A Phase III, Safety, Tolerability and Efficacy of Combination Treatment of BL-8040 and G-GSF as Compared to Placebo and G-CSF for the Mobilization of Hematopoietic Stem Cells for Autologous TransplantatIon in Subjects With MM (GENESIS)

A Phase III, Randomized, Placebo-Controlled, Multi-Centre Study Evaluating the Safety, Tolerability and Efficacy of Combination Treatment of BL-8040 and G-GSF as Compared to Placebo and G-CSF for the Mobilization of Hematopoietic Stem Cells for Autologous Transplantation in Subjects With Multiple Myeloma - The GENESIS Study

A total of 122 subjects were randomized into the study and investigated in the double-blind placebo-controlled setting to assess the efficacy and safety of G-CSF + BL-8040 as compared to G-CSF + placebo.

Study Overview

• Status: Active, not recruiting
• Conditions: Multiple Myeloma
• Intervention / Treatment: Drug: Placebo +G-CSF; Drug: BL-8040 1.25 mg/kg + G-CSF

Detailed Description

• Part 1: This lead-in period, designed to ascertain the dose of BL-8040, enrolled a total of 12 subjects to an open labeled treatment to assess the efficacy, safety, PK and PD parameters of treatment with G-CSF 10 µg/kg/day and BL-8040 1.25 mg/kg, per study protocol to goal collection of ≥ 6 × 10^6 CD34+ cells/kg.
• Part 2: Following the successful completion of Part 1, a total of 122 subjects were randomized into Part 2 of the study which employed a double-blind placebo-controlled setting to assess the efficacy and safety of G-CSF + BL-8040 as compared to G-CSF + placebo.

• Study Type: Interventional
• Enrollment (Actual): 180
• Phase: Phase 3

Contacts and Locations

Study Locations

• Germany
  • Koln
    • Köln, Koln, Germany, 50923
      • University of Koln
• Hungary
  • Budapest, Hungary, 1097
    • Central Hospital of Southern Pest National Institute of Hematology and Infectious Diseases
  • Debrecen, Hungary, 4032
    • University of Debrecen
• Italy
  • Catania, Italy, 95124
    • Div. Clinicizzata di Ematologia - Policlinico Vittorio Emanuele
  • Reggio Calabria, Italy, 89133
    • Presidio Ospedaliero Morelli Viale Europa
• Spain
  • Barcelona, Spain, 08041
    • Hospital de la Santa Creu i Sant Pau
  • Madrid, Spain, 28041
    • Hospital Universitario 12 de Octubre
  • Madrid, Spain, 135250
    • Hospital University Ramon y Cajal
• United States
  • California
    • Los Angeles, California, United States, 167817
      • UCLA Medical Center
  • Florida
    • Gainesville, Florida, United States, 100278
      • University of Florida
    • Miami, Florida, United States, 33136
      • University of Miami
  • Illinois
    • Chicago, Illinois, United States, 60611
      • Loyola University Medical Center
  • Maryland
    • Baltimore, Maryland, United States, 21201
      • University of Maryland
  • Minnesota
    • Rochester, Minnesota, United States, 55902
      • Mayo Clinic
  • Missouri
    • Saint Louis, Missouri, United States, 63110
      • The Washington University School of Medicine
  • Ohio
    • Cincinnati, Ohio, United States, 45221
      • University of Cincinnati
  • Texas
    • Houston, Texas, United States, 77030
      • MD Anderson Cancer Center
  • Utah
    • Salt Lake City, Utah, United States, 84112
      • Huntsman Cancer Institute in University of Utah

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 76 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Histologically confirmed Multiple Myeloma prior to enrolment and randomization.
2. At least 1 week (7 days) from last induction cycle of combination/multi-agent cyto-reductive chemotherapy (e.g., KRD [carfilzomib, lenalidomide, dexamethasone] or VRD (e.g., bortezomib, lenalidomide, dexamethasone) or last single agent chemotherapy (e.g., lenalidomide, pomalidomide, bortezomib, dexamethasone, etc.) prior to the first dose of G-CSF for mobilization.
3. Eligible for autologous hematopoietic stem cell transplantation according to the Investigator's discretion.
4. The subjects should be in first or second CR (including CR and SCR) or PR (including PR and VGPR).
5. Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1.

