<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03756896</url>
  </required_header>
  <id_info>
    <org_study_id>IRB00097882</org_study_id>
    <secondary_id>NCI-2017-02052</secondary_id>
    <secondary_id>Winship4101-17</secondary_id>
    <secondary_id>P30CA138292</secondary_id>
    <nct_id>NCT03756896</nct_id>
  </id_info>
  <brief_title>Carfilzomib, Pomalidomide, and Dexamethasone in Treating Patients With High-Risk Multiple Myeloma</brief_title>
  <official_title>Maintenance Therapy With Carfilzomib, Pomalidomide and Dexamethasone (CPd) in High-Risk Myeloma Patients: A Phase 2 Study With a Safety Run-In</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Emory University</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>Amgen</agency>
      <agency_class>Industry</agency_class>
    </collaborator>
    <collaborator>
      <agency>National Cancer Institute (NCI)</agency>
      <agency_class>NIH</agency_class>
    </collaborator>
    <collaborator>
      <agency>National Institutes of Health (NIH)</agency>
      <agency_class>NIH</agency_class>
    </collaborator>
  </sponsors>
  <source>Emory University</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
    <is_fda_regulated_drug>Yes</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      This phase II trial studies how well carfilzomib, pomalidomide, and dexamethasone work in&#xD;
      treating patients with high-risk multiple myeloma. Carfilzomib may stop the growth of cancer&#xD;
      cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy,&#xD;
      such as pomalidomide and dexamethasone, work in different ways to stop the growth of cancer&#xD;
      cells, either by killing the cells, by stopping them from dividing, or by stopping them from&#xD;
      spreading. Giving carfilzomib, pomalidomide, and dexamethasone may work better in treating&#xD;
      patients with multiple myeloma.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      PRIMARY OBJECTIVE:&#xD;
&#xD;
      I. To determine the ≥ complete response (CR) rates with carfilzomib, pomalidomide and&#xD;
      dexamethasone (CPd) maintenance.&#xD;
&#xD;
      SECONDARY OBJECTIVES:&#xD;
&#xD;
      I. To determine the improved progression free survival (PFS) with CPd maintenance among&#xD;
      high-risk patients.&#xD;
&#xD;
      II. To determine the best response rates (very good partial response rate [VGPR], stringent&#xD;
      complete response [sCR] rate) with CPd maintenance.&#xD;
&#xD;
      II. To evaluate the safety of the CPd combination as maintenance regimen.&#xD;
&#xD;
      III. To characterize safety in subjects who receive CPd maintenance.&#xD;
&#xD;
      IV. To evaluate the duration of response (DOR).&#xD;
&#xD;
      V. To evaluate the overall survival (OS) in high-risk patients.&#xD;
&#xD;
      VI. To evaluate the minimal residual disease (MRD) detection with CPd maintenance.&#xD;
&#xD;
      OUTLINE:&#xD;
&#xD;
      Patients receive carfilzomib intravenously (IV) over 30 minutes on days 1, 8, and 15,&#xD;
      pomalidomide orally (PO) daily on days 1-21, and dexamethasone PO daily on days 1, 8, and 15.&#xD;
      Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.&#xD;
&#xD;
      After completion of study treatment, patients are followed up every 3 months.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Active, not recruiting</overall_status>
  <start_date type="Actual">January 25, 2019</start_date>
  <completion_date type="Anticipated">August 31, 2024</completion_date>
  <primary_completion_date type="Anticipated">August 31, 2023</primary_completion_date>
  <phase>Phase 2</phase>
  <study_type>Interventional</study_type>
  <study_design_info>
    <allocation>N/A</allocation>
    <intervention_model>Single Group Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>≥ Complete response (CR) rates</measure>
    <time_frame>Up to 2 years after study start</time_frame>
    <description>Completed response (CR) rates will be determined for CPd maintenance.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Progression-free survival (PFS)</measure>
    <time_frame>From first dose until documented progression or death, assessed at 18 months</time_frame>
    <description>Progression-free survival (PFS) is defined as the time from first dose until documented progression or death. A subject who neither progresses nor dies will be censored on the date of his or her last tumor assessments. PFS will be determined by using all enrolled patients in accordance with the intention to treat (ITT) principle.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Best response on-study</measure>
    <time_frame>Up to 2 years after study start</time_frame>
