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A Study of Oral Ixazomib Maintenance Therapy After Initial Therapy in Participants With Newly Diagnosed Multiple Myeloma Not Treated With Stem Cell Transplantation (SCT)

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ClinicalTrials.gov Identifier: NCT03748953
Recruitment Status : Recruiting
First Posted : November 21, 2018
Last Update Posted : May 20, 2019
Sponsor:
Information provided by (Responsible Party):
Takeda ( Millennium Pharmaceuticals, Inc. )

Brief Summary:

The purpose of this study is to determine the effect of ixazomib maintenance therapy on progression-free survival (PFS) compared with placebo, in participants in China with newly diagnosed multiple myeloma (NDMM) who have had a major response [complete response (CR), very good partial response (VGPR), or partial response (PR)] to initial therapy and who have not undergone stem-cell transplantation (SCT).

This study is a China continuation of the global study C16021 (NCT02312258).


Condition or disease Intervention/treatment Phase
Multiple Myeloma Drug: Ixazomib Drug: Ixazomib Placebo Phase 3

Detailed Description:

The drug being tested in this study is called ixazomib. Ixazomib is being tested to slow disease progression and improve overall survival in Chinese participants who have newly diagnosed multiple myeloma (NDMM) who have had a major positive response to initial therapy and have not undergone stem cell transplantation (SCT). This study will look at the effect of ixazomib has on the length of time that participants are free of disease progression and their overall survival.

The study will enroll approximately 105 patients. Participants will be randomly assigned (by chance, like flipping a coin) in 3:2 ratio to one of the two treatment groups—which will remain undisclosed to the patient and study doctor during the study (unless there is an urgent medical need):

  • Ixazomib 3 mg
  • Placebo (dummy inactive pill) - this is a capsule that looks like the study drug but has no active ingredient

All participants will be asked to take one capsule on Days 1, 8, and 15 of every 28-day cycle, for up to 26 cycles or until documented PD or intolerable toxicity, whichever occurs first.

This multi-center trial will be conducted in China. The overall time to participate in this study is until a total of approximately 60 death events have been reported for Chinese participants or FA for OS in the global study (approximately up to 88 months). Participants will make multiple visits to the clinic, and every 4 weeks until the next line of therapy begins for a follow-up assessment.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 105 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Phase 3, Randomized, Placebo-Controlled, Double-Blind Study of Oral Ixazomib Maintenance Therapy After Initial Therapy in Patients With Newly Diagnosed Multiple Myeloma Not Treated With Stem Cell Transplantation
Actual Study Start Date : January 24, 2019
Estimated Primary Completion Date : September 1, 2024
Estimated Study Completion Date : September 1, 2026

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Multiple Myeloma

Arm Intervention/treatment
Experimental: Ixazomib
Ixazomib 3 mg, capsules, orally, once on Days 1, 8 and 15 of every 28-day cycle for Cycle 1 through Cycle 4, during which period if the participants have been tolerated, the dose may be escalated to ixazomib 4 mg, capsules, orally, once on Days 1, 8 and 15 of every 28-day cycle for Cycle 5 through Cycle 26. Participants experiencing adverse events (AEs) attributed to study drug during any cycle may continue in the study but may have doses of study drug held or reduced by at least 1 dose level. Reduced doses are: 3 mg, 2.3 mg, 1.5 mg and discontinuation of study drug.
Drug: Ixazomib
Ixazomib Capsules

Placebo Comparator: Placebo
Ixazomib 3 mg placebo-matching capsules, orally, once on Days 1, 8 and 15 of every 28-day cycle for Cycle 1 through Cycle 4, during which period if the participants have been tolerated , the dose may be escalated to ixazomib 4 mg placebo-matching capsules, orally, once on Days 1, 8 and 15 of every 28-day cycle for Cycle 5 through Cycle 26. Participants experiencing adverse events (AEs) attributed to study drug during any cycle may continue in the study but may have doses of study drug held or reduced by at least 1 dose level. Reduced doses are: 3 mg, 2.3 mg, 1.5 mg and discontinuation of study drug.
Drug: Ixazomib Placebo
Ixazomib placebo-matching capsules




