Multiple MyelomaPhase 2CardamonNCT02315716
Carfilzomib/Cyclophosphamide/Dexamethasone with Maintenance Carfilzomib in Multiple Myeloma
A Phase 2 study testing Autologous Stem Cell Transplant (ASCT) and Consolidation with 4 cycles of CarCyDex in people with Multiple Myeloma, run by University College, London at 20 sites in United Kingdom.
Trial summary
The Cardamon trial is a phase 2 trial using the standard chemotherapy drugs cyclophosphamide and dexamethasone in combination with a new drug called Carfilzomib in patients with multiple myeloma. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Multiple Myeloma
- What is being tested?
- Autologous Stem Cell Transplant (ASCT) and Consolidation with 4 cycles of CarCyDex
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 281 participants
- Where
- 20 sitesUnited Kingdom
- Study dates
- 16 Jun 2015to Nov 2029
- Phase
- Phase 2
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Previously untreated patients with symptomatic MM (see appendix 3) eligible for stem cell transplantation, with the exception of the following treatments:
- local radiotherapy to relieve bone pain and/or spinal cord compression
- bisphosphonates
- corticosteroids within the last 3 months. Within 14 days prior to study entry, the maximum permitted dose is 160mg (i.e. 4 days of Dexamethasone at 40mg, or equivalent), unless otherwise agreed by the TMG.
- Suitable for high dose therapy and ASCT
- Age ≥ 18 years
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- Life expectancy ≥ 3 months
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2)
- Measurable disease as defined by one of the following:
- Secretory myeloma: Monoclonal protein in the serum (≥10 g/L) or monoclonal light chain in the urine (Bence Jones protein ≥200mg/24hours), or serum free light chain (SFLC, involved light chain ≥100mg/L provided the FLC ratio is abnormal)
- Non-secretory myeloma:
- Either ≥30% clonal plasma cells in bone marrow (aspirate or trephine)
- Or 10-30% clonal plasma cells in the marrow and >1 soft tissue or extra-osseous plasmacytoma ≥ 2 cm that is measurable for response assessment by CT or MRI
- Adequate hepatic function, with serum ALT ≤ 3.5 times the upper limit of normal and serum direct bilirubin ≤ 2 mg/dL (34 µmol/L) within 14 days prior to registration
- Absolute neutrophil count (ANC) ≥ 1.0 × 109/L within 14 days prior to registration and subject has not received any growth factor support within 7 days of testing. ANC≥0.8x109/L allowed for patients with racial neutropenia.
- Haemoglobin ≥ 8 g/dL (80 g/L) within 14 days prior to registration (subjects may be receiving red blood cell (RBC) transfusions in accordance with institutional guidelines)
- Platelet count ≥ 75 × 109/L (≥ 50 × 109/L if myeloma involvement in the bone marrow is > 50%) within 14 days prior to registration and subject has not received any platelet transfusions within 7 days prior to testing.
- Creatinine clearance (CrCl) ≥ 30 mL/minute within 14 days prior to registration, either measured or calculated using a standard formula (e.g. Cockcroft and Gault).
- Written informed consent
- Females of childbearing potential (FCBP) must agree to ongoing pregnancy testing and to practice contraception.
- Male subjects must agree to practice contraception.
Who cannot join
- Pregnant or breast-feeding females (lactating women may participate if breastfeeding ceases for the duration of trial treatment and until 12 months after last treatment)
- Previous systemic chemotherapy for myeloma, with the exception of steroids, as detailed above (see section 6.3.1)
- Any major surgery within 21 days prior to registration which in the investigator's opinion would compromise trial treatment and/or the patient's ability to comply with trial visits. Surgery to relieve spinal cord compression or for treatment of bone fractures is permitted.
- Acute active infection requiring treatment (systemic antibiotics, antivirals, or antifungals) 7 days prior to planned start of treatment, unless otherwise agreed by the TMG.
- Known human immunodeficiency virus (HIV) infection
- Active hepatitis B or C infection (refer to appendix 4)
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- Unstable angina or myocardial infarction within 4 months prior to registration, NYHA Class III or IV heart failure, uncontrolled angina, history of severe coronary artery disease, severe uncontrolled ventricular arrhythmias, sick sinus syndrome, or electrocardiographic evidence of acute ischemia or Grade 3 conduction system abnormalities unless subject has a pacemaker
- Uncontrolled hypertension or uncontrolled diabetes within 14 days prior to registration
- Non-haematologic malignancy within the past 3 years with the exception of a) adequately treated basal cell carcinoma, squamous cell skin cancer, or thyroid cancer; b) carcinoma in situ of the cervix or breast; c) prostate cancer of Gleason Grade 6 or less with stable prostate-specific antigen levels; or d) cancer considered cured by surgical resection or unlikely to impact survival during the duration of the study, such as localised transitional cell carcinoma of the bladder or benign tumors of the adrenal or pancreas
- Significant neuropathy (Grades 3-4, or Grade 2 with pain) within 14 days prior to registration
- Known history of allergy to Captisol® (a cyclodextrin derivative used to solubilise carfilzomib)
- Contraindication to any of the required concomitant drugs or supportive treatments, including hypersensitivity to all anticoagulation and antiplatelet options, antiviral drugs, or intolerance to hydration due to preexisting pulmonary, cardiac or renal impairment
- Patients with pleural effusions requiring thoracentesis or ascites requiring paracentesis within 14 days prior to registration
- Any other clinically significant medical disease or condition that, in the Investigator's opinion, may interfere with protocol adherence or a subject's ability to give informed consent
Trial locations and contacts
20 sites in 1 country.
