Melflufen for Elderly Patients With Relapsed Myeloma

Inclusion Criteria:

* Patients affected by MM progressed or relapsed after 2 or more previous lines of therapy.
* Patient is, in the investigator's opinion, willing and able to comply with the study visits and procedures required per protocol.
* Patient has provided written informed consent in accordance with federal, local, and institutional guidelines prior to initiation of any study-specific activities or procedures. Subject does not have kind of condition that, in the opinion of the Investigator, may compromise the ability of the subject to give written informed consent and patient is, in the investigator(s) opinion, willing and able to comply with the protocol requirements.
* Life expectancy ≥ 3 months
* Previous exposure to, at least, one drug of all the following categories: an anti-CD38 MoAbs, an IMiD, and a proteasome inhibitor.
* Age ≥ 70 and ≤ 85 years.
* ECOG performance status ≤2.
* Subject must have serum monoclonal paraprotein (M-protein) level ≥0.5 g/dL or urine M-protein level ≥200 mg/24 hours, or serum immunoglobulin involved free light chain ≥10 mg/dL and abnormal serum immunoglobulin kappa lambda free light chain ratio.
* LVEF ≥40% as determined by a MUGA scan or ECHO.
* Adequate hepatic function characterized by the following:

oTotal bilirubin ≤1.5 x ULN. oAST ≤2.5 x ULN oALT ≤2.5 x ULN.

* Estimated creatinine clearance ≥30 mL/min (according to the Cockcroft Gault formula, by 24-hour urine collection for creatinine clearance, or per the local institutional standard method).
* Adequate BM function characterized by the following:

  * Absolute neutrophil count ≥1.0 × 109/L (use of granulocyte-colony stimulating factors is permitted if completed at least 7 days prior to planned start of dosing).
  * Platelet count ≥50 × 109/L (transfusion support is not permitted).
  * Hemoglobin ≥8 g/dL (transfusion support is permitted).
* Non-vasectomized male patients agree to practice appropriate methods of birth control

Exclusion Criteria:

* Previous exposure to chemotherapy (i.e. melphalan, high-dose melphalan and/or cyclophosphamide) with the exception of patients who have received an autologous stem cell transplantion with a progression free survival of at least 36 month.
* Plasma cell leukemia.
* Systemic amyloid light chain amyloidosis.
* POEMS Syndrome.
* Central Nervous System (CNS) disease localization.
* Subject with another tumor, not including MM, that required ongoing treatment or therapy completed less than 6 months before eligibility confirmation, and considered at substantial risk of relapse in the following 12 months.
* Active HBV, HCV, SARS-CoV2, HIV, or any active, uncontrolled bacterial, fungal, or viral infection. Active infections must be resolved at least 14 days prior to eligibility confirmation.
* Subject has any concurrent medical condition or disease (e.g. active systemic infection) that is likely to interfere with study procedures or results, or that in the opinion of the investigator would constitute a hazard for participating in this study.
* Subject has clinically significant cardiac disease, including:

  * Myocardial infarction within 6 months before trial eligibility
  * Uncontrolled disease/condition related to or affecting cardiac function (e.g. unstable angina, congestive heart failure, New York Heart Association Class III-IV)
  * Clinically significant ECG abnormalities.