A randomized phase III trial assessing iberdomide versus iberdomide plus isatuximab maintenance therapy post autologous hematopoietic stem-cell transplantation in patients with newly diagnosed multiple myeloma (GMMG-HD9/DSMM XVIII-trial)

Prior treatment

• Patients currently being treated with medically indispensable strong inhibitors or inducers of CYP3A4/5

Other illness

• Patients presenting with any of the following criteria will not be included in the trial: Subjects with gastrointestinal disease that may significantly alter the absorption of iberdomide
• Patients with active or uncontrolled hepatitis B or C or detectable liver disease due to hepatitis B or C. In case of history of hepatitis B or C, it must be clarified whether it has been overcome and negative circulating HBV-DNA or HCV-RNA with sensitive PCR blood tests must be provided. Positive hepatitis B status may only be acceptable in absence of circulating HBV-DNA or signs of chronic or acute infection and if an adequate prophylaxis is being implemented during the course of the study. Prophylaxis for patients with history of hepatitis B or C should be set on a patient individual basis
  • HIV positivity
  • Patients with active, uncontrolled infections
• Patients with a history of serious allergic reaction to another immunomodulatory agent (thalidomide, lenalidomide, or pomalidomide), as angioedema and severe dermatologic reactions, including Grade 4 rash and exfoliative or bullous rash

Lab values

• Corrected serum calcium > 14 mg/dL (> 3.5 mmol/L)
• Patient has known hypersensitivity or contraindication to any of the components of study therapy (e.g. known intolerance or hypersensitivity to iberdomide, isatuximab, infused proteins products, sucrose, histidine, and polysorbate 80 as well as intolerance to arginine and Poloxamer 188)
  • Pregnancy and lactation
  • Participant has any concurrent severe and/or uncontrolled medical condition or psychiatric disease that is likely to interfere with study procedures or results, or that in the opinion of the investigator would constitute a hazard for participating in this study or that confounds the ability to interpret data from the study
  • Participation in other interventional clinical trials. This does not include long-term follow-up periods without active drug treatment of previous studies during the last 6 months
  • Systemic AL amyloidosis (except for localized AL amyloidosis limited to the skin or the bone marrow) or plasma cell leukemia (> 2.0 × 109/L circulating plasma cells by standard differential blood count) or polyneuropathy, organomegaly, endocrinopathy, monoclonal-protein and skin abnormalities (POEMS syndrome); or Waldenström macroglobulinemia.
  • Previous systemic anti-myeloma treatment other than administered within the GMMG-HD8 / DSMM XIX trial (including up to two cycles cycle high dose melphalan therapy (HDM) and autologous stem cell transplantation (ASCT). Local, consolidative radiotherapy for myeloma disease is permitted unless performed in case of progressive disease (PD) according to IMWG criteria
  • Severe cardiac dysfunction (NYHA classification III-IV; see Appendix II)
  • Significant hepatic dysfunction (ASAT and/or ALAT ≥ 3 times normal level and/or serum bilirubin ≥ 1.5 times normal level if not due to hereditary abnormalities as Gilbert’s disease), unless related to MM or HDM/ASCT
  • Patients with severe renal insufficiency (Creatinine Clearance < 30 mL/min) or requiring hemodialysis
• Subjects, who are committed to an institution by virtue of an order issued either by the judicial or the administrative authorities
  • Patients with peripheral neuropathy or neuropathic pain, grade 2 or higher (as defined by the NCI Common Terminology Criteria for Adverse Events (NCI CTCAE, version 5.0, see Appendix V)
  • Patients with a history of any active malignancy during the past 5 years with the exception of following malignancies after curative therapy: basal cell carcinoma of the skin, squamous cell skin carcinoma, stage 0 cervical carcinoma or any in situ malignancy. A history of an early stage malignancy during the past 5 years may be acceptable, however, in this case the GMMG or DSMM study office has to be consulted prior to study inclusion
  • Patients with acute diffuse infiltrative pulmonary and/or pericardial disease
  • Autoimmune haemolytic anaemia with positive indirect Coombs test or immune thrombocytopenia
  • Platelet count < 75 x 10^9/L
  • Haemoglobin ≤ 8.0 g/dL, unless related to MM
  • Absolute neutrophil count (ANC) < 1.0 x 10^9/L (the use of colony stimulating factors within 14 days before the test is not allowed)

Other

• Unable or unwilling to undergo thromboprophylaxis

• Patients meeting all of the following criteria will be considered for admission to the trial: Prior inclusion and treatment within the GMMG-HD8/DSMM XIX trial (including confirmation of diagnosis of MM with myeloma-defining events [end-organ damage or biomarker of malignancy] and measurable disease prior to initiation of induction therapy as outlined in the IMWG criteria)
• All patients must agree to abstain from donating blood while taking study treatment and for 28 days following discontinuation of study treatment
• Ability of patient to understand character and individual consequences of the clinical trial
• Written informed consent (must be available before enrolment in the trial)
• Received at least one cycle high dose melphalan therapy (HDM) and autologous stem cell transplantation (ASCT)
• At least Partial Response (PR) according to IMWG criteria at inclusion in the trial
• Age of 18 years or higher at trial inclusion
• WHO performance status of 0, 1, or 2 (see Appendix II)
• A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy, or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (ie, has had menses at any time in the preceding 24 consecutive months) and must: a) Have two negative serum or urine pregnancy tests as verified by the Investigator prior to starting study treatment. She must agree to ongoing pregnancy testing during the course of the study, and after end of study treatment. This applies even if the subject practices true abstinence from heterosexual contact. b) Either commit to true abstinence from heterosexual contact (which must be reviewed on a monthly basis and source documented) or agree to use, and be able to comply with two forms of contraception: one highly effective, and one additional effective (barrier) measure of contraception without interruption 28 days prior to starting investigational product, during the study treatment (including dose interruptions), and for at least 28 days after the last dose of iberdomide.
• Male subjects must practice complete abstinence (True abstinence is acceptable when this is in line with the preferred and usual lifestyle of the subject. Periodic abstinence [e.g. calendar, ovulation, symptothermal or post-ovulation methods] and withdrawal are not acceptable methods of contraception) or agree to use a condom during sexual contact with a pregnant female or a FCBP while taking iberdomide, during dose interruptions and for at least 28 days following the last dose of iberdomide even if he has undergone a successful vasectomy.
• Males must agree to refrain from donating sperm while on study treatment, during dose interruptions and for at least 28 days following last dose of study treatment.
• All male and female subjects must follow all requirements defined in the Pregnancy Prevention Program (see section 7.1.7 and Appendix IV).