Inclusion Criteria:
- - For inclusion in the trial, all the following inclusion criteria must be fulfilled, as
no waivers will be permitted:
Voluntarily agree to participate by giving written informed consent.
≥18 years of age. Histologically confirmed multiple myeloma that has relapsed from, is considered refractory
to, or is intolerant to regimens containing any of the following:
A proteasome inhibitor. An immunomodulating agent. A CD38-monoclonal antibody. Measurable disease, defined as one of the following:
M-protein ≥ 0.5g/dL (0.3 g/dL or above if IgA subtype)
Urine M-protein ≥ 200 mg/24hours. Serum free light chain difference > 100 mg/L. Serum free light chain ratio (involved/uninvolved) ≥ 8. Biopsy proven plasmacytoma. Bone marrow involvement >10%
ECOG performance status of 0-2. Adequate organ function, as indicated by the following laboratory values:
Adequate hematological function, defined as ANC ≥ 1000/µL, platelet count ≥ 75,000/µL, and
hemoglobin ≥ 8 g/dL (transfusion and/or growth factor support is allowed for hematologic
parameters as long as the investigator deems the patient otherwise fit for screening)
Adequate hepatic function, defined as total bilirubin level ≤ 1.5 x institutional upper
limit of normal (IULN) except in participants with congenital bilirubinemia, such as
Gilbert syndrome (in which case direct bilirubin ≤1.5 x IULN is required), AST ≤ 2.5 x
IULN, and ALT ≤ 2.5 x IULN. Adequate renal function, defined as calculated creatinine clearance ≥ 30 mL/min per
institutional standard (assessment method should be recorded, measured or C-G acceptable)
Adequate coagulation, defined as international normalized ratio (INR) or prothrombin time ≤
1.5 x IULN and activated partial thromboplastin time (aPTT) ≤ 1.5 x IULN (unless patient is
receiving anticoagulant therapy)
Persons of childbearing potential must have a negative serum pregnancy test at screening
(within 72 hours of first dose of trial medication). Non-childbearing potential for a
person assigned as female at birth is defined as 1 of the following:
≥ 45 years of age and has not had menses for >1 year. Amenorrheic for > 2 years without a hysterectomy and/or oophorectomy and
follicle-stimulating hormone value in the postmenopausal range upon pretrial (screening)
evaluation. Status is post-hysterectomy, -oophorectomy, or -tubal ligation. Persons of childbearing potential must be willing to use highly effective contraceptive
measures during sexual contact with a person assigned as male at birth starting with the
Screening visit through 90 days after last dose of trial treatment.
Note: Abstinence is acceptable if this is the established and preferred contraception for
the participant.
Persons assigned as male at birth with a partner(s) of childbearing potential must agree to
use highly effective contraceptive measures throughout the trial starting with the
Screening visit through 90 days after the last dose of trial treatment is received. Persons
assigned as male at birth with pregnant partners must agree to use a condom; no additional
method of contraception is required for the pregnant partner.
Note: Abstinence is acceptable if this is the established and preferred contraception
method for the participant.
Known history or current symptoms of cardiac disease, or history of treatment with
cardiotoxic agents, should have a clinical risk assessment of cardiac function using New
York Heart Association Functional Classification. To be eligible for this trial, patients
should be Class 2 or lower. Class 2 is defined as slight limitation of physical activity,
in which ordinary physical activity leads to fatigue, palpitation, or dyspnea; the person
is comfortable at rest.
Patients with a prior or concurrent malignancy whose natural history or treatment does not
have the potential to interfere with the safety or efficacy assessments of the
investigational arms are eligible for this trial.
Patients with known HIV infection who are on effective anti-retroviral therapy with
undetectable viral load within 6 months are eligible for this trial.
Patients with evidence of chronic hepatitis B virus (HBV) infection must have an
undetectable HBV viral load on suppressive therapy, if indicated.
Patients with a history of hepatitis C virus (HCV) infection must have been treated and
cured. For patients with known HCV infection who are currently on treatment, they are
eligible if they have an undetectable HCV viral load.
Willing and able to comply with the requirements of the protocol.
Exclusion Criteria:
- - For inclusion in the trial, all the following inclusion criteria must be fulfilled, as
no waivers will be permitted:
Voluntarily agree to participate by giving written informed consent.
