KarMMa-3: Efficacy and Safety Study of bb2121 Versus Standard Regimens in Subjects With Relapsed and Refractory Multiple Myeloma (RRMM)

Sponsor
Celgene (Industry)
Overall Status
Recruiting
CT.gov ID
NCT03651128
Collaborator
(none)
381
105
2
89.2
3.6
0

Study Details

Study Description

Brief Summary

This is a multicenter, randomized, open-label, Phase 3 study comparing the efficacy and safety of bb2121 versus standard regimens in subjects with relapsed and refractory multiple myeloma (RRMM).

The study is anticipated to randomize approximately 381 subjects with RRMM. Approximately 254 subjects will be randomized to Treatment Arm A and approximately 127 subjects will be randomized to Treatment Arm B.

Study Design

Study Type:
Interventional
Anticipated Enrollment :
381 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
A Phase 3, Multicenter, Randomized, Open-label Study to Compare the Efficacy and Safety of bb2121 Versus Standard Regimens in Subjects With Relapsed and Refractory Multiple Myeloma (RRMM) (KarMMa-3)
Actual Study Start Date :
Apr 16, 2019
Anticipated Primary Completion Date :
Sep 22, 2026
Anticipated Study Completion Date :
Sep 22, 2026

Arms and Interventions

Arm Intervention/Treatment
Experimental: Arm A - Administration of bb2121

bb2121 autologous CAR T cells will be infused at a dose ranging from 150 - 450 x 10^6 CAR+ T cells after receiving lymphodepleting chemotherapy

Biological: bb2121
bb2121

Experimental: Arm B- standard regimens as per Investigator's discretion

The participants will receive one of following regimens dependent on the subject's most recent anti-myeloma treatment regimen: Daratumumab (DARA) in combination with pomalidomide (POM) and low-dose dexamethasone (dex) (DPd) OR DARA in combination with bortezomib (BTZ) and low-dose dex (DVd) OR Ixazomib (IXA) in combination with lenalidomide (LEN) and low-dose dex (IRd) OR Carfilzomib (CFZ) in combination with low-dose dexamethasone (Kd) OR Elotuzumab (ELO) in combination with POM and low-dose dexamethasone (EPd)

Drug: Daratumumab
Daratumumab

Drug: Pomalidomide
Pomalidomide

Drug: Dexamethasone
Dexamethasone

Drug: Bortezomib
Bortezomib

Drug: Ixazomib
Ixazomib

Drug: Lenalidomide
Lenalidomide

Drug: Carfilzomib
Carfilzomib

Drug: Elotuzumab
Elotuzumab

Outcome Measures

Primary Outcome Measures

  1. Progression-free Survival (PFS) [Minimum of 5 years from randomization]

    Time from randomization to the first documentation of progressive disease based on the International Myeloma Working Group (IMWG) Uniform Response Criteria for Multiple Myeloma assessed by an independent response committee (IRC) or death due to any cause, whichever occurs first.

Secondary Outcome Measures

  1. Overall Survival (OS) [Minimum of 5 years from randomization]

    Time from randomization to time of death due to any cause

  2. Event-free Survival (EFS) [Minimum of 5 years from randomization]

    Time from randomization to the first documentation of progressive disease, first day when subject receives another anti-myeloma treatment or death due to any cause, whichever occurs first

  3. Overall Response Rate (ORR) [Minimum of 5 years from randomization]

    Percentage of subjects who achieved partial response (PR) or better according to IMWG Uniform Response Criteria for Multiple Myeloma as assessed by an IRC

  4. Minimal Residual Disease (MRD) [Minimum of 5 years from randomization]

    Percentage of MRD evaluable subjects that are MRD negative (defined at a minimum of 1 in 10^5 nucleated cells) using flow cytometry (EuroFlow) and next generation sequencing (NGS)

  5. Complete Response (CR) Rate [Minimum of 5 years from randomization]

    Percentage of subjects who achieved CR or better according to IMWG Uniform Response Criteria for Multiple Myeloma as assessed by an IRC

  6. Duration of Response (DOR) [Minimum of 5 years from randomization]

    Time from first documentation of response (PR or better) to first documentation of disease progression or death from any cause, whichever occurs first

