Ensayos clínicos

Inclusion Criteria:

• Age ≥ 18 years and considered transplant eligible.
• Diagnosis: Pathologically confirmed diagnosis of multiple myeloma who are transplant eligible and have received any prior induction therapy (with or without maintenance).
• Measurable MRD in bone marrow within 28 days prior to registration (MPF method).
• ECOG Performance Status (PS) 0, 1, or 2 (Appendix I) at registration.
• The following laboratory values obtained ≤ 14 days prior to registration:
  • Absolute neutrophil count (ANC) ≥ 1,000 cell/mm3 without growth factor support;
  • Platelets ≥ 50,000 cells/mm3 for patients who have bone marrow plasmacytosis < 50% or ≥ 30,000 cells/mm3 for patients who have bone marrow plasmacytosis of ≥ 50%;
  • Calculated or measured creatinine clearance ≥ 30 ml/min;
  • Total bilirubin ≤1.5 x upper limit of normal (ULN) unless due to Gilbert’s syndrome, in which case the direct bilirubin must be ≤ 1.5 X ULN;
  • Aspartate aminotransferase (AST)/SGOT and alanine aminotransferase (ALT)/SGPT ≤ 3 x ULN;
  • PT/INR ≤ 1.5 X ULN;
  • Negative urine or serum pregnancy test for women of childbearing potential.
    • NOTE: Females of reproductive potential must adhere to the scheduled pregnancy testing as required in the Revlimid REMS® program.
• Provide informed written consent.
• Willing to provide bone marrow aspirate and core, and blood samples for correlative research purposes.
• Measureable disease of multiple myeloma  at the time specified by one of the following:
  • If no relapse prior to transplant, values obtained at the time of diagnosis;
  • If disease relapse prior to transplant and the patient did not have treatment for the relapsed disease prior to transplant, the values obtained at the time of relapse immediately prior to the transplant;
  • If disease relapse prior to transplant and the patient did have treatment for the relapsed disease prior to transplant, the values obtained prior to this therapy; i.e., the time of relapse.

Exclusion Criteria:

• Any previous ASCT for MM. EXCEPTION: Patient had autologous stem cell transplant > 3 years ago without any related adverse events and has not been on any post-transplant maintenance therapy. (NOTE: Patient may have had prior stem cell collection before registration on the study)
• Any prior therapy with daratumumab.
• Non-secretory MM or known AL amyloidosis.
• Clinically significant active infection requiring intravenous antibiotics (≤ 14 days prior to registration).
• ≥ Grade 3 neuropathy and/or POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes).
• Other prior malignancy.  EXCEPTIONS:
  • Adequately treated basal cell or squamous cell skin cancer;
  • Any in situ cancer;
  • Adequately treated Stage I or II cancer from which the patient is currently in complete remission; or
  • Any other cancer from which the patient has been disease free for at least three years.
• Concurrent therapy considered investigational.
  • NOTE: Patients must not be planning to receive any radiation therapy (except localized radiation for palliative care that must be completed prior to starting Cycle 1, Day 1).
• Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown:
  • Pregnant women;
  • Nursing women (lactating females are eligible provided that they agree not to breast feed while taking lenalidomide);
  • Men or women of childbearing potential who are unwilling to employ adequate contraception.
• Major surgery ≤ 4 weeks prior to registration.
• History of stroke/intracranial hemorrhage ≤ 6 months prior to registration.
• Clinically significant cardiac illness including New York Heart Association (NYHA) Class III or Class IV heart failure (Appendix III), unstable angina pectoris, myocardial infarction within the past 6 months, or ≥ Grade 3 cardiac arrhythmias noted ≤ 14 days prior to registration.
• Known HIV+ patients.
• Known Hepatitis B or Hepatitis C infection.
• Exhibiting clinical signs of meningeal involvement of multiple myeloma.                     
• Known severe chronic obstructive pulmonary disease or asthma defined as forced expiratory volume (FEV1) in 1 second less than < 60% of expected.