A Randomized, Open-label, Phase 3 Study Comparing Once-weekly vs Twice-weekly Carfilzomib in Combination With Lenalidomide and Dexamethasone in Subjects With Relapsed or Refractory Multiple Myeloma (A.R.R.O.W.2)

ClinicalTrials.gov processed this data on August 9, 2024. Link to the current ClinicalTrials.gov record.

Recruitment Status

COMPLETED - HAS RESULTS
 (See Contacts and Locations)
Verified August 2024 by Amgen

Sponsor

Amgen

Information Provided by (Responsible Party)

Amgen

Clinicaltrials.gov Identifier

NCT03859427
Other Study ID Numbers: 20180015
First Submitted: January 14, 2019
First Posted: March 1, 2019
Results First Posted: April 18, 2024
Last Update Posted: August 13, 2024
Last Verified: August 2024
History of Changes

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Study Description

Not Provided
Condition or Disease Intervention/Treatment
  • Relapsed or Refractory Multiple Myeloma
  • Drug: Carfilzomib
  • Drug: Carfilzomib
  • Drug: Lenalidomide
  • Drug: Dexamethasone

Study Design

Study TypeInterventional
Actual Enrollment454 participants
Design AllocationRandomized
Interventional ModelParallel Assignment
MaskingNone (Open Label)
Primary PurposeTreatment
Official TitleA Randomized, Open-label, Phase 3 Study Comparing Once-weekly vs Twice-weekly Carfilzomib in Combination With Lenalidomide and Dexamethasone in Subjects With Relapsed or Refractory Multiple Myeloma (A.R.R.O.W.2)
Study Start DateMay 8, 2019
Actual Primary Completion DateMarch 31, 2023
Actual Study Completion DateMarch 31, 2023

Groups and Cohorts

Group/ CohortIntervention/ Treatment
  • Carfilzomib once-weekly
    • Carfilzomib, lenalidomide, dexamethasone (KRd) regimen using once-weekly carfilzomib 56 mg/m2
  • Drug: Carfilzomib
    • Once weekly IV over 30 minutes on day 1, 8 and 15 of each 28 day cycle. The dose will be 20 mg/m2 on cycle 1 day 1 and 56 mg/m2 beginning with cycle 1 day 8 and thereafter. 12 cycles or until progression, unacceptable toxicity, death, loss to follow up or withdrawal of consent.
  • Drug: Lenalidomide
    • Drug: Dexamethasone
      • Carfilzomib twice-weekly
        • Carfilzomib, lenalidomide, dexamethasone (KRd) regimen using twice-weekly carfilzomib 27 mg/m2
      • Drug: Carfilzomib
        • Once weekly IV over 30 minutes on day 1, 8 and 15 of each 28 day cycle. The dose will be 20 mg/m2 on cycle 1 day 1 and 56 mg/m2 beginning with cycle 1 day 8 and thereafter. 12 cycles or until progression, unacceptable toxicity, death, loss to follow up or withdrawal of consent.
      • Drug: Lenalidomide
        • Drug: Dexamethasone

          Outcome Measures

          Primary Outcome Measures

          1. Overall Response Rate (ORR) Per International Myeloma Working Group Uniform Response Criteria (IMWG-URC) [Cycle 1 Day 1 up to approximately 12 months (cycle = 28 days); median treatment duration for the twice-weekly arm was 47.00 weeks and for the once-weekly arm was 47.14 weeks.]
            ORR was defined as the percentage of participants with a best overall response of stringent complete response (sCR), complete response (CR), very good partial response (VGPR), or partial response (PR) per IMWG-URC. CR: negative immunofixation on serum and urine, soft tissue plasmacytomas disappearance, < 5% plasma cells in bone marrow (BM). sCR: CR and normal serum free light chain ratio and no clonal cells in BM by immunohistochemistry. VGPR: Serum and urine M-protein detectable by immunofixation or ≥ 90% reduction in serum M-protein (urine M-protein level < 100 mg/24-hours). PR: ≥ 50% reduction of serum M-protein and reduction in 24-hours urinary M-protein by ≥ 90% or to < 200 mg/24-hours. The ORR 95% confidence intervals (CIs) were estimated using the Clopper-Pearson method.