  7. Time to Response (TTR) [Minimum of 5 years from randomization]

    TTR is calculated as the time from randomization to the initial documented response (PR or better) based on IMWG guideline for responders

  8. Adverse Events (AEs) [Minimum of 5 years from randomization]

    Number of participants with adverse events

  9. Pharmacokinetics- Cmax [Minimum 5 years after bb2121 infusion]

    Maximum peak in bb2121 chimeric antigen receptor (CAR) T cells

  10. Pharmacokinetics- tmax [Minimum 5 years after bb2121 infusion]

    Time to peak of bb2121 CAR T cells

  11. Pharmacokinetics- AUC [Minimum 5 years after bb2121 infusion]

    Area under the curve of CAR T cells

  12. Pharmacokinetics- t-last [Minimum 5 years after bb2121 infusion]

    Time to last measurable CAR T cells

  13. Pharmacokinetics- AUC0-28days [Minimum 5 years after bb2121 infusion]

    Area under the curve of CAR T cells from time zero to Day 28

  14. Subject-reported outcomes as measured by European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire (EORTC-QLQ-C30) [Minimum of 5 years from randomization]

    Questionnaire will be used as a measure of health-related quality of life

  15. Subject-reported outcomes as measured by EuroQoL Group European Quality of Life-5 Dimensions health state classifier to 5 Levels (EQ-5D-5L) Health Questionnaire [Minimum of 5 years from randomization]

    Is a standardized measure of health status developed by the EuroQol Group in order to provide a simple, generic measure of health for clinical and economic appraisal

  16. Subject-reported outcomes as measured by European Quality of Life Multiple Myeloma Module (EORTC-QLQ-MY20) [Minimum of 5 years from randomization]

    Is a 20-item myeloma module intended for use among patients varying in disease stage and treatment modality

  17. Time to next antimyeloma treatment [Minimum of 5 years from randomization]

    Time from randomization to first day when subject receives another anti-myeloma treatment

  18. Progression-free survival after next line therapy (PFS2) [Minimum of 5 years from randomization]

    Time from randomization to second objective disease progression or death from any cause, whichever is first

Eligibility Criteria

Criteria

Ages Eligible for Study:
18 Years and Older
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
Subjects must satisfy the following criteria to be enrolled in the study:
  1. Subject is ≥ 18 years of age at the time of signing the informed consent form (ICF).

  2. Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted.

  3. Subject is willing and able to adhere to the study visit schedule and other protocol requirements within this protocol and for a subject randomized to Treatment Arm A, subject agrees to continued follow-up for up to 15 years as mandated by the regulatory guidelines for gene therapy trials.

  4. Subject has documented diagnosis of MM and measurable disease, defined as:

  • M-protein (serum protein electrophoresis [sPEP] or urine protein electrophoresis [uPEP]): sPEP ≥ 0.5 g/dL or uPEP ≥ 200 mg/24 hours and/or

  • Light chain MM without measurable disease in the serum or urine: Serum immunoglobulin free light chain ≥ 10 mg/dL (100 mg/L) and abnormal serum immunoglobulin kappa lambda free light chain ratio

  1. Subject has received at least 2 but no greater than 4 prior MM regimens.

  2. Subject has received prior treatment with DARA, a proteasome inhibitor- and an immunomodulatory compound-containing regimen for at least 2 consecutive cycles.

  3. Subject must be refractory to the last treatment regimen. Refractory is defined as documented progressive disease during or within 60 days (measured from the last dose of any drug within the regimen) of completing treatment with the last anti-myeloma regimen before study entry.

  4. Subject achieved a response (minimal response [MR] or better) to at least 1 prior treatment regimen.

  5. Subject has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.

  6. Recovery to Grade 1 or baseline of any non-hematologic toxicities due to prior treatments, excluding alopecia and Grade 2 peripheral neuropathy.

  7. Adequate vascular access for leukapheresis

  8. Females of childbearing potential (FCBP) must:

  1. Have negative pregnancy test(s) as verified by the Investigator. This applies even if the subject practices true abstinence from heterosexual contact.

