The Effect of Ixazomib on the Latent HIV Reservoir

• Sponsor: Mayo Clinic (Other)
• Overall Status: Completed
• CT.gov ID: NCT02946047
• Collaborator: Takeda (Industry)
• Enrollment: 17
• Location: 1
• Arms: 4
• Actual Duration (Months): 29
• Patients Per Site Per Month: 0.6

Study Details

Study Description

Brief Summary

The primary purpose of the trial is to determine the safety and tolerability of ixazomib in HIV infected patients on antiretroviral therapy. The secondary purpose is to determine the effect of ixazomib on the size of the HIV reservoir.

Condition or Disease	Intervention/Treatment	Phase
Human Immunodeficiency Virus (HIV)	Drug: Ixazomib 1 MG; Drug: Ixazomib 2 MG; Drug: Ixazomib 3 MG; Drug: Ixazomib 4 MG	Phase 1/Phase 2

Study Design

• Study Type: Interventional
• Actual Enrollment: 17 participants
• Allocation: Non-Randomized
• Intervention Model: Sequential Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Pilot Study of Ixazomib to Reduce the Number of HIV DNA Positive Lymphoid Cells
• Actual Study Start Date: Mar 20, 2017
• Actual Primary Completion Date: Aug 19, 2019
• Actual Study Completion Date: Aug 19, 2019

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Ixazomib 1 mg Cohort A: Patients will receive ixazomib 1mg 3 times monthly for 12 weeks, then weekly for 12 weeks.	Drug: Ixazomib 1 MG; 1 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 1 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.; Other Names: Ninlaro
Experimental: Ixazomib 2 mg Cohort B: Patients will receive ixazomib 2mg 3 times monthly for 12 weeks, then weekly for 12 weeks.	Drug: Ixazomib 2 MG; 2mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 2 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.; Other Names: Ninlaro
Experimental: Ixazomib 3 mg Cohort C: Patients will receive ixazomib 3 mg 3 times monthly for 12 weeks, then weekly for 12 weeks.	Drug: Ixazomib 3 MG; 3 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 3 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.; Other Names: Ninlaro
Experimental: Ixazomib 4 mg Cohort D: Patients will receive ixazomib 4mg 3 times monthly for 12 weeks, then weekly for 12 weeks.	Drug: Ixazomib 4 MG; 4 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 4 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.; Other Names: Ninlaro

Outcome Measures

Primary Outcome Measures

1. Incidence of Treatment-Emergent Adverse Events [7 months]

   Number of treatment-emergent adverse events experienced by subjects as defined by NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0

Secondary Outcome Measures

1. Cell Associated HIV DNA in CD4 T Cell Subsets [24 weeks]

   HIV copies per million CD4 T cells

2. Culturable HIV by Quantitative Viral Outgrowth Assay [24 weeks]

   Infectious units per million CD4 T cells

3. Absolute CD4 T Cell Count [24 weeks]

   Cells per microliter

4. Absolute CD8 T Cell Count [24 weeks]

   Cells per microliter

5. CD4/CD8 Ratio [24 weeks]

   CD4/CD8 T cell count ratio

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• The following laboratory values obtained <=14 days prior to registration.

• ANC ≥ LLN (lower limit of normal) and ≤ULN (upper limit of normal), Hgb ≥ LLN and ≤ULN, PLT ≥ LLN and ≤ULN

• Total bilirubin ≤ULN and the direct bilirubin must be ≤ ULN; AST <1.5 x ULN and ALT <1.5 x ULN

• Creatinine <2.0 x ULN and an estimated creatinine clearance > 60 ml/min

• HIV infection with suppressed viral replication on at least 3 active drug ART for at least 6 months

• Suppressed viral replication is defined by plasma HIV viral load <20copies/mL.

• Patient must have HIV viral load <20 copies/ml on two occasions at least 3 months apart.

• In the opinion of the treating physician, patients must have available other regimens likely to suppress HIV should their current regimen fail.

• Male or female patients age >=18 years

• A plasma HIV RNA viral load demonstrating a measure of <20 copies/mL within 30 days prior to study initiation.

• CD4 count >500 cells/mm3 within 30 days prior to study enrollment

• Females must have a negative pregnancy test prior to receiving the 1st dose of ixazomib and be postmenopausal for at least 1 year before the screen visit, or surgically sterile,

• Male patients, even if surgically sterilized (ie, status post-vasectomy), must agree to one of the following:

• Agree to practice effective barrier contraception AND a second method of contraception for female partners of childbearing potential during the entire study treatment period and through 90 days after the last dose of ixazomib,

• OR

• Agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence (eg, calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are not acceptable methods of contraception.)