≥18 years of age. Histologically confirmed multiple myeloma that has relapsed from, is considered refractory
to, or is intolerant to regimens containing any of the following:
A proteasome inhibitor. An immunomodulating agent. A CD38-monoclonal antibody. Measurable disease, defined as one of the following:
M-protein ≥ 0.5g/dL (0.3 g/dL or above if IgA subtype)
Urine M-protein ≥ 200 mg/24hours. Serum free light chain difference > 100 mg/L. Serum free light chain ratio (involved/uninvolved) ≥ 8. Biopsy proven plasmacytoma. Bone marrow involvement >10%
ECOG performance status of 0-2. Adequate organ function, as indicated by the following laboratory values:
Adequate hematological function, defined as ANC ≥ 1000/µL, platelet count ≥ 75,000/µL, and
hemoglobin ≥ 8 g/dL (transfusion and/or growth factor support is allowed for hematologic
parameters as long as the investigator deems the patient otherwise fit for screening)
Adequate hepatic function, defined as total bilirubin level ≤ 1.5 x institutional upper
limit of normal (IULN) except in participants with congenital bilirubinemia, such as
Gilbert syndrome (in which case direct bilirubin ≤1.5 x IULN is required), AST ≤ 2.5 x
IULN, and ALT ≤ 2.5 x IULN. Adequate renal function, defined as calculated creatinine clearance ≥ 30 mL/min per
institutional standard (assessment method should be recorded, measured or C-G acceptable)
Adequate coagulation, defined as international normalized ratio (INR) or prothrombin time ≤
1.5 x IULN and activated partial thromboplastin time (aPTT) ≤ 1.5 x IULN (unless patient is
receiving anticoagulant therapy)
Persons of childbearing potential must have a negative serum pregnancy test at screening
(within 72 hours of first dose of trial medication). Non-childbearing potential for a
person assigned as female at birth is defined as 1 of the following:
≥ 45 years of age and has not had menses for >1 year. Amenorrheic for > 2 years without a hysterectomy and/or oophorectomy and
follicle-stimulating hormone value in the postmenopausal range upon pretrial (screening)
evaluation. Status is post-hysterectomy, -oophorectomy, or -tubal ligation. Persons of childbearing potential must be willing to use highly effective contraceptive
measures during sexual contact with a person assigned as male at birth starting with the
Screening visit through 90 days after last dose of trial treatment.
Note: Abstinence is acceptable if this is the established and preferred contraception for
the participant.
Persons assigned as male at birth with a partner(s) of childbearing potential must agree to
use highly effective contraceptive measures throughout the trial starting with the
Screening visit through 90 days after the last dose of trial treatment is received. Persons
assigned as male at birth with pregnant partners must agree to use a condom; no additional
method of contraception is required for the pregnant partner.
Note: Abstinence is acceptable if this is the established and preferred contraception
method for the participant.
Known history or current symptoms of cardiac disease, or history of treatment with
cardiotoxic agents, should have a clinical risk assessment of cardiac function using New
York Heart Association Functional Classification. To be eligible for this trial, patients
should be Class 2 or lower. Class 2 is defined as slight limitation of physical activity,
in which ordinary physical activity leads to fatigue, palpitation, or dyspnea; the person
is comfortable at rest.
Patients with a prior or concurrent malignancy whose natural history or treatment does not
have the potential to interfere with the safety or efficacy assessments of the
investigational arms are eligible for this trial.
Patients with known HIV infection who are on effective anti-retroviral therapy with
undetectable viral load within 6 months are eligible for this trial.
Patients with evidence of chronic hepatitis B virus (HBV) infection must have an
undetectable HBV viral load on suppressive therapy, if indicated.
Patients with a history of hepatitis C virus (HCV) infection must have been treated and
cured. For patients with known HCV infection who are currently on treatment, they are
eligible if they have an undetectable HCV viral load.
Willing and able to comply with the requirements of the protocol.
For inclusion in the trial, patients will not be eligible to participate in Horizon if any
of the following criteria are met, as no waivers will be permitted:
Major concurrent illness or organ dysfunction including but not limited to the following:
Plasma cell leukemia (the presence of ≥5% circulating plasma cells in peripheral blood
smears)
Waldenström's macroglobulinemia. POEMS syndrome. primary light-chain amyloidosis. History of allergy or known hypersensitivity to any of the trial treatments or any of their
excipients, or contraindication to any of the trial treatments as outlined in the local
prescribing information (e.g., United States Prescribing Information [USPI]).
Complete spinal cord compression or CNS involvement. Allogeneic tissue/solid organ transplant recipients with chronic GVHD requiring steroid
equivalent dose of > 20 mg prednisone. Active infection requiring treatment. History or current evidence of any condition, therapy, or laboratory abnormality that might
confound the results of the trial, interfere with the patient's participation for the full
duration of the trial, or is not in the best interest of the patient to participate, in the
opinion of the treating investigator. Psychiatric or substance abuse disorder that would interfere with cooperation with the
requirements of the trial. Legally incapacitated or has limited legal capacity. Persons who are pregnant or lactating