  2. Either practice true abstinence from heterosexual contact or agree to use, and be able to comply with, effective measures of contraception without interruption.

  3. Agree to abstain from breastfeeding during study participation. d. Refrain from tissue donation including egg cell donation or any other tissue/blood/organ donations.

  1. Male subjects must:
  1. Practice true abstinence or agree to use a condom during sexual contact with a pregnant female or a female of childbearing potential while participating in the study, during dose interruptions, even if he has undergone a successful vasectomy.

  2. Refrain from tissue donation including sperm or any other tissue/blood/organ donations.

  1. Only subjects that would be considered for any of the 5 proposed standard regimens (DPd, DVd, IRd, Kd, or EPd), as judged by the investigator, should be included in the study.
Exclusion Criteria:
The presence of any of the following will exclude a subject from enrollment:
  1. Subject has any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in the study.

  2. Subject has any condition including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study.

  3. Subject has any condition that confounds the ability to interpret data from the study.

  4. Subject has nonsecretory multiple myeloma (MM).

  5. Subject has any of the following laboratory abnormalities:

  1. Absolute neutrophil count (ANC) < 1,000/μL b. Platelet count: < 75,000/μL in subjects in whom < 50% of bone marrow nucleated cells are plasma cells and platelet count < 50,000/μL in subjects in whom ≥ 50% of bone marrow nucleated cells are plasma cells (it is not permissible to transfuse a subject to reach this level) c. Hemoglobin < 8 g/dL (< 4.9 mmol/L) (it is not permissible to transfuse a subject to reach this level) d. Serum creatinine clearance (CrCl) < 45 mL/min e. Corrected serum calcium > 13.5 mg/dL (> 3.4 mmol/L) f. Serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 2.5 × upper limit of normal (ULN) g. Serum total bilirubin > 1.5 × ULN or > 3.0 mg/dL for subjects with documented Gilbert's syndrome h. International normalized ratio (INR) or activated partial thromboplastin time (aPTT) > 1.5 × ULN, or history of Grade ≥ 2 hemorrhage within 30 days, or subject requires ongoing treatment with chronic, therapeutic dosing of anticoagulants (eg, warfarin, low molecular weight heparin, Factor Xa inhibitors)
  1. Subject has inadequate pulmonary function defined as oxygen saturation (SaO2) < 92% on room air.

  2. Subject has prior history of malignancies, other than MM, unless the subject has been free of the disease for ≥ 5 years • Basal cell carcinoma of the skin

• Squamous cell carcinoma of the skin

  • Carcinoma in situ of the cervix

  • Carcinoma in situ of the breast

  • Incidental histologic finding of prostate cancer (T1a or T1b using the tumor, nodes, metastasis [TNM] clinical staging system) or prostate cancer that can be treated with curative intent

  1. Subject has active or history of plasma cell leukemia, Waldenstrom's macroglobulinemia, POEMS syndrome or amyloidosis.

  2. Subject with known central nervous system (CNS) involvement with myeloma.

  3. Subject has clinical evidence of pulmonary leukostasis and disseminated intravascular coagulation.

  4. Subject has known chronic obstructive pulmonary disease (COPD) with a forced expiratory volume in 1 second (FEV1) 50% of predicted normal.

  5. Subject has a history or presence of clinically relevant CNS pathology such as epilepsy, seizure, paresis, aphasia, stroke, subarachnoid hemorrhage or other CNS bleed, severe brain injuries, dementia, Parkinson's disease, cerebellar disease, organic brain syndrome, or psychosis.

  6. Subject was treated with DARA in combination with POM with or without dex (DP±d) as part of their most recent anti-myeloma treatment regimen, cannot receive DPd as bridging therapy but may receive DVd, IRd, Kd or EPdas bridging as per Investigator's discretion if randomized to Treatment Arm A.

  7. Subject was treated with DP±d as part of their most recent anti-myeloma treatment regimen, cannot receive DPd if randomized to Treatment Arm B but may receive DVd, IRd, Kd, or EPd as per Investigator's discretion.