20 sites in 1 country
United Kingdom20 sites
Royal United Hospital
Bath, BA1 3NG
Birmingham Heartlands Hospital
Birmingham, B9 5SS
NHS Lanarkshire
Bothwell
Bradford Royal Infirmary
Bradford
Kent and Canterbury Hospital
Canterbury, CT1 3NH
University Hospital of Wales
Cardiff, CF14 4XW
Medway NHS Foundation Trust
Gillingham, ME7 5NY
St James' Hospital
Leeds, LS9 7TF
St Bartholomew's Hospital
London, EC1A 7BE
Barnet Hospital
London, EN5 3DJ
Guy's Hospital
London, SE1 9RT
King's College Hospital
London, SE5 9RS
St George's Hospital
London, SW17 0QT
University College London Hospital
London
Maidstone and Tunbridge Wells
Maidstone
Churchill Hospital
Oxford, OX3 7LE
Queen's Hospital
Romford, Essex, RM7 0AG
Royal Hallamshire Hospital
Sheffield, S10 2SB
Royal Stoke University Hospital
Stoke
City Hospital Sunderland
Sunderland
About this study
Official title: Carfilzomib/Cyclophosphamide/Dexamethasone with Maintenance Carfilzomib in Untreated Transplant-eligible Patients with Symptomatic MM to Evaluate the Benefit of Upfront ASCT
The Cardamon trial is a phase 2 trial using the standard chemotherapy drugs cyclophosphamide and dexamethasone in combination with a new drug called Carfilzomib in patients with multiple myeloma.
Read the detailed description
Multiple Myeloma is a cancer of the bone marrow and, for those patients that are young and fit enough, the disease is usually treated with chemotherapy (sometimes called induction chemotherapy) followed by a stem cell transplant using the patient's own stem cells (autograft or Autologous Stem Cell Transplant). Unfortunately almost all patients will experience a relapse at some point following this treatment. After relapse there are a number of treatment options but eventually the disease will become resistant to further therapy.
The use of an Autologous Stem Cell Transplant (or Transplant) after initial chemotherapy treatment has been shown in studies to increase the amount of time that patients are without symptoms of their myeloma before unfortunately their disease relapses. However, recently more effective induction chemotherapy regimens have been developed and patients treated with these new regimens are able to achieve higher and deeper responses than those previously treated on older regimens. Many also achieve complete or very good partial response, which was rare with the traditional chemotherapy regimens.
So, the investigators now do not know if giving patients an Autologous Stem Cell Transplant straight after their initial induction chemotherapy is the best thing to do. It may be that patients who respond well to a new drug containing regimen will obtain most benefit from their stem cells if these stem cells are frozen and stored, so that they can be used when their disease relapses.
In the Cardamon trial, the investigators will directly compare the outcome of patients who receive a transplant, versus those patients who do not and who instead receive Consolidation therapy. After induction treatment and stem cell harvest, patients will be randomly allocated to receive either a transplant or to receive consolidation therapy. Patients in the Cardamon trial will also be given maintenance treatment. This is treatment that is given on an ongoing basis, after the transplant or after the Consolidation therapy. The aim of maintenance treatment is to prolong disease response and delay the time to relapse.
In summary the purpose of the Cardamon study is:
- to confirm the high response rate to a new treatment regime that includes Carfilzomib plus 2 standard chemotherapy drugs used for the treatment of Multiple Myeloma,
- to investigate whether patients who respond well to this new Carfilzomib-containing induction regimen are able to maintain a long remission period without having an Autologous Stem Cell Transplant 'up-front', and
- to find out if maintenance treatment with Carfilzomib is able to further reduce the number of remaining myeloma cells in the bone marrow, using the Minimal Residual Disease test.