Primary Outcome Measures :
  1. Progression-Free Survival (PFS) [ Time Frame: From randomization to progressive disease (PD) or death from any cause (until 60 death events or the full analysis (FA) for overall survival (OS) in global study, whichever occurs later [approximately 88 months]) ]
    PFS is defined as the time from randomization to the first occurrence of PD as evaluated by an independent review committee (IRC) or death from any cause, whichever occurs first. PD is defined as >=25% increase from lowest value in serum M component or urine M-component; difference between involved and uninvolved free light chain (FLC) levels (absolute increase >10 mg/dL); bone marrow plasma cell percent >/=10%; new bone lesions or soft tissue plasmacytomas development or definite increase in existing bone lesions/soft tissue plasmacytomas size; hypercalcaemia development.


Secondary Outcome Measures :
  1. Overall Survival (OS) [ Time Frame: From randomization to every 12 weeks during follow-up after PD on next line therapy (until 60 death events or the FA for OS in global study, whichever occurs later [approximately 88 months]) ]
    OS is measured as the time of randomization to the date of death.

  2. Percentage of Participants who Achieve or Maintain Best Response Before PD or up to Subsequent Therapy [ Time Frame: From randomization to PD or death from any cause (until 60 death events or the FA for OS in global study, whichever occurs later [approximately 88 months]) ]
    Response will be assessed as per IMWG criteria. Best response will include partial responses (PR), very good partial response (VGPR) and complete response (CR). PR is defined as >=50% reduction of serum M-component, urinary M- component by >=90% to <200 mg/24-hour reduction; >=50% in the difference between involved and uninvolved FLC; bone marrow plasma cells (PC) >/= 30%; reduction >/= 50% reduction in the soft tissue size. VGPR is defined as serum or urine M-component detectable by immunofixation but not on electrophoresis; >=90% reduction in serum or urine M-component level <100 mg/24 hour. CR is defined as negative immunofixation on the serum and urine; soft tissue plasmacytomas disappearance; <5% PCs in bone marrow.

  3. Duration of Complete Response (CR) [ Time Frame: From randomization to PD or death from any cause (until 60 death events or the FA for OS in global study, whichever occurs later [approximately 88 months]) ]
    Duration of CR is defined as the time from the date of randomization or the date of CR to the date of first documentation of PD. CR is defined as negative immunofixation on the serum and urine; soft tissue plasmacytomas disappearance; <5% PCs in bone marrow.

  4. Time to Progression (TTP) [ Time Frame: From randomization to PD or death from any cause (until 60 death events or the FA for OS in global study, whichever occurs later [approximately 88 months]) ]
    TTP is defined as the time from the date of randomization to the date of first documentation of PD. PD is defined as >=25% increase from lowest value in serum M component or urine M-component; difference between involved and uninvolved FLC levels (absolute increase >10 mg/dL); bone marrow plasma cell percent >/=10%; new bone lesions or soft tissue plasmacytomas development or definite increase in existing bone lesions/soft tissue plasmacytomas size; hypercalcaemia development.

  5. Second Progression-Free Survival (PFS2) [ Time Frame: Every 12 weeks from the start of next-line therapy to second disease progression or death (until 60 death events or the FA for OS in global study, whichever occurs later [approximately 88 months]) ]
    PFS2 is defined as the time from the start of next-line therapy to second disease progression using IMWG criteria, or death from any cause. PD is defined as >=25% increase from lowest value in serum M component or urine M-component; difference between involved and uninvolved FLC levels (absolute increase >10 mg/dL); bone marrow plasma cell percent >/=10%; new bone lesions or soft tissue plasmacytomas development or definite increase in existing bone lesions/soft tissue plasmacytomas size; hypercalcaemia development.

  6. Time to Next-Line Therapy (TTNT) [ Time Frame: From randomization to PD or death from any cause (until 60 death events or the FA for OS in global study, whichever occurs later [approximately 88 months]) ]
    TTNT is defined as the time from the date of randomization to the date of the first dose of next-line antineoplastic therapy.

