MUKnine OPTIMUM protocol: a screening study to identify high-risk patients with multiple myeloma suitable for novel treatment approaches combined with a phase II study evaluating optimised combination of biological therapy in newly diagnosed high-risk multiple myeloma and plasma cell leukaemia.
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Date
2021-03-24ICR Author
Author
Brown, S
Sherratt, D
Hinsley, S
Flanagan, L
Roberts, S
Walker, K
Hall, A
Pratt, G
Messiou, C
Jenner, M
Kaiser, M
Myeloma UK Early Phase Clinical Trial Network,
Type
Journal Article
Metadata
Show full item recordAbstract
INTRODUCTION: Multiple myeloma (MM) is a plasma cell tumour with over 5800 new cases each year in the UK. The introduction of biological therapies has improved outcomes for the majority of patients with MM, but in approximately 20% of patients the tumour is characterised by genetic changes which confer a significantly poorer prognosis, generally termed high-risk (HR) MM. It is important to diagnose these genetic changes early and identify more effective first-line treatment options for these patients. METHODS AND ANALYSIS: The Myeloma UK nine OPTIMUM trial (MUKnine) evaluates novel treatment strategies for patients with HRMM. Patients with suspected or newly diagnosed MM, fit for intensive therapy, are offered participation in a tumour genetic screening protocol (MUKnine a), with primary endpoint proportion of patients with molecular screening performed within 8 weeks. Patients identified as molecularly HR are invited into the phase II, single-arm, multicentre trial (MUKnine b) investigating an intensive treatment schedule comprising bortezomib, lenalidomide, daratumumab, low-dose cyclophosphamide and dexamethasone, with single high-dose melphalan and autologous stem cell transplantation (ASCT) followed by combination consolidation and maintenance therapy. MUKnine b primary endpoints are minimal residual disease (MRD) at day 100 post-ASCT and progression-free survival. Secondary endpoints include response, safety and quality of life. The trial uses a Bayesian decision rule to determine if this treatment strategy is sufficiently active for further study. Patients identified as not having HR disease receive standard treatment and are followed up in a cohort study. Exploratory studies include longitudinal whole-body diffusion-weighted MRI for imaging MRD testing. ETHICS AND DISSEMINATION: Ethics approval London South East Research Ethics Committee (Ref: 17/LO/0022, 17/LO/0023). Results of studies will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: ISRCTN16847817, May 2017; Pre-results.
Collections
Subject
Myeloma UK Early Phase Clinical Trial Network
Humans
Multiple Myeloma
Dexamethasone
Antineoplastic Combined Chemotherapy Protocols
Hematopoietic Stem Cell Transplantation
Transplantation, Autologous
Bayes Theorem
Cohort Studies
Quality of Life
London
Leukemia, Plasma Cell
Multicenter Studies as Topic
Clinical Trials, Phase II as Topic
Research team
Myeloma Group
Myeloma Group
Language
eng
Date accepted
2021-02-09
License start date
2021-03-24
Citation
BMJ open, 2021, 11 (3), pp. e046225 - ?
Publisher
BMJ PUBLISHING GROUP
Except where otherwise noted, this item's license is described
as
https://creativecommons.org/licenses/by-nc/4.0
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