          Secondary Outcome Measures

          1. Kaplan-Meier Estimate of Progression-free Survival (PFS) Rate at 12 Months [12 months]
            PFS rate was defined as the percentage of participants without disease progression or death due to any cause at 12 months. The PFS rate at 12 months was estimated using the Kaplan-Meier method by Klein and Moeschberger (1997). 95% CIs were estimated using the method by Kalbfleisch and Prentice (1980). PFS data was censored for participants who met any one of the following: 1. no baseline/no post-baseline disease assessments; 2. starting new anti-myeloma therapy before documentation of progressive disease (PD) or death; 3. PD or death immediately after more than 1 consecutively missed disease assessment visit (PD or death immediately after > 63 days without disease assessment visit); 4. alive without documentation of PD; 5. lost to follow-up or withdrawn consent.
          2. Percentage of Participants Who Reported Convenience as Measured by the Patient-reported Convenience With Carfilzomib-dosing Schedule Question [Day 28 of Cycle 4]
            Patient-reported convenience was measured by the Patient-reported Convenience with Carfilzomib-dosing Schedule Question. The items in the questionnaire were categorized as 'Convenient', which included responses of 'Very Convenient' and 'Convenient', and 'Inconvenient' which included responses of 'Inconvenient' and 'Very Inconvenient'. The 95% CIs were estimated using the Clopper-Pearson method.
          3. Number of Participants With Treatment-emergent Adverse Events (TEAEs) [Cycle 1 Day 1 up to end of Cycle 12 + 30 days, where each cycle was 28 days; median treatment duration (any study treatment) was 47.00 weeks in the twice-weekly KRd group and 47.14 weeks in the once-weekly KRd group]
            An adverse event (AE) was any untoward medical occurrence in a clinical study participant irrespective of a causal relationship with the study treatment. TEAEs were AEs starting on or after the first dose of any study drug, and up to 30 days of the last dose of any study drug, excluding AEs reported after End of Study date.
          4. Time to Response (TTR) [Cycle 1 Day 1 up to approximately 12 months (cycle = 28 days); median treatment duration for the twice-weekly arm was 47.00 weeks and for the once-weekly arm was 47.14 weeks.]
            TTR was defined as the time from randomization to the earliest date when confirmed sCR, CR, VGPR, or PR per IMWG-URC was first achieved.
          5. Kaplan-Meier Estimate of Duration of Response (DOR) [Cycle 1 Day 1 up to approximately 12 months (cycle = 28 days); median treatment duration for the twice-weekly arm was 47.00 weeks and for the once-weekly arm was 47.14 weeks.]
            For participants who achieved a PR or better, i.e., sCR, CR, VGPR, or PR per IMWG-URC, the DOR was defined as the time from the earliest date when a PR or better was first achieved, and subsequently confirmed, to the earliest date of confirmed PD or death due to any cause. Median DOR was estimated using the Kaplan-Meier method. 95% CIs were estimated using the method by Klein and Moeschberger (1997) with log-log transformation. For those alive and who had not experienced PD by analysis time, DOR was censored for participants who met any one of the following: 1. no baseline/no post-baseline disease assessments; 2. starting new anti-myeloma therapy before documentation of PD or death; 3. PD or death immediately after more than 1 consecutively missed disease assessment visit (PD or death immediately after > 63 days without disease assessment visit); 4. alive without documentation of PD; 5. lost to follow-up or withdrawn consent.
          6. Kaplan-Meier Estimate of Time to Progression (TTP) [Cycle 1 Day 1 up to approximately 12 months (cycle = 28 days); median treatment duration for the twice-weekly arm was 47.00 weeks and for the once-weekly arm was 47.14 weeks.]
