Selinexor, Daratumumab, and Dexamethasone (XDd) for Light-Chain Cardiac Amyloidosis
Selinexor Combined With Daratumumab and Dexamethasone (XDd) for the Treatment of Patients With Advanced Light-Chain Cardiac Amyloidosis: A Prospective, Multicenter, Phase II Clinical Study
The goal of this clinical trial is to evaluate whether selinexor combined with daratumumab and dexamethasone (XDd) can treat patients with advanced light-chain cardiac amyloidosis. The main questions it aims to answer are:
Does XDd regimen achieve hematologic complete response in patients with advanced light-chain cardiac amyloidosis? Does XDd regimen improve cardiac response, organ response, progression-free survival, overall survival, quality of life, and safety?
Přehled studie
Postavení
Postavení
Podmínky
Podmínky
Intervence / Léčba
Intervence / Léčba
Typ studie
Typ studie
Zápis (Odhadovaný)
Zápis
Fáze
Fáze
- Fáze 2
Kontakty a umístění
Studijní kontakt
Studijní kontakt
- Jméno: Yini Wang
- Telefonní číslo: +86-010-84005477
- E-mail: wangyini@ccmu.edu.cn
Kritéria účasti
Kritéria způsobilosti
Kritéria způsobilosti
Věk způsobilý ke studiu
- Dospělý
- Starší dospělý
Přijímá zdravé dobrovolníky
Popis
Inclusion Criteria:
- Age ≥ 18 years.
Confirmed systemic light-chain amyloidosis, meeting both of the following:
- Tissue biopsy confirms amyloid deposition, and the amyloid precursor protein is immunoglobulin light chain or heavy-light chain. Pathologic evidence includes at least one of the following: Congo red staining positive with apple-green birefringence under polarized light microscopy; Light-chain restricted expression demonstrated by immunohistochemistry, immunofluorescence, or immunoelectron microscopy, or mass spectrometry confirming the precursor protein as immunoglobulin light chain; Electron microscopy showing nonbranching, rigid, randomly arranged fibrils with a diameter of 8 to 14 nm.
- Evidence of monoclonal immunoglobulin or free light chain in serum or urine, or detection of monoclonal plasma cells/B cells in bone marrow examination.
Clinical manifestations, physical examination, laboratory tests, or imaging studies confirm involvement of one or more organs, with mandatory cardiac involvement. Cardiac involvement is defined as either:
- Mean ventricular wall thickness > 12 mm on echocardiography, with other cardiac diseases excluded; or
- NT-proBNP > 332 ng/L in the absence of renal insufficiency and atrial fibrillation.
- Mayo 2004 stage IIIa or IIIb disease, including newly diagnosed and relapsed/refractory patients.
Measurable disease in light-chain amyloidosis, defined by at least one of the following:
- Serum monoclonal protein ≥ 0.5 g/dL by serum protein electrophoresis and immunofixation performed by the central laboratory;
- Serum free light chain ≥ 50 mg/L with an abnormal kappa/lambda ratio; or
- Difference between involved and uninvolved free light chains (dFLC) ≥ 50 mg/L. Note: Urine Bence Jones proteinuria alone is not sufficient to define measurable disease for eligibility.
- Not pregnant or breastfeeding. Men and women of childbearing potential must agree to use appropriate contraception before treatment, during treatment, during any treatment interruption, and for 4 weeks after treatment completion.
- Written informed consent has been signed by the participant. If the participant is unable to sign because of their medical condition, informed consent may be signed by a legal guardian or immediate family member.
Exclusion Criteria:
- Active hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, or other acquired or congenital immunodeficiency disorders.
- Baseline peripheral neuropathy or neuropathic pain of grade ≥ 2 according to NCI CTCAE v4.0.
- Major surgery within 30 days before enrollment.
- Epilepsy requiring medication, dementia, or other psychiatric conditions that prevent understanding of or compliance with the study protocol.
- Any severe physical or psychiatric illness that may interfere with participation in this clinical study.
- Any other condition that the investigator considers unsuitable for enrollment.
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: N/A
- Intervenční model: Přiřazení jedné skupiny
- Maskování: Žádné (otevřený štítek)
Počet zbraní
Zbraně a zásahy
Skupina účastníků / ArmSkupina účastníků / Arm |
Intervence / LéčbaIntervence / Léčba |
|---|---|
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Experimentální: XDd
|
Selinexor (X): 40 mg orally once weekly (QW) Daratumumab (D): 1800 mg per dose, subcutaneous injection; administered once weekly during cycles 1-2, once every 2 weeks during cycles 3-6, and once every 4 weeks from cycle 7 onward. One cycle is 4 weeks. Dexamethasone (d): 20-40 mg once weekly (QW) |
Co je měření studie?