- Conditions
- Multiple Myeloma
- Being tested
- Autologous Stem Cell Transplant (ASCT), Consolidation with 4 cycles of CarCyDex
- Keywords
- Multiple Myeloma, Carfilzomib
- Medical subject headings
- Multiple Myeloma
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Autologous Stem Cell Transplant (ASCT)Procedure or surgery
Randomisation to melphalan conditioned autologous stem cell transplant
Consolidation with 4 cycles of CarCyDexDrug
Randomisation to 4 further cycles of Carfilzomib, Cyclophosphamide and Dexamethasone for responding patients following 4 cycles of induction chemotherapy
| Study group | Role | What they receive |
|---|---|---|
| Consolidation with 4 cycles of CarCyDex | Experimental | Patients responding to induction treatment will receive 4 further cycles of Carfilzomib, Cyclophosphamide and Dexamethasone (CarCyDex) treatment followed by 18 months of maintenance carfilzomib Receives: Drug: Consolidation with 4 cycles of CarCyDex |
| Autologous Stem Cell Transplant (ASCT) | Active comparator | Patients responding to induction treatment will receive a melphalan conditioned autologous stem cell transplant followed by 18 months of maintenance carfilzomib Receives: Procedure: Autologous Stem Cell Transplant (ASCT) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Response rate
Major response rate (sCR, CR \& VGPR) to 4 cycles of CarCyDex
Measured: Within 4 weeks of the end of induction treatment
PFS
Progression free survival at 2 years for both ASCT and non-ASCT (consolidation) arms
Measured: 2 years after randomisation
Secondary outcomes (6)
To assess toxicity and tolerability of CarCyDex and carfilzomib as maintenance therapy in untreated patients with symptomatic multiple myeloma
Adverse Events (including peripheral neuropathy), dose reductions and delays, tolerability of the induction and maintenance regimens (treatment delays, discontinuation rates)
Measured: From start of treatment until 30 days post end of maintenance treatment
Disease response rate
Disease response rate (sCR, CR, VGPR, PR) to CarCyDex induction
Measured: Within 4 weeks of the end of induction treatment
PFS
PFS in both the ASCT and non-ASCT arms
Measured: Assessed every 6 months from the end of treatment until 36 months post induction
Overall survival
Overall survival in both the ASCT and non-ASCT arms
Measured: Assessed every 6 months from the end of treatment until 36 months post induction
MRD conversion following treatment
Improvement in disease response and conversion from MRD-positive to MRD-negative post ASCT and post Consolidation
Measured: Baseline, Day 100 post ASCT or within 4 weeks of the end of consolidation treatment
MRD conversion following maintenance
Improvement in disease response and conversion from MRD-positive to MRD-negative after 6 months of maintenance treatment
Measured: Baseline, after 6 months of maintenance
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 Dec 2014 (estimated)
- Study start16 Jun 2015
- Primary completionNov 2019
- Study completionNov 2029 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Multiple MyelomaStudies of the same condition, open and under way.
- More trials run by University College, LondonThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 281 participants (actual)
Sponsor and investigators
- Lead sponsor
- University College, London
- Sponsor type
- University, hospital or other
- Collaborators
- Amgen
- Responsible party
- Sponsor
- Investigators
- Kwee Yong, Principal investigator, University College, London
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02315716
- Sponsor's protocol ID
- UCL/12/0500
- Other IDs
- 2014-000506-35, 2014
- Acronym
- Cardamon
- Status last verified
- Dec 2024
- First submitted
- 3 Dec 2014
- Last updated
- 6 Dec 2024
- Results posted
- No
- Data monitoring committee
- Yes
- Individual data sharing
- No
Publications
Yong K, Wilson W, de Tute RM, Camilleri M, Ramasamy K, Streetly M, Sive J, Bygrave CA, Benjamin R, Chapman M, Chavda SJ, Phillips EH, Del Mar Cuadrado M, Pang G, Jenner R, Dadaga T, Kamora S, Cavenagh J, Clifton-Hadley L, Owen RG, Popat R. Upfront autologous haematopoietic stem-cell transplantation versus carfilzomib-cyclophosphamide-dexamethasone consolidation with carfilzomib maintenance in patients with newly diagnosed multiple myeloma in England and Wales (CARDAMON): a randomised, phase 2, non-inferiority trial. Lancet Haematol. 2023 Feb;10(2):e93-e106. doi: 10.1016/S2352-3026(22)00350-7. Epub 2022 Dec 15.