            TTP was defined as the duration from randomization for the first documented disease progression per IMWG-UCR. Median TTP was estimated using the Kaplan-Meier method. 95% CIs were estimated using the method by Klein and Moeschberger (1997) with log-log transformation. TTP was censored for participants who had no confirmed PD at the last non non-evaluable (non-NE), post-baseline disease assessment or the earlier of the following, where applicable: 1. the last non-NE, post-baseline disease assessment prior to start of a new anti-myeloma treatment, or 2. the last non-NE, post-baseline assessment followed > 63 days later by disease progression; otherwise, at randomization.
          7. Kaplan-Meier Estimate of Overall Survival (OS) [Cycle 1 Day 1 up to approximately 12 months (cycle = 28 days); median treatment duration for the twice-weekly arm was 47.00 weeks and for the once-weekly arm was 47.14 weeks.]
            OS was defined as the time from randomization to the date of death due to any cause. Median OS was estimated using the Kaplan-Meier method. 95% CIs were estimated using the method by Klein and Moeschberger (1997) with log-log transformation. Participants still alive or lost to follow-up or withdrawn consent from study by the analysis time were censored at the date on which the participant was last known to be alive.
          8. Percentage of Participants Who Achieved Minimal Residual Disease Negative Complete Response (MRD[-]CR) by Independent Review Committee (IRC) Per IMWG-URC [Cycle 1 Day 1 up to approximately 12 months (cycle = 28 days); median treatment duration for the twice-weekly arm was 47.00 weeks and for the once-weekly arm was 47.14 weeks.]
            MRD[-]CR was defined as achievement of CR or better by IRC per IMWG-URC and achievement of MRD negativity as assessed by next generation sequencing method at a 10^-5 threshold over the duration of the study. The 95% CIs for percentages were estimated using the Clopper-Pearson method.
          9. Percentage of Participants With Minimal Residual Disease Negativity (MRD[-]) by IRC Per IMWG-URC at 12 Months [Cycle 1 Day 1 up to 12 months (cycle = 28 days)]
            The percentage of participants with achievement of MRD[-] at 12 months (± 4 weeks) from randomization, as assessed by next generation sequencing method at a 10^-5 threshold. MRD negativity results from BM samples obtained at 8 to 13 months from randomization and prior to new anti-myeloma therapy or disease progression were considered in the calculation. The 95% CIs for percentages were estimated using the Clopper-Pearson method.
          10. Change From Baseline in European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ)-Core 30 (C30) Physical Functioning Scale [Baseline (Cycle 1 Day 1), Cycle 3 Day 1, Cycle 5 Day 1, Cycle 7 Day 1, Cycle 9 Day 1, Cycle 12 Day 1, and safety follow-up (30 days after last dose)]
            The QLQ-C30 physical function is one of the functional domains of the EORTC QLQ-C30 self-reported instrument and the physical functioning score score ranges from 0-100 points, with 100 points indicating the best possible functioning. A positive change from baseline indicated an improvement in functioning.
          11. Change From Baseline in EORTC QLQ-C30 Role Functioning Scale [Baseline (Cycle 1 Day 1), Cycle 3 Day 1, Cycle 5 Day 1, Cycle 7 Day 1, Cycle 9 Day 1, Cycle 12 Day 1, and safety follow-up (30 days after last dose)]
            The QLQ-C30 role function is one of the functional domains of the EORTC QLQ-C30 self-reported instrument and the role functioning score ranges from 0-100 points, with 100 points indicating the best possible functioning. A positive change from baseline indicated an improvement in functioning.
          12. Patient-reported Treatment Satisfaction as Measured by the Cancer Therapy Satisfaction Questionnaire (CTSQ) [Cycle 5 Day 1, Cycle 12 Day 1, and safety follow-up (30 days after last dose)]
            The CTSQ measures treatment satisfaction in individuals with cancer and includes a domain for satisfaction with therapy. The satisfaction with therapy scores ranges from 0 to 100 points, with 100 points indicating greatest satisfaction.