    <description>Best response on-study refers to the best response (very good partial response rate [VGPR], stringent complete response [sCR] rate) prior to discontinuation of all study therapy.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Objective response rate (ORR) defined as the proportion of treated subjects who achieve a best response of CR, stringent complete response (sCR), very good partial response (VGPR), or partial response (PR)</measure>
    <time_frame>Up to 2 years after study start</time_frame>
    <description>The objective response rate (ORR) will be assessed using International Myeloma Working Group (IMWG) criteria.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Duration of response (DOR)</measure>
    <time_frame>From first response (PR or better) until a progression event (documented progression or death), assessed up to 2 years</time_frame>
    <description>Duration of response (DOR) is the time from first response (PR or better) until a progression event (documented progression or death). Only subjects who ever achieved a response of PR or better will be considered. Subjects who neither progress nor die will be censored on the date of their last tumor assessment.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Overall survival (OS)</measure>
    <time_frame>Up to 2 years after study start</time_frame>
    <description>Overall survival (OS) is defined as the time from first dose until documented death.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Minimal residual disease (MRD) detection</measure>
    <time_frame>Up to 2 years after study start</time_frame>
    <description>The achievement of minimal residual disease (MRD) will be evaluated and reported on patients that achieve a complete response. MRD testing will be performed by adaptive clonoSEQ testing.</description>
  </secondary_outcome>
  <number_of_arms>1</number_of_arms>
  <enrollment type="Actual">29</enrollment>
  <condition>Plasma Cell Myeloma</condition>
  <arm_group>
    <arm_group_label>Carfilzomib, pomalidomide, dexamethasone</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Patients receive carfilzomib IV over 30 minutes on days 1, 8, and 15, pomalidomide PO daily on days 1-21, and dexamethasone PO daily on days 1, 8, and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.</description>
  </arm_group>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Carfilzomib</intervention_name>
    <description>Given IV</description>
    <arm_group_label>Carfilzomib, pomalidomide, dexamethasone</arm_group_label>
    <other_name>Kyprolis</other_name>
    <other_name>PR-171</other_name>
  </intervention>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Dexamethasone</intervention_name>
    <description>Given PO</description>
    <arm_group_label>Carfilzomib, pomalidomide, dexamethasone</arm_group_label>
    <other_name>Decadron</other_name>
    <other_name>Dekacort</other_name>
    <other_name>Dexameth</other_name>
    <other_name>Hexadrol</other_name>
  </intervention>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Pomalidomide</intervention_name>
    <description>Given PO</description>
    <arm_group_label>Carfilzomib, pomalidomide, dexamethasone</arm_group_label>
    <other_name>4-Aminothalidomide</other_name>
    <other_name>Actimid</other_name>
    <other_name>CC-4047</other_name>
    <other_name>Imnovid</other_name>
    <other_name>Pomalyst</other_name>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Patients must meet the following criteria on screening examination to be eligible to&#xD;
             participate in the study; all laboratory assessments should be performed within 28&#xD;
             days of initiation of protocol therapy unless otherwise specified; subject is, in the&#xD;
             investigator's opinion, willing and able to comply with the protocol requirements&#xD;
&#xD;
          -  Subject has given voluntary signed written informed consent before performance of any&#xD;
             study-related procedure that is not part of normal medical care, with the&#xD;
             understanding that consent may be withdrawn by the subject at any time without&#xD;
             prejudice to their future medical care&#xD;
&#xD;
          -  Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤ 1&#xD;
&#xD;
          -  Subject is a transplant-eligible patient that have undergone autologous stem cell&#xD;
             transplant (ASCT) within one year of their diagnosis and have achieved ≥ partial&#xD;
             response (PR) based on International Myeloma Working Group (IMWG) standard criteria&#xD;
&#xD;
          -  Patients with high risk disease defined as&#xD;
&#xD;
               -  Presence of del(17p); t(4;14); t(14;16); t(14;20) by fluorescence in situ&#xD;
                  hybridization (FISH) or by cytogenetics (CTG)&#xD;
&#xD;
               -  Plasma cell leukemia at diagnosis with ≥ 20% circulating plasma cells on&#xD;