  8. Subject was treated with DARA in combination with BTZ with or without dexamethasone (DV±d) as part of their most recent anti-myeloma treatment regimen, cannot receive DVd as bridging therapy but may receive DPd, IRd, Kd, or EPd as bridging as per Investigator's discretion if randomized to Treatment Arm A.

  9. Subject was treated with DV±d as part of their most recent anti-myeloma treatment regimen, cannot receive DVd if randomized to Treatment Arm B but may receive DPd, IRd, Kd, or EPd as per Investigator's discretion.

  10. Subject was treated with IXA in combination with LEN with or without dexamethasone (IR±d) as part of their most recent anti-myeloma treatment regimen, cannot receive IRd as bridging therapy but may receive DPd, DVd, Kd, or EPd as bridging as per Investigator's discretion if randomized to Treatment Arm A.

  11. Subject was treated with IR±d as part of their most recent anti-myeloma treatment regimen, cannot receive IRd if randomized to Treatment Arm B but may receive DPd, DVd, Kd, or EPd as per Investigator's discretion.

  12. Previous history of an allogeneic hematopoietic stem cell transplantation, treatment with any gene therapy-based therapeutic for cancer, investigational cellular therapy for cancer or BCMA targeted therapy.

  13. Subject has received autologous stem cell transplantation (ASCT) within 12 weeks prior to randomization.

  14. Subject has received any of the following within the last 14 days prior to randomization:

  1. Plasmapheresis b. Major surgery (as defined by the Investigator) c. Radiation therapy other than local therapy for myeloma-associated bone lesions d. Use of any investigational agents and systemic anti-myeloma drug therapy
  1. Echocardiogram (ECHO) or multigated acquisition (MUGA) with left ventricular ejection fraction (LVEF) < 45%.

  2. Ongoing treatment with chronic immunosuppressants (eg, cyclosporine or systemic steroids at any dose). Intermittent topical, inhaled or intranasal corticosteroids are allowed.

  3. Subject is positive for human immunodeficiency virus (HIV-1 and HIV-2), chronic or active hepatitis B or active hepatitis A or C.

  4. Subject has uncontrolled systemic fungal, bacterial, viral or other infection (defined as exhibiting ongoing signs/symptoms related to the infection and without improvement, despite appropriate antimicrobial treatment) or requiring IV antimicrobials for management.

  5. Subject has a history of class III or IV congestive heart failure (CHF) or severe nonischemic cardiomyopathy, unstable or poorly controlled angina, myocardial infarction, or ventricular arrhythmia within the previous 6 months prior to randomization.

  6. Hypersensitivity to DARA, thalidomide, lenalidomide, POM, BTZ, IXA, CFZ, ELO or dexamathasone. This includes rash ≥ Grade 3 during prior thalidomide, POM or lenalidomide therapy.

  7. Subject with known hypersensitivity to any component of bb2121 product, cyclophosphamide, fludarabine, and/or tocilizumab or hypersensitivity to the excipients contained in the formulation of DARA, POM, LEN, IXA, BTZ, CFZ, ELO or dexamethasone.

  8. Subject is a female who is pregnant, nursing, or breastfeeding

  9. For a subject randomized to Treatment Arm B and will be on a POM- or LEN-containing regimen; unable or unwilling to undergo protocol required thromboembolism prophylaxis.

28 Subject is intolerant to bortezomib, or has acute diffuse infiltrative pulmonary and pericardial disease, subject cannot receive DVd as bridging therapy if randomized to Treatment Arm A or cannot receive DVd if randomized to Treatment Arm B.

  1. Subject was treated with K±d as part of their most recent anti-myeloma treatment regimen, cannot receive Kd if randomized to Treatment Arm B but may receive DPd, DVd, IRd or EPd as per Investigator's discretion.

  2. Subject was treated with EP±d as part of their most recent anti-myeloma treatment regimen, cannot receive EPd if randomized to Treatment Arm B but may receive DPd, DVd, Kd or IRd as per Investigator's discretion.