            Analysis was based on ANCOVA model. The dependent variable of the models were the scale scores measured at each visit. The model included effects of intercept, scale score measured at cycle 2 day 1 visit, treatment arm, and randomization stratification factors.

          Eligibility Criteria

          Ages Eligible for Study 18 Years to 99 Years (Adult, Older Adult)
          Sexes Eligible for Study All
          Accepts Healthy Volunteers No
          Inclusion Criteria
          • Multiple myeloma with documented relapse or progression after most recent myeloma treatment. Subjects refractory to the most recent line of therapy are eligible, unless last treatment contained proteasome inhibitor (PI) or lenalidomide and dexamethasone. Refractory is defined as disease that is nonresponsive or progresses within 60 days of last therapy.
          • Subjects must have at least PR to at least 1 line of prior therapy.
          • Subjects must have received at least 1 but not more than 3 prior lines of therapy for multiple myeloma (induction therapy followed by stem cell transplant and consolidation maintenance therapy will be considered as 1 line of therapy).
          • Prior therapy with a PI or the combination of lenalidomide and dexamethasone are allowed if the patient had at least a PR to the most recent treatment with a PI or lenalidomide and dexamethasone, neither PI or lenalidomide and dexamethasone containing treatment were ceased due to toxicity, the patient has not relapsed within 60 days of discontinuation of the PI or lenalidomide and dexamethasone containing treatment. A history of prior neuropathy is permitted if this was not grade 3, grade 4 or grade 2 with pain and if not resolved within the 14 days before enrollment, is less than or equal to grade 2 without pain. Patients are permitted to have received single agent lenalidomide as maintenance therapy within 60 days of enrollment.
          • Previous treatment with a lenalidomide and dexamethasone containing regimen is allowed, as long as the subject did not progress during the first 3 months after initiating lenalidomide and dexamethasone containing therapy.
          • Measurable disease with at least 1 of the following assessed within 21 days prior to randomization:
          • Immunoglobulin G (IgG) multiple myeloma: serum monoclonal protein (M-protein) level ≥ 1.0 g/dL
          • Immunoglobulin A (IgA), Immunoglobulin D (IgD), Immunoglobulin E (IgE) multiple myeloma: serum M-protein level ≥ 0.5 g/dL
          • Urine M-protein ≥ 200 mg per 24 hours
          • In subjects without measurable serum or urine M-protein, serum-free light chain (SFLC) ≥ 100 mg/L (involved light chain) and an abnormal serum kappa lambda ratio
          • Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0 ≤ 2
          • Other inclusion criteria may apply
          Exclusion Criteria
          • Waldenström macroglobulinemia.
          • Multiple myeloma of Immunoglobulin M (IgM) subtype.
          • Plasma cell leukemia (> 2.0 × 10^9 /L circulating plasma cells by standard differential).
          • Uncontrolled hypertension, defined as a subject whose blood pressure is greater than or equal to 160 mmHg systolic or greater than or equal to 100 mmHg diastolic when taken in accordance with the European Society of Hypertension/European Society of Cardiology 2018 guidelines (Section 12.10; Williams et al, 2018).
          • Active congestive heart failure (New York Heart Association Class III to IV), symptomatic ischemia, uncontrolled arrhythmias, screening ECG with corrected QT interval (QTc) of > 470 msec, pericardial disease, or myocardial infarction within 4 months prior to randomization.
          • Calculated or measured creatinine clearance < 30 mL/min (calculation must be based on the Cockcroft and Gault formula) within 28 days prior to randomization.
          • Other exclusion criteria may apply