  7. Time to End of the Next Line of Therapy [ Time Frame: From randomization to PD or death from any cause (until 60 death events or the FA for OS in global study, whichever occurs later [approximately 88 months]) ]
    Time to end of next-line therapy is defined as the time from the date of randomization to the date of last dose of next-line antineoplastic therapy.

  8. Duration of Next-Line Therapy [ Time Frame: From start of next-line therapy up to PD2 (until approximately 60 death events have been reported or the FA for OS in global study, whichever occurs later, or termination of the study by the sponsor [approximately 88 months]) ]
    Duration of next-line therapy is defined as the time from the date of onset of next-line therapy to the date of the last dose or PD2. PD2 is s defined as >=25% increase from lowest value in serum M component or urine M-component; difference between involved and uninvolved FLC levels (absolute increase >10 mg/dL); bone marrow plasma cell percent >/=10%; new bone lesions or soft tissue plasmacytomas development or definite increase in existing bone lesions/soft tissue plasmacytomas size; hypercalcaemia development.

  9. Percentage of Participants With A New Primary Malignancy [ Time Frame: From randomization to PD or death from any cause (until 60 death events or the FA for OS in global study, whichever occurs later [approximately 88 months]) ]
    Percentage of participants with a new primary malignancy will be reported.

  10. Percentage of Participants with Conversion from Minimal Residual Disease (MRD) Positive to MRD Negative, or the Maintenance of MRD Negativity [ Time Frame: Up to 26 cycles (each cycle of 28 days), 24 months ]
    MRD negativity is defined as absence of MRD and MRD positivity is defined as presence of MRD. MRD will be assessed using next generation sequencing (NGS) methodology.

  11. Overall (OS) Survival in High-Risk Cytogenetic Population [ Time Frame: From randomization to every 12 weeks during follow-up after PD on next line therapy (until 60 death events or the FA for OS in global study, whichever occurs later [approximately 88 months]) ]
    OS will be measured as the time from the date of randomization to the date of death. High-risk population will include but not be limited to participants carrying mutations including, but not limited to, del17, t(4;14), or t(14;16).

  12. Progression-Free Survival (PFS) in High-Risk Cytogenetic Population [ Time Frame: From randomization to PD or death from any cause (until 60 death events or the FA for OS in global study, whichever occurs later [approximately 88 months]) ]
    PFS is defined as the time from randomization to the first occurrence of PD as evaluated by an IRC. PD is defined as >=25% increase from lowest value in serum M component or urine M-component; difference between involved and uninvolved FLC levels (absolute increase >10 mg/dL); bone marrow plasma cell percent >/=10%; new bone lesions or soft tissue plasmacytomas development or definite increase in existing bone lesions/soft tissue plasmacytomas size; hypercalcaemia development. High-risk population will include but not be limited to participants carrying mutations including, but not limited to, del17, t(4;14), or t(14;16).

  13. Eastern Cooperative Oncology Group (ECOG) Performance Status [ Time Frame: First dose of study drug through 30 days after last dose of study drug (Up to 25 months) ]
    ECOG performance status will assess participant's performance status on 5 point scale: 0=Fully active/able to carry on all pre-disease activities without restriction; 1=restricted in physically strenuous activity, ambulatory/able to carry out light or sedentary work; 2=ambulatory (>50% of waking hrs), capable of all self care, unable to carry out any work activities; 3=capable of only limited self care, confined to bed/chair >50% of waking hrs; 4=completely disabled, cannot carry on any self care, totally confined to bed/chair; 5=dead.

  14. Percentage of Participants with Serious Adverse Events and Adverse Events (AEs) [ Time Frame: First dose of study drug through 30 days after last dose of study drug (Up to 25 months) ]
    A serious adverse event is any experience that suggests a significant hazard, contraindication, side effect or precaution that: results in death, is life-threatening, required in-patient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect or is medically significant. Adverse events are defined as any unfavorable and unintended sign, symptom or disease temporally associated with the use of a medicinal product reported from first dose of study drug through 30 days after the last dose of study drug.