• AND

• Agree to forego sperm donation for the same period as above.

Exclusion Criteria:

• The following laboratory values obtained <=14 days prior to registration.

• ANC < LLN and >ULN, Hgb < LLN and >ULN, PLT < LLN and >ULN

• Total bilirubin >ULN or the direct bilirubin is > ULN; AST >1.5 x ULN or AST >1.5 x ULN

• Creatinine >=2.0 x ULN or an estimated creatinine clearance <=60mL/min

• Diagnosed and treated for a malignancy within 5 years before randomization, or previously diagnosed with a malignancy and have any evidence of residual disease. Patients with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection

• Any infection except HIV (excluding benign conditions that is unlikely to be affected or modulated by treatment with ixazomib, e.g. stye or furuncle), or treatment with anti-infective agents within 14 days of enrollment.

• Pregnant women

• Women of childbearing potential and Nursing women

• Men who are unwilling to use a condom (even if they have undergone a prior vasectomy) while having intercourse, while taking the drug and for 90 days after stopping ixazomib.

• Any history of peripheral neuropathy, or peripheral neuropathy detected during the screening period.

• Major surgery within 14 days before study registration

• Systemic treatment with strong CYP3A inducers (rifampin, rifapentine, rifabutin,carbamazepine, phenytoin, phenobarbital), or use of St. John's wort.

• Evidence of current uncontrolled cardiovascular conditions, including serious cardiac arrhythmias, congestive heart failure, angina, or myocardial infarction within the past 6 months.

• QTc > 450 milliseconds (msec) for men and >470 milliseconds for women (83) on a 12 lead ECG obtained during the Screening period.

• Known hepatitis B DNA positive status and/or HBsAg positive and/or HBeAg positive, or active hepatitis C replication (HCV RNA positive) or currently on hepatitis C treatment.

• Known history of cirrhosis or active liver inflammation, including "fatty liver" or non-alcohol steatohepatitis (NASH).

• Any serious medical or psychiatric illness that could, in the investigator's opinion, potentially interfere with the completion of treatment according to this protocol.

• Known allergy to any of the study medications, their analogues or excipients in the various formulations.

• Any other recent or concurrent medical condition that, in the Investigator's opinion, would impose any risk to the patient

• Known GI disease or GI procedure that could interfere with the oral absorption or tolerance of ixazomib including difficulty swallowing.

• Participation in other clinical trials, including those with other investigational agents not included in this trial, within 30 days of the start of this trial and throughout the duration of this trial.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Mayo Clinic	Rochester	Minnesota	United States	55905

Sponsors and Collaborators

• Mayo Clinic
• Takeda

Investigators

• Principal Investigator: Nathan Cummins, MD, Mayo Clinic

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Nov 16, 2018

More Information

Additional Information:

• Mayo Clinic Clinical Trials

Publications

None provided.

• Responsible Party: Nathan W. Cummins, M.D., MD, Mayo Clinic
• ClinicalTrials.gov Identifier: NCT02946047
• Other Study ID Numbers: 16-001938
• First Posted: Oct 26, 2016
• Last Update Posted: Jan 6, 2022
• Last Verified: Dec 1, 2021

• Individual Participant Data (IPD) Sharing Statement: No
• Plan to Share IPD: No
• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No
• Keywords provided by Nathan W. Cummins, M.D., MD, Mayo Clinic: Antiretroviral Therapy (ART)
• Additional relevant MeSH terms: Acquired Immunodeficiency Syndrome; HIV Infections; Ixazomib; Glycine

Study Results

Participant Flow

Arm/Group Title	Ixazomib 1 mg	Ixazomib 2 mg	Ixazomib 3 mg	Ixazomib 4 mg
Arm/Group Description	Cohort A: Patients will receive ixazomib 1mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 1 MG: 1 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 1 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort B: Patients will receive ixazomib 2mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 2 MG: 2mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 2 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort C: Patients will receive ixazomib 3 mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 3 MG: 3 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 3 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort D: Patients will receive ixazomib 4mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 4 MG: 4 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 4 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.
Period Title: Overall Study
STARTED	4	3	3	7
COMPLETED	3	3	3	7
NOT COMPLETED	1	0	0	0

