Carfilzomib-Based Chemotherapy before Autologous Stem Cell Transplant for the Treatment of Multiple Myeloma

Inclusion Criteria

• Subject has voluntarily agreed to participate by giving written informed consent before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the subject at any time without prejudice to future medical care. Informed consent must be obtained prior to mobilization
• Subject has a confirmed diagnosis of multiple myeloma as specified by the International Myeloma Working Group criteria and must have measurable disease as defined by at least one of the following criteria: * Serum monoclonal protein >= 0.5 g/dL * >= 200 mg of monoclonal protein in the urine on 24-hour electrophoresis * Serum immunoglobulin free light chain: involved free light chain (FLC) >= 10 mg/dL (>= 100 mg/L) AND abnormal serum immunoglobulin kappa to lambda free light chain ratio
• Subject has an Eastern Cooperative Oncology Group (ECOG) performance status of < 2
• Subjects must have measurable monoclonal protein, free light chains, and/or M-spike in blood or urine
• Subjects must have completed any “induction therapy” and have achieved less than a complete response (CR)
• Subject has a life expectancy of > 12 weeks
• Absolute neutrophil count (ANC) >= 1000 cells/mm^3 (>= 500 for patients with bone marrow biopsy displaying > 50% involvement by myeloma)
• Platelets count >= 50,000/mm^3 (>= 30,000 for patients with bone marrow biopsy displaying > 50% involvement by myeloma)
• Hemoglobin > 9.0 g/dL
• Serum glutamic oxaloacetic transaminase (SGOT)/aspartate aminotransferase (AST) < 3.0 x upper limits of normal (ULN)
• Serum glutamic pyruvic transaminase (SGPT)/alanine aminotransferase (ALT) < 3.0 x upper limits of normal (ULN)
• Serum total bilirubin < 1.5 x ULN
• Subject must have a multigated acquisition scan (MUGA) scan or echo with left ventricular ejection fraction (LVEF) > 50% within 6 months of enrollment
• Females of childbearing potential (FCBP) must have a negative serum pregnancy test should be done within 7 days of treatment initiation and a negative urine pregnancy test within the 24 hours prior to the first study drug administration
• FCBP and male subjects who are sexually active with FCBP must agree to use 2 highly effective concomitant methods of contraception including a male condom during the study and for 90 days following the last dose of study treatment
• Male subjects must agree to not donate sperm while taking carfilzomib and for 90 days after the last dose of carfilzomib

Exclusion Criteria

• Subject has a history of allergic reactions to compounds containing captisol, or carfilzomib
• Subject has a New York Health Association (NYHA) class III or IV heart disease and/or a history of active unstable angina, congestive heart disease, severe uncontrolled cardiac arrhythmia, electrocardiographic evidence of acute ischemia, active conduction system abnormalities or myocardial infarction within 6 months prior to enrollment. Prior to study entry, any electrocardiogram (ECG) abnormality at Screening has to be documented by the investigator as not medically relevant
• Uncontrolled hypertension
• Pulmonary hypertension
• Subject has a known human immunodeficiency virus (HIV) or hepatitis A, B, or C positivity---ONLY IF ACTIVE
• Subject has active viral or bacterial infections or any coexisting medical problem that would significantly increase the risks of this treatment program
• Subject has concurrent, uncontrolled medical condition, laboratory abnormality, or psychiatric illness which could place him/her at unacceptable risk, including, but not limited to, uncontrolled hypertension, uncontrolled diabetes, active uncontrolled infection, and/or acute chronic liver disease (i.e., hepatitis, cirrhosis)
• Subject has >= grade 2 peripheral neuropathy
• Subject has been diagnosed or treated for another malignancy within 3 years of enrollment, with the exception of complete resection of basal cell carcinoma or squamous cell carcinoma of the skin, an in situ malignancy, or low-risk prostate cancer after curative therapy
• Subject has received radiation therapy within 3 weeks of enrollment. Enrollment of subjects who require concurrent radiotherapy (which must be localized in its field size) should be deferred until the radiotherapy is completed and 3 weeks have elapsed since the last date of therapy
• Subject has had prior mobilization or stem cell transplant