Contacts and Locations

Locations

Site City State Country Postal Code
1 Local Institution - 109 Birmingham Alabama United States 10016
2 University of Alabama Birmingham Birmingham Alabama United States 10016
3 Local Institution - 141 Scottsdale Arizona United States 85259
4 Mayo Clinic Arizona Scottsdale Arizona United States 85259
5 Local Institution - 122 Los Angeles California United States 90095
6 UCLA Medical Centre-Santa Monica Hematology and Oncology Los Angeles California United States 90095
7 Local Institution - 142 Aurora Colorado United States 80045
8 University of Colorado Anschutz Cancer Pavilion Aurora Colorado United States 80045
9 Local Institution - 108 Jacksonville Florida United States 32224
10 Mayo Clinic - Jacksonville Jacksonville Florida United States 32224
11 Local Institution - 102 Tampa Florida United States 33612
12 Moffit Cancer Center Tampa Florida United States 33612
13 Emory University Hospital Atlanta Georgia United States 30322
14 Local Institution - 131 Atlanta Georgia United States 30322
15 Blood and Marrow Transplant Group of Georgia Atlanta Georgia United States 30342
16 Local Institution - 140 Atlanta Georgia United States 30342
17 Local Institution - 139 Chicago Illinois United States 60611
18 Northwestern University Feinberg School of Medicine Chicago Illinois United States 60611
19 Indiana University Cancer Center Indianapolis Indiana United States 46202-528
20 Local Institution - 100 Indianapolis Indiana United States 46202-528
21 Local Institution - 112 Westwood Kansas United States 66205-2003
22 The University of Kansas Hospital Westwood Kansas United States 66205-2003
23 Greenebaum University of Maryland Baltimore Maryland United States 21201-1595
24 Local Institution - 104 Baltimore Maryland United States 21201-1595
25 Local Institution - 134 Boston Massachusetts United States 02114
26 Mass General Boston Massachusetts United States 02114
27 Dana Farber Cancer Institute (DFCI) Boston Massachusetts United States 02215
28 Local Institution - 123 Boston Massachusetts United States 02215
29 University of Michigan Comprehensive Cancer Center Ann Arbor Michigan United States 48109-5936
30 Local Institution - 125 Rochester Minnesota United States 55905-0001
31 Mayo Clinic - Rochester Rochester Minnesota United States 55905
32 Local Institution - 114 Saint Louis Missouri United States 63110
33 Washington University School of Medicine, Siteman Cancer Center Saint Louis Missouri United States 63110
34 Hackensack University Medical Center Hackensack New Jersey United States 07601
35 Local Institution - 138 Hackensack New Jersey United States 07601
36 Local Institution - 119 New York New York United States 10029
37 Mount Sinai Medical Center New York New York United States 10029
38 Local Institution - 115 New York New York United States 10065
39 Local Institution - 135 New York New York United States 10065
40 New York Presbyterian Hospital Weil Cornell Medical College New York New York United States 10065
41 Duke Clinical Research Institute Duke University School of Medicine Durham North Carolina United States 27705
42 Local Institution - 113 Durham North Carolina United States 27705
43 Local Institution - 111 Philadelphia Pennsylvania United States 19107
44 Thomas Jefferson University Philadelphia Pennsylvania United States 19107
45 Fox Chase Cancer Center Philadelphia Pennsylvania United States 19111
46 Local Institution - 110 Philadelphia Pennsylvania United States 19111
47 University of Pittsburgh Medical Center - William M. Cooper Ambulatory Care Pavilion Pittsburgh Pennsylvania United States 15232
48 University of Pittsburgh Medical Center William M. Cooper Ambulatory Care Pavillion Pittsburgh Pennsylvania United States 15232
49 Sarah Cannon Research Institute Center for Blood Nashville Tennessee United States 37203:
50 Baylor University Medical Center at Dallas Dallas Texas United States 75246