Baseline Characteristics

Arm/Group Title	Ixazomib 1 mg	Ixazomib 2 mg	Ixazomib 3 mg	Ixazomib 4 mg	Total
Arm/Group Description	Cohort A: Patients will receive ixazomib 1mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 1 MG: 1 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 1 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort B: Patients will receive ixazomib 2mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 2 MG: 2mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 2 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort C: Patients will receive ixazomib 3 mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 3 MG: 3 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 3 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort D: Patients will receive ixazomib 4mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 4 MG: 4 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 4 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Total of all reporting groups
Overall Participants	4	3	3	7	17
Age (years) [Median (Inter-Quartile Range) ]
Median (Inter-Quartile Range) [years]	54.1	49.3	51.0	49.0	51.0
Sex: Female, Male (Count of Participants)
Female	0 0%	0 0%	0 0%	1 14.3%	1 5.9%
Male	4 100%	3 100%	3 100%	6 85.7%	16 94.1%
Race and Ethnicity Not Collected (Count of Participants)
Count of Participants [Participants]	0 0%
Region of Enrollment (participants) [Number]
United States	4 100%	3 100%	3 100%	3 42.9%	7 41.2%

Outcome Measures

1. Primary Outcome

Title	Incidence of Treatment-Emergent Adverse Events
Description	Number of treatment-emergent adverse events experienced by subjects as defined by NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0
Time Frame	7 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Ixazomib 1 mg	Ixazomib 2 mg	Ixazomib 3 mg	Ixazomib 4 mg
Arm/Group Description	Cohort A: Patients will receive ixazomib 1mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 1 MG: 1 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 1 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort B: Patients will receive ixazomib 2mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 2 MG: 2mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 2 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort C: Patients will receive ixazomib 3 mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 3 MG: 3 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 3 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort D: Patients will receive ixazomib 4mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 4 MG: 4 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 4 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.
Measure Participants	4	3	3	7
Count of Participants [Participants]	0 0%	0 0%	0 0%	0 0%

2. Secondary Outcome

Title	Cell Associated HIV DNA in CD4 T Cell Subsets
Description	HIV copies per million CD4 T cells
Time Frame	24 weeks

Outcome Measure Data

Analysis Population Description

24 week data for 1 participant in the Ixazomib 1 mg arms was not collected or analyzed

Arm/Group Title	Ixazomib 1 mg	Ixazomib 2 mg	Ixazomib 3 mg	Ixazomib 4 mg
Arm/Group Description	Cohort A: Patients will receive ixazomib 1mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 1 MG: 1 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 1 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort B: Patients will receive ixazomib 2mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 2 MG: 2mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 2 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort C: Patients will receive ixazomib 3 mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 3 MG: 3 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 3 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort D: Patients will receive ixazomib 4mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 4 MG: 4 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 4 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.
Measure Participants	4	3	3	7
Baseline	378	626	664.8	416
24 weeks	394	425	624	481

3. Secondary Outcome

Title	Culturable HIV by Quantitative Viral Outgrowth Assay
Description	Infectious units per million CD4 T cells
Time Frame	24 weeks

Outcome Measure Data

Analysis Population Description

24 week data for 1 participant in the Ixazomib 1 mg arms was not collected or analyzed

Arm/Group Title	Ixazomib 1 mg	Ixazomib 2 mg	Ixazomib 3 mg	Ixazomib 4 mg
Arm/Group Description	Cohort A: Patients will receive ixazomib 1mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 1 MG: 1 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 1 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort B: Patients will receive ixazomib 2mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 2 MG: 2mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 2 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort C: Patients will receive ixazomib 3 mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 3 MG: 3 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 3 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort D: Patients will receive ixazomib 4mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 4 MG: 4 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 4 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.
Measure Participants	4	3	3	7
Baseline	0.49	0.30	0.62	1.54
24 weeks	0.30	0.48	0.82	1.31

4. Secondary Outcome

Title	Absolute CD4 T Cell Count
Description	Cells per microliter
Time Frame	24 weeks

Outcome Measure Data

Analysis Population Description

24 week data for 1 participant in the Ixazomib 1 mg arms was not collected or analyzed

Arm/Group Title	Ixazomib 1 mg	Ixazomib 2 mg	Ixazomib 3 mg	Ixazomib 4 mg
Arm/Group Description	Cohort A: Patients will receive ixazomib 1mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 1 MG: 1 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 1 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort B: Patients will receive ixazomib 2mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 2 MG: 2mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 2 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort C: Patients will receive ixazomib 3 mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 3 MG: 3 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 3 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort D: Patients will receive ixazomib 4mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 4 MG: 4 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 4 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.
Measure Participants	4	3	3	7
Baseline	724	914	1130	735
24 weeks	714	809	765	632

5. Secondary Outcome

Title	Absolute CD8 T Cell Count
Description	Cells per microliter
Time Frame	24 weeks

Outcome Measure Data

Analysis Population Description

24 week data for 1 participant in the Ixazomib 1 mg arms was not collected or analyzed