  15. Number of Participants with Any Markedly Abnormal Standard Safety Laboratory Values [ Time Frame: From First dose date of study drug through 30 days after the last dose of study drug (Up to 25 months) ]
    Clinical laboratory evaluations will be performed by a central laboratory. The number of participants with any markedly abnormal standard safety laboratory values collected throughout study.

  16. European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC) QLQ-C30 [ Time Frame: From randomization to second disease progression or death (until 60 death events or the FA for OS in global study, whichever occurs later [approximately 88 months]) ]
    The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC) QLQ-C30 is completed by the participant. The EORTC QLQ-30 contains 30 questions that incorporate 5 functional scales (physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning), 1 global health status scale, 3 symptom scales (fatigue, nausea and vomiting, and pain), and 6 single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). The participant answers questions about their health during the past week. There are 28 questions answered on a 4-point scale where 1=not at all (best) to 4=very Much (worst) and 2 questions answered on a 7-point scale where 1=very poor (worst) to 7= excellent (best).

  17. Correlation between Frailty Status and PFS and OS [ Time Frame: From randomization to every 12 weeks during follow-up after PD on next line therapy (until 60 death events or the FA for OS in global study, whichever occurs later [approximately 88 months]) ]
    Participants frailty status will be assessed on the basis of 4 components: age (<75, 75- 80, and>80 years correspond to frailty scores of 0, 1, and 2, respectively), the charlson comorbidity scoring system without age weighting (scores of ≤ 1 and ≥ 2 correspond to frailty scores of 0 and 1, respectively), the katz index of independence in activities of daily living (scores of >4 and ≤ 4 correspond to frailty scores of 0 and 1, respectively) and lawton instrumental activities of daily living scale (scores of >5 and ≤ 5 correspond to frailty scores of 0 and 1, respectively). The sum of the 4 frailty scores equals the total frailty score. A total frailty score of 0 corresponds to a frailty status of fit; a total score of 1, to unfit; and a total score of 2 or more, to frail. PFS is defined as the time from randomization to the first occurrence of PD as evaluated by an IRC. OS will be measured as the time from the date of randomization to the date of death.

  18. Plasma Concentration of Ixazomib [ Time Frame: Cycle 1 Day 1 (1 and 4 hours post dose), Cycle 1 pre-dose on Days 8 and 15; Cycle 2 pre-dose on Days 1 and 8; Cycle 3-10 pre-dose on Day 1; Cycle 5 pre-dose on Day 8 (only for participants who have dose escalated after Cycle 4), each cycle of 28 days ]
  19. Time to Resolution of Peripheral Neuropathy (PN) Events [ Time Frame: From First dose date of study drug through 30 days after the last dose of study drug (Up to 25 months) ]
    PN is defined as the treatment-emergent adverse event in the high-level term of peripheral neuropathies not elsewhere classified (NEC) according to the Medical Dictionary for Regulatory Activities (MedDRA). A PN event is considered as resolved if its final outcome is resolved with no subsequent PN event of the same preferred term occurring on the resolution date or the day before and after. Time to resolution is defined as the time from the initial onset date (inclusive) to the resolution date for resolved events.

  20. Time to Improvement of PN Events [ Time Frame: From First dose date of study drug through 30 days after the last dose of study drug (Up to 25 months) ]
    PN is defined as the treatment-emergent adverse event in the high-level term of peripheral neuropathies not elsewhere classified (NEC) according to the MedDRA. A PN event is considered to be improved if the event improves from the maximum grade; that is, all the grades recorded after the maximum grade are less than the maximum grade. Time to improvement is defined as the time from the initial onset date (inclusive) of the maximum grade to the first onset date that the toxicity grade is below the maximum grade with no higher grade thereafter, or the resolution date, whichever occurs first.