6. Adequate organ function at screening as defined as below:

   1. Hematology:

      • White blood cell counts more than 2.5 x 109/L
      • Absolute neutrophil count more than 1.5 x 109/L

   2. Platelet count more than 100 x109/L Renal Function:

      • GFR value of ≥15 mL/min/1.732 calculated by MDRD equation

   3. Hepatic function:

      • ALT and/or AST ≤ 2.5 x ULN
      • Total Bilirubin ≤ 2.0 x ULN unless the subject has Gilbert disease

   4. Coagulation test:

      • INR or PT: ≤1.5xULN unless subject is receiving anticoagulant therapy, as long as PT or PTT is within therapeutic range of intended use of anticoagulants
      • aPTT: ≤1.5xULN unless subject is receiving anticoagulant therapy, as long as PT or PTT is within therapeutic range of intended use of anticoagulants
7. Male subjects must agree to use an adequate method of contraception starting with the first day of G-CSF administration through 30 days after the last dose of study drug.
8. Patients must have a signed study informed consent prior to entering the study.

Exclusion Criteria:

1. Previous history of autologous or allogeneic-HCT.
2. Failed previous HSC collections or collection attempts.

3. Taken any of the listed below concomitant medications, growth factors or stimulating agents within the designated washout period:

   1. Dexamethasone: 7 days;
   2. Thalidomide: 7 days;
   3. Lenalidomide: 7 days;
   4. Pamolidomide: 7 days;
   5. Bortezomib: 7 days;
   6. Carfilzomib: 7 days;
   7. G-CSF: 14 days;
   8. GM-CSF or Neulasta®: 21 days;
   9. Erythropoietin or erythrocyte stimulating agents: 30 days;
   10. Eltrombopag, romiplostim or platelet stimulating agents: 30 days;
   11. Carmustine (BCNU): 42 days/6 weeks;
   12. Daratumumab: 28 days;
   13. Ixazomib: 7 days.
4. Received >6 cycles lifetime exposure to thalidomide or lenalidomide.
5. Received >8 cycles of alkylating agent combinations.
6. Received >6 cycles of melphalan.
7. Received prior treatment with radioimmunotherapy (e.g., radionuclides, holmium).
8. Received prior treatment wiht venetoclax.
9. Plans to receive maintenance treatment within 60 days post-engraftment (e.g., lenalidomide, bortezomib, pomalidomide, thalidomide, carfilzomib, etc.)
10. Has received a live vaccine within 30 days of the planned start of G-CSF administration. Seasonal flu vaccines that do not contain live virus are permitted.
11. Known active CNS metastases or carcinomatous meningitis.
12. A history of allergic reactions attributed to compounds of similar chemical or biologic composition to BL-8040, G-CSF, or other agents used in the study.
13. Has an active infection requiring systemic therapy or uncontrolled infection.
14. Has a known additional malignancy that is progressing or requires active treatment.
15. Has an underlying medical condition that would preclude study participation.
16. Is currently participating and receiving study therapy or has participated in a study of an investigational agent and received study therapy or used an investigational device within 4 weeks of the first dose of treatment.
17. O2 saturation < 92% (on room air).
18. Personal history or family history of Long QT Syndrome or Torsade de Pointes.
19. History of unexplained syncope, syncope from an uncorrected cardiac etiology, or family history of sudden cardiac death.
20. Myocardial infarction, CABG, coronary or cerebral artery stenting and /or angioplasty, stroke, cardiac surgery, or hospitalization for congestive heart failure within 3 months or greater than Angina Pectoris Class >2 or NYHA Heart Failure >2.
21. ECG in screening showing QTcF > 470 msec, and/or PR > 280 msec,.
22. Mobitz II 2nd degree AV Block, 2:1 AV Block, High Grade AV Block, or Complete Heart Block, unless the patient has an implanted pacemaker or implantable cardiac defibrillator (ICD) with backup pacing capabilities.
23. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is notin the best interest of the subject to participate, in the opinion of the treating investigator.
24. Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
25. Is pregnant or breastfeeding, or expecting to conceive within the projected duration of the trial, starting with the screening visit through 30 days after the last dose of study drug.
26. Has a known history of HIV (HIV 1/2 antibodies)
27. Has known active Hepatitis B (e.g., Hepatitis B Surface Antigen [HBsAg] reactive) or Hepatitis C (e.g., Hepatitis C Virus [HCV] RNA [qualitative] is detected).
28. Untreated or unsuccessfully treated Hepatitis B or C.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: BL-8040 1.25 mg/kg + G-CSF; Double-blind placebo-controlled setting designed to assess the safety, tolerability and efficacy of G-CSF + BL-8040 as compared to G-CSF + Placebo, for stem cell mobilization in MM.	Drug: BL-8040 1.25 mg/kg + G-CSF; Up to 2 SC injections of BL-8040 are anticipated during the study. Injections of G-CSF per standard of care
Active Comparator: Placebo + G-CSF; Double-blind placebo-controlled setting designed to assess the safety, tolerability and efficacy of G-CSF + BL-8040 as compared to G-CSF + Placebo, for stem cell mobilization in MM.	Drug: Placebo +G-CSF; Up to 2 SC injections of Placebo are anticipated during the study. Injections of G-CSF per standard of care