Arm/Group Title	Ixazomib 1 mg	Ixazomib 2 mg	Ixazomib 3 mg	Ixazomib 4 mg
Arm/Group Description	Cohort A: Patients will receive ixazomib 1mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 1 MG: 1 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 1 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort B: Patients will receive ixazomib 2mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 2 MG: 2mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 2 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort C: Patients will receive ixazomib 3 mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 3 MG: 3 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 3 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort D: Patients will receive ixazomib 4mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 4 MG: 4 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 4 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.
Measure Participants	4	3	3	7
Baseline	508	803	1014	573
24 weeks	387	885	689	416

6. Secondary Outcome

Title	CD4/CD8 Ratio
Description	CD4/CD8 T cell count ratio
Time Frame	24 weeks

Outcome Measure Data

Analysis Population Description

24 week data for 1 participant in the Ixazomib 1 mg arms was not collected or analyzed

Arm/Group Title	Ixazomib 1 mg	Ixazomib 2 mg	Ixazomib 3 mg	Ixazomib 4 mg
Arm/Group Description	Cohort A: Patients will receive ixazomib 1mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 1 MG: 1 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 1 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort B: Patients will receive ixazomib 2mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 2 MG: 2mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 2 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort C: Patients will receive ixazomib 3 mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 3 MG: 3 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 3 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.	Cohort D: Patients will receive ixazomib 4mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 4 MG: 4 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 4 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.
Measure Participants	4	3	3	7
Baseline	1.45	1.14	1.28	1.58
24 weeks	1.84	0.92	1.17	1.75

Adverse Events

Time Frame	Adverse events were collected from baseline to end of study for a total of approximately 7 months on all participatns.
Arm/Group Title	Ixazomib 1 mg		Ixazomib 2 mg		Ixazomib 3 mg		Ixazomib 4 mg
Arm/Group Description	Cohort A: Patients will receive ixazomib 1mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 1 MG: 1 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 1 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.		Cohort B: Patients will receive ixazomib 2mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 2 MG: 2mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 2 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.		Cohort C: Patients will receive ixazomib 3 mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 3 MG: 3 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 3 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.		Cohort D: Patients will receive ixazomib 4mg 3 times monthly for 12 weeks, then weekly for 12 weeks. Ixazomib 4 MG: 4 mg on days 1, 8 and 15 for three 28 days cycles, then be reviewed by DSMB and based upon their recommendation patients will receive ixazomib once weekly for 12 weeks or ixazomib 4 mg on days 1, 8 and 15 for three 28 days cycles. Visits 3-15 will have a window of ± 3 days.
All Cause Mortality
	Ixazomib 1 mg		Ixazomib 2 mg		Ixazomib 3 mg		Ixazomib 4 mg
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/4 (0%)		0/3 (0%)		0/3 (0%)		0/7 (0%)
Serious Adverse Events
	Ixazomib 1 mg		Ixazomib 2 mg		Ixazomib 3 mg		Ixazomib 4 mg
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/4 (0%)		0/3 (0%)		0/3 (0%)		0/7 (0%)
Other (Not Including Serious) Adverse Events
	Ixazomib 1 mg		Ixazomib 2 mg		Ixazomib 3 mg		Ixazomib 4 mg
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	3/4 (75%)		2/3 (66.7%)		1/3 (33.3%)		1/7 (14.3%)
Gastrointestinal disorders
Constipation	1/4 (25%)	1	0/3 (0%)	0	0/3 (0%)	0	0/7 (0%)	0
Diarrhea	1/4 (25%)	1	0/3 (0%)	0	1/3 (33.3%)	1	1/7 (14.3%)	1
Nausea	0/4 (0%)	0	0/3 (0%)	0	1/3 (33.3%)	1	0/7 (0%)	0
General disorders
Edema Limbs	0/4 (0%)	0	1/3 (33.3%)	1	0/3 (0%)	0	0/7 (0%)	0
Fatigue	0/4 (0%)	0	0/3 (0%)	0	1/3 (33.3%)	1	0/7 (0%)	0
Infection	1/4 (25%)	1	0/3 (0%)	0	0/3 (0%)	0	0/7 (0%)	0
Nervous system disorders
Peripheral motor neuropathy	0/4 (0%)	0	0/3 (0%)	0	1/3 (33.3%)	1	0/7 (0%)	0
Peripheral sensory neuropathy	0/4 (0%)	0	0/3 (0%)	0	1/3 (33.3%)	1	0/7 (0%)	0
Skin and subcutaneous tissue disorders
Rash, maculopapular	0/4 (0%)	0	1/3 (33.3%)	1	0/3 (0%)	0	1/7 (14.3%)	1

Limitations/Caveats

[Not Specified]

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Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.