approximately 5 years | |
Secondary | Progression Free Survival 2 | Progression Free Survival to the date of second objective disease progression by investigator per IMWG response criteria | Assessed for up to approximately 5 years |
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