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Subjects Mobilizing ≥6 × 10^6 CD34+ Cells/kg With up to 2 Apheresis Sessions	Percentage of subjects mobilizing ≥6 × 10^6 CD34+ cells/kg with up to 2 apheresis sessions in preparation for autologous hematopoetic cell transplantation (auto-HCT) after treatment with G-CSF + single administration of BL-8040/placebo. Based on central laboratory data.	From first day of study treatment (G-CSF) until day of second apheresis which was planned to occur on Day 6

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of Subjects Mobilizing ≥2 × 10^6 CD34+ Cells/kg in 1 Apheresis Session	Percentage of subjects mobilizing ≥2 × 10^6 CD34+ cells/kg in 1 apheresis session after treatment with G-CSF + single administration of BL-8040/ placebo.	From first day of study treatment (G-CSF) until day of first apheresis which was planned to occur on Day 5
Percentage of Subjects Mobilizing ≥6 × 10^6 CD34+ Cells/kg in 1 Apheresis Session	Percentage of subjects mobilizing ≥6 × 10^6 CD34+ cells/kg in 1 apheresis session after treatment with G-CSF + single administration of BL-8040/ placebo.	From first day of study treatment (G-CSF) until day of first apheresis which was planned to occur on Day 5
Time to Neutrophil Engraftment, After Auto-HCT	Time to neutrophil engraftment after auto-HCT, where engraftment was defined as absolute neutrophil count (ANC) ≥0.5 × 10^9/L for 3 days or ≥1.0 × 10^9/L for 1 day following the conditioning regimen associated nadir.	End of engraftment period, which was defined as 29 days post transplantation
Time to Platelet Engraftment, After Auto-HCT	Time to platelet engraftment, after auto-HCT, where engraftment was defined as the first of 3 consecutive measurements of platelet count ≥20 × 10^9/L without platelet transfusion support for 7 days following the conditioning regimen associated nadir.	End of engraftment period, which was defined as 29 days post transplantation
Subjects With Graft Durability at 100 Days Post Transplant/ Early Termination	Subjects achieving graft durability were defined as meeting the following 2 criteria: Platelet count ≥50 × 10^9/L without transfusion for at least 2 weeks.; Hemoglobin level ≥10 g/dL with no erythropoietin support or transfusions for at least 1 month. This analysis was performed in part 2 of the study only.	Day 100 Post-Transplantation (± 7 days)

Collaborators and Investigators

• Sponsor: BioLineRx, Ltd.
• Investigators: Principal Investigator: John DiPersio, MD, Washington University School of Medicine; Principal Investigator: Crees Zachary, MD, Washington University School of Medicine

Publications and helpful links

General Publications

• Crees ZD, Stockerl-Goldstein K, Vainstein A, Chen H, DiPersio JF. GENESIS: Phase III trial evaluating BL-8040 + G-CSF to mobilize hematopoietic cells for autologous transplant in myeloma. Future Oncol. 2019 Nov;15(31):3555-3563. doi: 10.2217/fon-2019-0380. Epub 2019 Sep 9.

Study record dates

Study Major Dates

• Study Start (Actual): March 23, 2018
• Primary Completion (Actual): December 22, 2020
• Study Completion (Estimated): September 30, 2029

Study Registration Dates

• First Submitted: August 2, 2017
• First Submitted That Met QC Criteria: August 7, 2017
• First Posted (Actual): August 11, 2017

Study Record Updates

• Last Update Posted (Actual): February 8, 2024
• Last Update Submitted That Met QC Criteria: February 6, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Immunoproliferative Disorders; Hematologic Diseases; Hemorrhagic Disorders; Hemostatic Disorders; Paraproteinemias; Blood Protein Disorders; Multiple Myeloma; Neoplasms, Plasma Cell; Physiological Effects of Drugs; Immunologic Factors; Adjuvants, Immunologic; Lenograstim
• Other Study ID Numbers: BL-8040.SCM.301

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No