51 Local Institution - 118 Dallas Texas United States 75246
52 Local Institution - 103 Dallas Texas United States 75390
53 Local Institution - 132 Houston Texas United States 77030
54 MD Anderson Cancer center Houston Texas United States 77030
55 Local Institution - 136 Salt Lake City Utah United States 84112
56 University of Utah Huntsman Cancer Center Salt Lake City Utah United States 84112
57 Swedish Cancer Institute Seattle Washington United States 98104
58 Local Institution - 107 Madison Wisconsin United States 53792
59 University of Wisconsin Carbone Cancer Center Madison Wisconsin United States 53792
60 Local Institution - 202 Leuven Belgium 3000
61 UZ Leuven Leuven Belgium 3000
62 Local Institution - 302 Calgary Alberta Canada T2N 4N2
63 Tom Baker Cancer center Calgary Alberta Canada T2N 4N2
64 Local Institution - 303 Toronto Ontario Canada M5G 2M9
65 Princess Margaret Cancer Centre Toronto Ontario Canada M5G 2M9
66 CHRU Lille Lille Cedex France 59037
67 Local Institution - 402 Lille Cedex France 59037
68 Centre Hospitalier Univ De Nantes Hotel-Dieu Nantes France 44093
69 Local Institution - 403 Nantes France 44093
70 Hospital Saint-Louis - APHP Paris France 75010
71 Local Institution - 400 Paris France 75010
72 IUCT Oncopole Toulouse CEDEX 9 France 31059
73 Local Institution - 401 Toulouse CEDEX 9 France 31059
74 Local Institution - 513 Dusseldorf Germany 40225
75 Local Institution - 514 Hamburg Germany 20246
76 Local Institution - 512 Heidelberg Germany 69120
77 Medizinische Universitaetsklinik Heidelberg Heidelberg Germany 69120
78 Local Institution - 515 Köln Germany 50937
79 Universitat zu Koln Köln Germany 50937
80 Local Institution - 511 Würzburg Germany 97080
81 Universitaetsklinikum Wuerzburg Würzburg Germany 97080
82 Azienda Ospedaliero Universitaria di Bologna - Policlinico S. Orsola-Malpighi - Istituto di Ematolog Bologna Italy 40138
83 Local Institution - 611 Bologna Italy 40138
84 Local Institution - 806 Bunkyo-ku Japan 113-8677
85 Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Bunkyo-ku Japan 113-8677
86 Local Institution - 804 Isehara City, Kanagawa Japan 259-1193
87 Tokai University Hospital Isehara, Kanagawa Japan 259-1193
88 Local Institution - 807 Nagoya Japan 467-8602
89 Japan Red Cross Medical Center Shibuya-ku Japan 150-8935
90 Local Institution - 805 Shibuya-ku Japan 150-8935
91 Local Institution - 650 Amsterdam Netherlands 1081 HV
92 Erasmus Medical Center Rotterdam Netherlands 3015 CN
93 Local Institution - 651 Rotterdam Netherlands 3015 CN
94 Oslo universitetssykehus, Rikshospitalet Oslo Universitetssykehus, Rikshospitalet Norway N-0027
95 Local Institution - 700 Oslo Norway N-0027
96 Clinica Universidad de Navarra Pamplona Spain 31008
97 Local Institution - 750 Pamplona Spain 31008
98 Hospital Universitario de Salamanca Salamanca Spain 37007
99 Local Institution - 751 Salamanca Spain 37007
100 Karolinska Universitetssjukhuset - Huddinge Stockholm Sweden SE-141 86
101 Local Institution - 251 Bern Switzerland 3010
102 Universitaetsspital Bern - Inselspital Bern Switzerland 3010
103 Local Institution - 850 Leeds United Kingdom LS9 7TF
104 Kings College Hospital London United Kingdom SE5 9RS
105 Local Institution - 851 London United Kingdom SE5 9RS

Sponsors and Collaborators

  • Celgene

Investigators

  • Study Director: Bristol-Myers Squibb, Bristol-Myers Squibb

Study Documents (Full-Text)

None provided.

More Information

Additional Information:

Publications

None provided.
Responsible Party:
Celgene
ClinicalTrials.gov Identifier:
NCT03651128
Other Study ID Numbers:
  • BB2121-MM-003
  • U1111-1217-9988
  • 2018-001023-38
First Posted:
Aug 29, 2018
Last Update Posted:
Aug 2, 2022
Last Verified:
Jul 1, 2022
Studies a U.S. FDA-regulated Drug Product:
Yes
Studies a U.S. FDA-regulated Device Product:
No
Keywords provided by Celgene
Additional relevant MeSH terms:

Study Results

No Results Posted as of Aug 2, 2022