                  peripheral blood&#xD;
&#xD;
          -  Subject agrees to refrain from blood donations during therapy on study and for 90 days&#xD;
             after therapy is completed&#xD;
&#xD;
          -  Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy&#xD;
             test with a sensitivity of at least 50 milli-International units (mIU)/mL within 10-14&#xD;
             days prior to and again within 24 hours of starting pomalidomide and must either&#xD;
             commit to continued abstinence from heterosexual intercourse or begin TWO acceptable&#xD;
             methods of birth control, one highly effective method and one additional effective&#xD;
             method AT THE SAME TIME, at least 28 days before she starts taking pomalidomide&#xD;
             through 90 days after the last dose of study drug; FCBP must also agree to ongoing&#xD;
             pregnancy testing; men must agree to use a latex condom during sexual contact with a&#xD;
             FCBP even if they have had a vasectomy from the time of signing the informed consent&#xD;
             form through 90 days after the last dose of study drug; all patients must be&#xD;
             registered in and must comply with all requirements of the pomalidomide Risk&#xD;
             Evaluation and Mitigation Strategies (REMS) program; male subjects should refrain from&#xD;
             sperm donation for at least 90 days after the last dose of carfilzomib or pomalidomide&#xD;
&#xD;
               -  FCBP refers to sexually mature female, regardless of sexual orientation or&#xD;
                  whether they have undergone tubal ligation, who: 1) has not undergone a&#xD;
                  hysterectomy or bilateral oophorectomy; or 2) has not been naturally menopausal&#xD;
                  for at least 24 consecutive months&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Diagnosed with smoldering multiple myeloma (MM), monoclonal gammopathy of undetermined&#xD;
             significance, Waldenstrom's macroglobulinemia, polyneuropathy, organomegaly,&#xD;
             endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome, amyloidosis&#xD;
             or standard risk myeloma or secondary plasma cell leukemia&#xD;
&#xD;
          -  High risk patients that did not achieve ≥ PR after stem cell transplant&#xD;
&#xD;
          -  Participant has ≥ grade 2 peripheral neuropathy on clinical examination within 21 days&#xD;
             before initiation of protocol therapy&#xD;
&#xD;
          -  Creatinine clearance &lt; 30 mL/min (either actual or calculated value), within 21 days&#xD;
             of initiation of protocol therapy; the Cockcroft-Gault formula should be used for&#xD;
             calculating creatinine clearance values&#xD;
&#xD;
          -  Platelet count &lt; 75,000 cells/mm³ at time of screening evaluation; transfusion may not&#xD;
             be used to meet platelet eligibility criteria within 7 days of obtaining screening&#xD;
             evaluation&#xD;
&#xD;
          -  Participants with an absolute neutrophil count (ANC) &lt; 1000 cells/mm³ at time of&#xD;
             screening evaluation; growth factors may not be used to meet ANC eligibility criteria&#xD;
             within 14 days of obtaining screening evaluation&#xD;
&#xD;
          -  Participants with hemoglobin level &lt; 8.0 g/dL, at time of screening; transfusion may&#xD;
             not be used to meet eligibility criteria within 7 days of obtaining screening&#xD;
             evaluation&#xD;
&#xD;
          -  Bilirubin &gt; 1.5 x institutional upper limit of normal (ULN), within 21 days of&#xD;
             initiation of protocol therapy&#xD;
&#xD;
          -  Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]),&#xD;
             alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]), or&#xD;
             alkaline phosphatase &gt; 3 x institutional ULN, within 21 days of initiation of protocol&#xD;
             therapy&#xD;
&#xD;
          -  Other ongoing or prior anti-myeloma therapy; patients may be receiving concomitant&#xD;
             therapy with bisphosphonates and low dose corticosteroids (e.g., prednisone up to but&#xD;
             no more than 10 mg p.o. once daily [q.d.] or its equivalent) for symptom management&#xD;
             and comorbid conditions; doses of corticosteroid should be stable for at least 7 days&#xD;
             prior to study treatment)&#xD;
&#xD;
          -  Known significant cardiac abnormalities including:&#xD;
&#xD;
               -  Congestive heart failure, New York Heart Association (NYHA) class III or IV&#xD;
&#xD;
               -  Uncontrolled angina, arrhythmia or hypertension&#xD;
&#xD;
               -  Myocardial infarction within the past six months&#xD;
&#xD;