Primární výstupní opatření
Primární výstupní opatření
Měření výsledku |
Časové okno |
|---|---|
|
Hematologic complete response rate
Časové okno: From enrollment to the end of treatment at 1 year
|
From enrollment to the end of treatment at 1 year
|
Sekundární výstupní opatření
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Cardiac organ response rate
Časové okno: From enrollment to the end of treatment at 1 year
|
From enrollment to the end of treatment at 1 year
|
|
|
Organ response rate (heart, kidney, and liver)
Časové okno: From enrollment to the end of treatment at 1 year
|
From enrollment to the end of treatment at 1 year
|
|
|
Duration of response
Časové okno: From first documented response until documented progression or death, assessed up to 1 years.
|
From first documented response until documented progression or death, assessed up to 1 years.
|
|
|
Time to response
Časové okno: From first dose until first documented response, assessed up to 1 years
|
From first dose until first documented response, assessed up to 1 years
|
|
|
Progression-free survival
Časové okno: From first dose until date of first documented progression or date of death from any cause, whichever came first, assessed up to 12 months.
|
From first dose until date of first documented progression or date of death from any cause, whichever came first, assessed up to 12 months.
|
|
|
Overall survival
Časové okno: From first dose until date of death from any cause, assessed up to 12 months.
|
From first dose until date of death from any cause, assessed up to 12 months.
|
|
|
Quality of life assessed by EORTC QLQ-C30
Časové okno: Through study completion, up to 1 year.
|
Mean change from baseline in EORTC Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) Global health status/Quality of life score (range 0-100; higher scores indicate better quality of life)
|
Through study completion, up to 1 year.
|
|
Incidence and Severity of Adverse Events
Časové okno: From the first dose through 28 days after the last dose
|
From the first dose through 28 days after the last dose
|
|
|
Biomarker Outcome: dFLC
Časové okno: Baseline and every 4 weeks during treatment, up to 12 months.
|
Change from baseline in difference between involved and uninvolved free light chains (dFLC) (mg/L).
|
Baseline and every 4 weeks during treatment, up to 12 months.
|
|
Biomarker outcome: NT-proBNP
Časové okno: Baseline and every 4 weeks during treatment, up to 12 months.
|
Change from baseline in N-terminal pro-B-type natriuretic peptide (NT-proBNP) (pg/mL)
|
Baseline and every 4 weeks during treatment, up to 12 months.
|
|
Biomarker outcome: MRD
Časové okno: Baseline and at end of treatment, up to 12 months.
|
Minimal residual disease (MRD) status in bone marrow (assessed by multiparameter flow cytometry of bone marrow).
|
Baseline and at end of treatment, up to 12 months.
|
Spolupracovníci a vyšetřovatelé
Sponzor
Sponzor
Publikace a užitečné odkazy
Obecné publikace
- Huang XH, Liu ZH. The Clinical Presentation and Management of Systemic Light-Chain Amyloidosis in China. Kidney Dis (Basel). 2016 Apr;2(1):1-9. doi: 10.1159/000444287. Epub 2016 Feb 25.
- Hou JH, Zhu HX, Zhou ML, Le WB, Zeng CH, Liang SS, Xu F, Liang DD, Shao SJ, Liu Y, Liu ZH. Changes in the Spectrum of Kidney Diseases: An Analysis of 40,759 Biopsy-Proven Cases from 2003 to 2014 in China. Kidney Dis (Basel). 2018 Feb;4(1):10-19. doi: 10.1159/000484717. Epub 2017 Dec 8.
- Morikawa K, Izumiya Y, Takashio S, Kawano Y, Oguni T, Kuyama N, Oike F, Yamamoto M, Tabata N, Ishii M, Hanatani S, Hoshiyama T, Kanazawa H, Matsuzawa Y, Usuku H, Yamamoto E, Ueda M, Tsujita K. Early experience with daratumumab-containing regimens in patients with light-chain cardiac amyloidosis. J Cardiol. 2025 Jun;85(6):440-446. doi: 10.1016/j.jjcc.2024.11.003. Epub 2024 Dec 4.
- Gregory Kaufman, Ronald Witteles, Matthew Wheeler, Patricia Ulloa, Marie Lugtu, Sally Arai, Stanley Schrier, Richard Lafayette, Michaela Liedtke; Hematologic Responses and Cardiac Organ Improvement in Patients with Heavily Pretreated Cardiac Immunoglobulin Light Chain (AL) Amyloidosis Receiving Daratumumab. Blood 2016; 128 (22): 4525.
- 戈程, 李佳月, 刘博罕, 等. 心肌淀粉样变性临床特点及远期预后的影响因素[J]. 中华老年多器官疾病杂志, 2020, 19(6):405-409.
- Nienhuis HL, Bijzet J, Hazenberg BP. The Prevalence and Management of Systemic Amyloidosis in Western Countries. Kidney Dis (Basel). 2016 Apr;2(1):10-9. doi: 10.1159/000444206. Epub 2016 Feb 25.
- 中国系统性轻链型淀粉样变性协作组, 国家肾脏疾病临床医学研究中心, 国家血液系统疾病临床医学研究中心. 系统性轻链型淀粉样变性诊断和治疗指南(2021年修订) [J] . 中华医学杂志, 2021, 101(22) : 1646-1656.
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Odhadovaný)
Začátek studia
Primární dokončení (Odhadovaný)
Primární dokončení
Dokončení studie (Odhadovaný)
Dokončení studie
Termíny zápisu do studia
První předloženo
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
První zveřejněno
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Poslední zveřejněná aktualizace
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Naposledy ověřeno
Více informací
Termíny související s touto studií
Další identifikační čísla studie
Další identifikační čísla studie
- XDd-LCA-Phase2
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Plánujete sdílet data jednotlivých účastníků (IPD)?
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
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