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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Embargo End Date
ICR Authors
Authors
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,
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,
Document Type
Journal Article
Date
2021-03-24
Date Accepted
2021-02-09
Abstract
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.
Citation
BMJ open, 2021, 11 (3), pp. e046225 - ?
Source Title
Publisher
BMJ PUBLISHING GROUP
ISSN
2044-6055
eISSN
2044-6055
Collections
Research Team
Myeloma Group
Myeloma Group
Myeloma Group