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Adult male or female participants aged 18 years or older with a confirmed diagnosis of symptomatic NDMM according to standard criteria.
  2. Has completed 6 to 12 months (± 2 weeks) of initial therapy, during which the participant was treated to best response, defined as the best response maintained for 2 cycles after the M-protein nadir is reached.
  3. Has documented major response [partial response (PR), very good partial response (VGPR), complete response (CR)] according to the international myeloma working group (IMWG) uniform response criteria, version 2011, after this initial therapy.
  4. Female participants who:

    Are postmenopausal for at least 1 year before the screening visit, OR Are surgically sterile, OR If they are of childbearing potential, agree to practice 2 effective methods of contraception, at the same time, from the time of signing the informed consent through 90 days after the last dose of study drug, or Agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the participant. (Periodic abstinence (eg, calendar, ovulation,symptothermal, postovulation methods] and withdrawal are not acceptablemethods of contraception.)

    Male participants, even if surgically sterilized (ie, status postvasectomy), who:

    Agree to practice effective barrier contraception during the entire study Treatment period and through 90 days after the last dose of study drug, or Agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the participant. (Periodic abstinence [eg, calendar, ovulation, symptothermal, postovulation methods for the female partner] and withdrawal are not acceptable methods of contraception.)

  5. Voluntary written consent must be given before performance of any study-related procedure not part of standard medical care, with the understanding that consent may be withdrawn by the participant at any time without prejudice to future medical care.
  6. Has availability of complete documentation for:

    1. Details of initial disease state, initial therapy, and response
    2. Cytogenetic assessment at diagnosis (cytogenetic assessment performed after diagnosis must be approved by a Millennium project clinician or designee)
    3. ISS staging at diagnosis (requiring beta 2-microglobulin and serum albumin results).
  7. Has eastern cooperative oncology group performance status of 0 to 2.
  8. Suitable venous access for the study-required blood sampling and consent for the specific amounts that will be taken.
  9. Participant is willing and able to adhere to the study visit schedule and other protocol requirements including blood sampling and bone marrow aspiration.
  10. Participants must meet the following clinical laboratory criteria at study entry:

1. Absolute neutrophil count (ANC) ≥1,000/mm^3 without growth factor support and platelet count ≥ 75,000/mm^3. Platelet transfusions to help participants meet eligibility criteria are not allowed within 3 days before randomization.

2. Total bilirubin≤1.5*the upper limit of the normal range (ULN). 3. Alanine aminotransferase and aspartate aminotransferase≤3*ULN. 4. Calculated creatinine clearance≥ 30 mL/min (using the Cockroft-Gault equation.

Exclusion Criteria:

  1. Has multiple myeloma that has relapsed after, or was not responsive to, initial therapy.
  2. Had prior stem-cell transplantation (SCT).
  3. Has radiotherapy within 14 days before randomization.
  4. Had diagnosed or treated for another malignancy within 5 years before randomization or previously diagnosed with another malignancy with evidence of residual disease. Participants with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection.
  5. Female participants who are lactating and breastfeeding or have a positive serum pregnancy test during the Screening period.
  6. Has major surgery within 14 days before randomization.
  7. Has central nervous system involvement.
  8. Infection requiring IV antibiotic therapy or other serious infection within 14 days before randomization.
  9. Has diagnosis of waldenstrom's macroglobulinemia, polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome, plasma cell leukemia, primary amyloidosis, myelodysplastic syndrome, or myeloproliferative syndrome.
  10. Evidence of current uncontrolled cardiovascular conditions, including uncontrolled hypertension, uncontrolled cardiac arrhythmias, uncontrolled congestive heart failure, unstable angina, or myocardial infarction within the past 6 months.
  11. Systemic treatment with strong CYP3A inducers (rifampin, rifapentine, rifabutin, carbamazepine, phenytoin, phenobarbital) or use of St. John's wort within 14 days before randomization.
  12. Ongoing or active infection, known human immunodeficiency virus positive, active hepatitis B or C infection.
  13. Has comorbid systemic illnesses or other severe concurrent disease that, in the judgment of the investigator, would make the participant inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens (eg, peripheral neuropathy (PN) that is Grade 1 with pain or Grade 2 or higher of any cause).
  14. Psychiatric illness/social situation that would limit compliance with study requirements.
  15. Known allergy to any of the study medications, their analogues, or excipients in the various formulations of any agent.
  16. Inability to swallow oral medication, inability or unwillingness to comply with the drug administration requirements, or GI procedure that could interfere with the oral absorption or tolerance of treatment.
  17. Treatment with any investigational products within 30 days before randomization.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03748953