               -  Any other uncontrolled or severe cardiovascular condition&#xD;
&#xD;
               -  Prior cerebrovascular event with residual neurologic deficit&#xD;
&#xD;
          -  Serious, intercurrent illness including, but not limited to, clinically relevant&#xD;
             active infection, known active hepatitis B or C viral infection, known human&#xD;
             immunodeficiency virus (HIV) infection, uncontrolled diabetes mellitus, or serious&#xD;
             co-morbid medical conditions such as chronic restrictive pulmonary disease, and&#xD;
             cirrhosis&#xD;
&#xD;
          -  Any condition, including laboratory abnormalities, that in the opinion of the&#xD;
             investigator places the subject at unacceptable risk if he/she were to participate in&#xD;
             the study&#xD;
&#xD;
          -  Prior malignancy (within the last 5 years) except for adequately treated basal cell or&#xD;
             squamous cell skin cancer, or in situ cervical cancer&#xD;
&#xD;
          -  Known hypersensitivity to acyclovir or similar anti-viral drug&#xD;
&#xD;
          -  Known intolerance to steroid therapy&#xD;
&#xD;
          -  Contraindication or prior intolerance to thromboembolic prophylaxis with aspirin,&#xD;
             warfarin or low-molecular weight heparin&#xD;
&#xD;
          -  Participants with known central nervous system (CNS) disease&#xD;
&#xD;
          -  Poor tolerability or known allergy to any of the study drugs or compounds of similar&#xD;
             chemical or biologic composition to dexamethasone, boron or mannitol&#xD;
&#xD;
          -  Female participants pregnant or breast-feeding&#xD;
&#xD;
          -  Participants who have undergone major surgery ≤ 4 weeks prior to starting study drug&#xD;
             or who have not recovered from side effects of the surgery&#xD;
&#xD;
          -  Participants with any significant history of non-compliance to medical regimens or&#xD;
             unwilling or unable to comply with the instructions given to him/her by the study&#xD;
             staff&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Ajay Nooka, MD, MPH</last_name>
    <role>Principal Investigator</role>
    <affiliation>Emory University</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Emory University Hospital/Winship Cancer Institute</name>
      <address>
        <city>Atlanta</city>
        <state>Georgia</state>
        <zip>30322</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <verification_date>May 2023</verification_date>
  <study_first_submitted>November 27, 2018</study_first_submitted>
  <study_first_submitted_qc>November 27, 2018</study_first_submitted_qc>
  <study_first_posted type="Actual">November 28, 2018</study_first_posted>
  <last_update_submitted>May 3, 2023</last_update_submitted>
  <last_update_submitted_qc>May 3, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">May 6, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Emory University</investigator_affiliation>
    <investigator_full_name>Ajay Nooka</investigator_full_name>
    <investigator_title>Principal Investigator</investigator_title>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Multiple Myeloma</mesh_term>
    <mesh_term>Neoplasms, Plasma Cell</mesh_term>
  </condition_browse>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Dexamethasone</mesh_term>
    <mesh_term>Pomalidomide</mesh_term>
  </intervention_browse>
  <provided_document_section>
    <provided_document>
      <document_type>Informed Consent Form</document_type>
      <document_has_protocol>No</document_has_protocol>
      <document_has_icf>Yes</document_has_icf>
      <document_has_sap>No</document_has_sap>
      <document_date>August 10, 2022</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/96/NCT03756896/ICF_000.pdf</document_url>
    </provided_document>
  </provided_document_section>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03756896
org study id: IRB00097882
secondary id: NCI-2017-02052
secondary id: Winship4101-17
secondary id: P30CA138292
nct id: NCT03756896
lead sponsor: 
collaborator: 
collaborator: 
collaborator: 
has dmc: Yes
is fda regulated drug: Yes
is fda regulated device: No
This phase II trial studies how well carfilzomib, pomalidomide, and dexamethasone work in
      treating patients with high-risk multiple myeloma. Carfilzomib may stop the growth of cancer
      cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy,
      such as pomalidomide and dexamethasone, work in different ways to stop the growth of cancer
      cells, either by killing the cells, by stopping them from dividing, or by stopping them from
      spreading. Giving carfilzomib, pomalidomide, and dexamethasone may work better in treating
      patients with multiple myeloma.
PRIMARY OBJECTIVE:

      I. To determine the ≥ complete response (CR) rates with carfilzomib, pomalidomide and
      dexamethasone (CPd) maintenance.

      SECONDARY OBJECTIVES:

      I. To determine the improved progression free survival (PFS) with CPd maintenance among
      high-risk patients.

      II. To determine the best response rates (very good partial response rate [VGPR], stringent
      complete response [sCR] rate) with CPd maintenance.

      II. To evaluate the safety of the CPd combination as maintenance regimen.

      III. To characterize safety in subjects who receive CPd maintenance.

      IV. To evaluate the duration of response (DOR).

      V. To evaluate the overall survival (OS) in high-risk patients.

      VI. To evaluate the minimal residual disease (MRD) detection with CPd maintenance.

      OUTLINE:

      Patients receive carfilzomib intravenously (IV) over 30 minutes on days 1, 8, and 15,
      pomalidomide orally (PO) daily on days 1-21, and dexamethasone PO daily on days 1, 8, and 15.
      Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up every 3 months.
allocation: N/A
intervention model: Single Group Assignment
primary purpose: Treatment
masking: None (Open Label)
measure: ≥ Complete response (CR) rates
time frame: Up to 2 years after study start
description: Completed response (CR) rates will be determined for CPd maintenance.
measure: Progression-free survival (PFS)
time frame: From first dose until documented progression or death, assessed at 18 months
description: Progression-free survival (PFS) is defined as the time from first dose until documented progression or death. A subject who neither progresses nor dies will be censored on the date of his or her last tumor assessments. PFS will be determined by using all enrolled patients in accordance with the intention to treat (ITT) principle.
measure: Best response on-study
time frame: Up to 2 years after study start
description: Best response on-study refers to the best response (very good partial response rate [VGPR], stringent complete response [sCR] rate) prior to discontinuation of all study therapy.
measure: Objective response rate (ORR) defined as the proportion of treated subjects who achieve a best response of CR, stringent complete response (sCR), very good partial response (VGPR), or partial response (PR)
time frame: Up to 2 years after study start
description: The objective response rate (ORR) will be assessed using International Myeloma Working Group (IMWG) criteria.
measure: Duration of response (DOR)
time frame: From first response (PR or better) until a progression event (documented progression or death), assessed up to 2 years
description: Duration of response (DOR) is the time from first response (PR or better) until a progression event (documented progression or death). Only subjects who ever achieved a response of PR or better will be considered. Subjects who neither progress nor die will be censored on the date of their last tumor assessment.
measure: Overall survival (OS)
time frame: Up to 2 years after study start
description: Overall survival (OS) is defined as the time from first dose until documented death.
measure: Minimal residual disease (MRD) detection
time frame: Up to 2 years after study start
description: The achievement of minimal residual disease (MRD) will be evaluated and reported on patients that achieve a complete response. MRD testing will be performed by adaptive clonoSEQ testing.
arm group label: Carfilzomib, pomalidomide, dexamethasone
arm group type: Experimental
description: Patients receive carfilzomib IV over 30 minutes on days 1, 8, and 15, pomalidomide PO daily on days 1-21, and dexamethasone PO daily on days 1, 8, and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
intervention type: Drug
intervention name: Carfilzomib
description: Given IV
arm group label: Carfilzomib, pomalidomide, dexamethasone
other name: Kyprolis
other name: PR-171
intervention type: Drug
intervention name: Dexamethasone
description: Given PO
arm group label: Carfilzomib, pomalidomide, dexamethasone
other name: Decadron
other name: Dekacort
other name: Dexameth
other name: Hexadrol
intervention type: Drug
intervention name: Pomalidomide
description: Given PO
arm group label: Carfilzomib, pomalidomide, dexamethasone
other name: 4-Aminothalidomide
other name: Actimid
other name: CC-4047
other name: Imnovid
other name: Pomalyst
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: No
last name: Ajay Nooka, MD, MPH
role: Principal Investigator
affiliation: Emory University
facility: 
country: United States
responsible party type: Principal Investigator
investigator affiliation: Emory University
investigator full name: Ajay Nooka
investigator title: Principal Investigator
mesh term: Multiple Myeloma
mesh term: Neoplasms, Plasma Cell
mesh term: Dexamethasone
mesh term: Pomalidomide
provided document: 