          Contacts and Locations

          Sponsors and Collaborators Amgen
          Locations
          • Robert A Moss Oncology | Fountain Valley, California, United States, 92708
          • Rocky Mountain Cancer Centers Denver Midtown | Denver, Colorado, United States, 80218
          • Hartford HealthCare Cancer Institute at The Hospital of Central Connecticut | Plainville, Connecticut, United States, 06062
          • Baptist MD Anderson Cancer Center | Jacksonville, Florida, United States, 32207
          • Advocate Lutheran General Hospital | Park Ridge, Illinois, United States, 60068
          • New York Oncology Hematology, PC | Albany, New York, United States, 12208
          • Oncology Hematology Care Inc | Cincinnati, Ohio, United States, 45242
          • Texas Oncology-Denton | Denton, Texas, United States, 76201
          • US Oncology Research Investigational Products Center | Fort Worth, Texas, United States, 76177
          • Oncology Consultants PA | Houston, Texas, United States, 77030
          • Texas Oncology | San Antonio, Texas, United States, 78229
          • United States Oncology Regulatory Affairs Corporate Office | The Woodlands, Texas, United States, 77380
          • Universitaetsklinikum Salzburg | Salzburg, Austria, 5020
          • University Multiprofile Hospital for Active Treatment Sveti Georgi EAD | Plovdiv, Bulgaria, 4002
          • University Multiprofile Hospital for Active Treatment Sveti Ivan Rilski EAD | Sofia, Bulgaria, 1431
          • Specialized Hospital for Active Treatment of Hematology Diseases EAD | Sofia, Bulgaria, 1756
          • Fakultni nemocnice Brno | Brno, Czechia, 625 00
          • Fakultni nemocnice Hradec Kralove | Hradec Kralove, Czechia, 500 05
          • Fakultni nemocnice Olomouc | Olomouc, Czechia, 775 20
          • Vseobecna fakultni nemocnice v Praze | Praha 2, Czechia, 128 08
          • Helsingin Yliopistollinen Keskussairaala | Helsinki, Finland, 00290
          • Oulun Yliopistollinen Sairaala | Oulu, Finland, 90220
          • Turun Yliopistollinen Keskussairaala | Turku, Finland, 20521
          • Centre Hospitalier Universitaire de Nantes | Nantes, France, 44000
          • Centre Hospitalier Universitaire Archet 2 | Nice cedex 3, France, 06202
          • Hopital Saint Louis | Paris, France, 75010
          • Hopital Pitie-Salpetriere | Paris, France, 75013
          • Centre Hospitalier Lyon Sud | Pierre-Benite, France, 69495
          • Centre Hospitalier Universitaire de Poitiers - Hopital la Miletrie | Poitiers Cedex, France, 86021
          • Centre Hospitalier Universitaire de Rennes | Rennes, France, 35033
          • Institut de Cancerologie Strasbourg | Strasbourg, France, 67033
          • Institut Universitaire du Cancer Toulouse Oncopole | Toulouse cedex 9, France, 31059
          • Centre Hospitalier Universitaire de Nancy - Hopital de Brabois | Vandoeuvre les Nancy Cedex, France, 54511
          • Charité, Universitätsklinikum Berlin, Campus Benjamin Franklin | Berlin, Germany, 12200
          • Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden | Dresden, Germany, 01307
          • Universitatsklinikum Hamburg-Eppendorf | Hamburg, Germany, 20246
          • Universitatsklinikum Koln | Köln, Germany, 50924
          • Johannes Gutenberg Universitaet Mainz | Mainz, Germany, 55131
          • University Hospital of Alexandroupolis | Alexandroupoli, Greece, 68100
          • General Hospital Evangelismos | Athens, Greece, 10676
          • Agios Savvas Anticancer Hospital | Athens, Greece, 115 22
          • 251 General Airforce Hospital | Athens, Greece, 11525
          • Alexandra Hospital | Athens, Greece, 11528
          • Metropolitan Hospital | Athens, Greece, 18547
          • General University Hospital of Patras Panagia i Voithia | Patra, Greece, 26504
          • Theagenion Cancer Hospital of Thessaloniki | Thessaloniki, Greece, 54007
          • General Hospital of Thessaloniki Georgios Papanikolaou | Thessaloniki, Greece, 57010
          • Nagoya City University Hospital | Nagoya-shi, Aichi, Japan, 467-8602
          • Toyohashi Municipal Hospital | Toyohashi-shi, Aichi, Japan, 441-8570
          • Tesshokai Kameda General Hospital | Kamogawa-shi, Chiba, Japan, 296-8602
          • National Hospital Organization Kyushu Cancer Center | Fukuoka-shi, Fukuoka, Japan, 811-1395
          • Ogaki Municipal Hospital | Ogaki-shi, Gifu, Japan, 503-8502
          • National Hospital Organization Shibukawa Medical Center | Shibukawa-shi, Gunma, Japan, 377-0280
          • Japanese Red Cross Society Himeji Hospital | Himeji-shi, Hyogo, Japan, 670-8540
          • Hyogo College of Medicine Hospital | Nishinomiya-shi, Hyogo, Japan, 663-8501
          • Hitachi Ltd Hitachi General Hospital | Hitachi-shi, Ibaraki, Japan, 317-0077