Contacts
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Contact: Takeda Study Registration Call Center +1-877-825-3327 medicalinformation@tpna.com

Locations
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China, Beijing
Beijing Chaoyang Hospital Capital Medical University Recruiting
Beijing, Beijing, China, 100020
Peking University Third Hospital Active, not recruiting
Beijing, Beijing, China, 100191
Peking Union Medical College Hospital Active, not recruiting
Beijing, Beijing, China, 100730
China, Hubei
Union Hospital Tongji Medical College Huazhong University of Science and Technology Active, not recruiting
Wuhan, Hubei, China, 430022
Tongji Hospital Tongji Medical College Huazhong University of Science and Technology Not yet recruiting
Wuhan, Hubei, China, 430030
China, Jiangsu
Jiangsu Province Hospital (the First Affiliated Hospital With Nanjing Medical University) Active, not recruiting
Nanjing, Jiangsu, China, 210029
China, Jilin
First Hospital of Jilin University Not yet recruiting
Changchun, Jilin, China, 130021
China, Liaoning
Shengjing Hospital of China Medical University Active, not recruiting
Shenyang, Liaoning, China, 110004
China, Shanghai
Renji Hospital Shanghai Jiaotong University School of Medicine Recruiting
Shanghai, Shanghai, China, 200001
Shanghai Chang Zheng Hospital Recruiting
Shanghai, Shanghai, China, 200003
Ruijin Hospital Shanghai Jiaotong University School of Medicine Active, not recruiting
Shanghai, Shanghai, China, 200025
China, Shanxi
Shanxi Medical University - Second Hospital Not yet recruiting
Taiyuan, Shanxi, China, 300001
China, Zhejiang
1st Affiliated Hospital of Zhejiang University Active, not recruiting
Hangzhou, Zhejiang, China, 310003
Sponsors and Collaborators
Millennium Pharmaceuticals, Inc.
Investigators
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Study Director: Medical Director Clinical Science Millennium Pharmaceuticals, Inc.

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Responsible Party: Millennium Pharmaceuticals, Inc.
ClinicalTrials.gov Identifier: NCT03748953     History of Changes
Other Study ID Numbers: C16021CSC
2014-001394-13 ( EudraCT Number )
First Posted: November 21, 2018    Key Record Dates
Last Update Posted: May 20, 2019
Last Verified: May 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Takeda makes patient-level, de-identified data sets and associated documents available after applicable marketing approvals and commercial availability have been received, an opportunity for the primary publication of the research has been allowed, and other criteria have been met as set forth in Takeda's Data Sharing Policy (see www.TakedaClinicalTrials.com/Approach for details). To obtain access, researchers must submit a legitimate academic research proposal for adjudication by an independent review panel, who will review the scientific merit of the research and the requestor's qualifications and conflict of interest that can result in potential bias. Once approved, qualified researchers who sign a data sharing agreement are provided access to these data in a secure research environment.

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Takeda ( Millennium Pharmaceuticals, Inc. ):
Drug Therapy

Additional relevant MeSH terms:
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Multiple Myeloma
Neoplasms, Plasma Cell
Neoplasms by Histologic Type
Neoplasms
Hemostatic Disorders
Vascular Diseases
Cardiovascular Diseases
Paraproteinemias
Blood Protein Disorders
Hematologic Diseases
Hemorrhagic Disorders
Lymphoproliferative Disorders
Immunoproliferative Disorders
Immune System Diseases
Ixazomib
Glycine
Antineoplastic Agents
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Glycine Agents
Neurotransmitter Agents
Physiological Effects of Drugs