          • University Hospital Kyoto Prefectural University of Medicine | Kyoto-shi, Kyoto, Japan, 602-8566
          • National Hospital Organization Sendai Medical Center | Sendai-shi, Miyagi, Japan, 983-8520
          • Niigata Cancer Center Hospital | Niigata-shi, Niigata, Japan, 951-8566
          • National Hospital Organization Okayama Medical Center | Okayama-shi, Okayama, Japan, 701-1192
          • Japanese Red Cross Osaka Hospital | Osaka-shi, Osaka, Japan, 543-8555
          • Kindai University Hospital | Osakasayama-shi, Osaka, Japan, 589-8511
          • Osaka University Hospital | Suita-shi, Osaka, Japan, 565-0871
          • Saitama Medical Center | Kawagoe-shi, Saitama, Japan, 350-8550
          • Tochigi Cancer Center | Utsunomiya-shi, Tochigi, Japan, 320-0834
          • Juntendo University Hospital | Bunkyo-ku, Tokyo, Japan, 113-8431
          • The Cancer Institute Hospital of Japanese Foundation for Cancer Research | Koto-ku, Tokyo, Japan, 135-8550
          • Japanese Red Cross Medical Center | Shibuya-ku, Tokyo, Japan, 150-8935
          • Hospital of Lithuanian University of Health Sciences Kaunas Clinics Public Institution | Kaunas, Lithuania, 50009
          • Vilnius University Hospital Santaros Clinic Public Institution | Vilnius, Lithuania, 08661
          • VU Medisch Centrum | Amsterdam, Netherlands, 1081 HV
          • Gelre Ziekenhuizen | Apeldoorn, Netherlands, 7334 DZ
          • Spaarne Gasthuis | Hoofddorp, Netherlands, 2134 TM
          • Fundeni Clinical Institute | Bucharest, Romania, 022328
          • Institutul Clinic Fundeni | Bucharest, Romania, 022328
          • Spitalul Clinic Coltea | Bucharest, Romania, 030171
          • Spitalul Universitar de Urgenta Bucuresti | Bucharest, Romania, 050098
          • Spitalul Clinic Colentina | Bucuresti, Romania, 020125
          • Institutul Oncologic Prof Dr Ion Chiricuta | Cluj-Napoca, Romania, 400015
          • Institutul Regional de Oncologie Iasi | Iasi, Romania, 700483
          • Spitalul Clinic Dr Gavril Curteanu Oradea | Oradea, Romania, 410469
          • Spitalul Clinic Judetean de Urgenta Sibiu | Sibiu, Romania, 550245
          • Spitalul Clinic Municipal de Urgenta Timisoara | Timisoara, Romania, 300079
          • Regional Clinical Hospital | Krasnoyarsk, Russian Federation, 660022
          • Moscow State Budget Healthcare Institution City clinical Hospital 52 of Moscow Healthcare Department | Moscow, Russian Federation, 123182
          • SBHI of Moscow city City clinical hospital na S P Botkin of Moscow city Healthcare department | Moscow, Russian Federation, 125284
          • SBHI of Republic of Karelia Republic Hosiptal n a V A Baranov | Petrozavodsk, Russian Federation, 185019
          • Federal centre of heart, blood and endocrinology Almazova | Saint Petersburg, Russian Federation, 197341
          • State Budget Educational Institution of High Professional Skills Samara State Medical University | Samara, Russian Federation, 443079
          • Univerzitna nemocnica Bratislava, Nemocnica sv Cyrila a Metoda | Bratislava, Slovakia, 851 07
          • Hospital Universitari Son Espases | Palma de Mallorca, Baleares, Spain, 07010
          • Hospital Clinico Universitario de Salamanca | Salamanca, Castilla León, Spain, 37007
          • Hospital Universitari Germans Trias i Pujol | Badalona, Cataluña, Spain, 08916
          • Hospital Clinic i Provincial de Barcelona | Barcelona, Cataluña, Spain, 08036
          • Hospital Universitario Quironsalud Madrid | Pozuelo de Alarcon, Madrid, Spain, 28223
          • Clinica Universidad de Navarra | Pamplona, Navarra, Spain, 31008
          • Falu Lasarett | Falun, Sweden, 791 82
          • Sahlgrenska Universitetssjukhuset | Goteborg, Sweden, 413 45
          • Hallands Sjukhus Halmstad | Halmstad, Sweden, 301 85
          • Sunderby Sjukhus | Lulea, Sweden, 971 80
          • Skanes Universitetssjukhus | Lund, Sweden, 221 85
          • Gazi Universitesi Saglik Arastirma ve Uygulama Merkezi Gazi Hastanesi | Ankara, Turkey, 06560
          • Ankara Universitesi Tip Fakultesi Cebeci Arastirma ve Uygulama Hastanesi | Ankara, Turkey, 06590
          • Istanbul Universitesi Istanbul Tip Fakultesi | Istanbul, Turkey, 34093
          • Bagcilar Medipol Mega Universite Hastanesi | Istanbul, Turkey, 34214
          • Istanbul Florence Nightingale Hastanesi | Istanbul, Turkey, 34387
          • Dokuz Eylul Universitesi Arastirma Uygulama Hastanesi | Izmir, Turkey, 35340
          • Erciyes Universitesi Tip Fakultesi Mehmet Kemal Dedeman Hematoloji-Onkoloji Hastanesi | Kayseri, Turkey, 38039
          Investigators

            Study Documents (Full Text)

            More Information

            Additional Information

            Additional Relevant MeSH Terms

            • 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