PubMed 36529145
Study at a glance
From the registry record, last updated by the sponsor on 6 Dec 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Carfilzomib/Cyclophosphamide/Dexamethasone with Maintenance Carfilzomib in Untreated Transplant-eligible Patients with Symptomatic MM to Evaluate the Benefit of Upfront ASCT
- ClinicalTrials.gov ID
- NCT02315716
- Acronym / sponsor ID
- Cardamon / UCL/12/0500
- Conditions
- Multiple Myeloma
- Keywords
- Multiple Myeloma, Carfilzomib
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 281 participants (actual)
- Lead sponsor
- University College, LondonUniversity, hospital or other
- Collaborators
- Amgen
- Study start
- 16 Jun 2015 (actual)
- Primary completion
- Nov 2019 (actual)
- Study completion
- Nov 2029 (estimated)
- First posted
- 12 Dec 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The Cardamon trial is a phase 2 trial using the standard chemotherapy drugs cyclophosphamide and dexamethasone in combination with a new drug called Carfilzomib in patients with multiple myeloma.
Detailed description
Multiple Myeloma is a cancer of the bone marrow and, for those patients that are young and fit enough, the disease is usually treated with chemotherapy (sometimes called induction chemotherapy) followed by a stem cell transplant using the patient's own stem cells (autograft or Autologous Stem Cell Transplant). Unfortunately almost all patients will experience a relapse at some point following this treatment. After relapse there are a number of treatment options but eventually the disease will become resistant to further therapy.
The use of an Autologous Stem Cell Transplant (or Transplant) after initial chemotherapy treatment has been shown in studies to increase the amount of time that patients are without symptoms of their myeloma before unfortunately their disease relapses. However, recently more effective induction chemotherapy regimens have been developed and patients treated with these new regimens are able to achieve higher and deeper responses than those previously treated on older regimens. Many also achieve complete or very good partial response, which was rare with the traditional chemotherapy regimens.
So, the investigators now do not know if giving patients an Autologous Stem Cell Transplant straight after their initial induction chemotherapy is the best thing to do. It may be that patients who respond well to a new drug containing regimen will obtain most benefit from their stem cells if these stem cells are frozen and stored, so that they can be used when their disease relapses.
In the Cardamon trial, the investigators will directly compare the outcome of patients who receive a transplant, versus those patients who do not and who instead receive Consolidation therapy. After induction treatment and stem cell harvest, patients will be randomly allocated to receive either a transplant or to receive consolidation therapy. Patients in the Cardamon trial will also be given maintenance treatment. This is treatment that is given on an ongoing basis, after the transplant or after the Consolidation therapy. The aim of maintenance treatment is to prolong disease response and delay the time to relapse.
In summary the purpose of the Cardamon study is:
- to confirm the high response rate to a new treatment regime that includes Carfilzomib plus 2 standard chemotherapy drugs used for the treatment of Multiple Myeloma,
- to investigate whether patients who respond well to this new Carfilzomib-containing induction regimen are able to maintain a long remission period without having an Autologous Stem Cell Transplant 'up-front', and
- to find out if maintenance treatment with Carfilzomib is able to further reduce the number of remaining myeloma cells in the bone marrow, using the Minimal Residual Disease test.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Consolidation with 4 cycles of CarCyDex | Experimental | Drug: Consolidation with 4 cycles of CarCyDexPatients responding to induction treatment will receive 4 further cycles of Carfilzomib, Cyclophosphamide and Dexamethasone (CarCyDex) treatment followed by 18 months of maintenance carfilzomib |
| Autologous Stem Cell Transplant (ASCT) | Active comparator | Procedure: Autologous Stem Cell Transplant (ASCT)Patients responding to induction treatment will receive a melphalan conditioned autologous stem cell transplant followed by 18 months of maintenance carfilzomib |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (21 listed)
- Previously untreated patients with symptomatic MM (see appendix 3) eligible for stem cell transplantation, with the exception of the following treatments:
- Suitable for high dose therapy and ASCT
- Age ≥ 18 years
- Life expectancy ≥ 3 months
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2)
Key exclusion criteria (14 listed)
- Pregnant or breast-feeding females (lactating women may participate if breastfeeding ceases for the duration of trial treatment and until 12 months after last treatment)
- Previous systemic chemotherapy for myeloma, with the exception of steroids, as detailed above (see section 6.3.1)
- Any major surgery within 21 days prior to registration which in the investigator's opinion would compromise trial treatment and/or the patient's ability to comply with trial visits. Surgery to relieve spinal cord compression or for treatment of bone fractures is permitted.
- Acute active infection requiring treatment (systemic antibiotics, antivirals, or antifungals) 7 days prior to planned start of treatment, unless otherwise agreed by the TMG.
- Known human immunodeficiency virus (HIV) infection
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Autologous Stem Cell Transplant (ASCT)Randomisation to melphalan conditioned autologous stem cell transplant | Procedure or surgery | Autologous Stem Cell Transplant (ASCT) |
| Consolidation with 4 cycles of CarCyDexRandomisation to 4 further cycles of Carfilzomib, Cyclophosphamide and Dexamethasone for responding patients following 4 cycles of induction chemotherapy | Drug | Consolidation with 4 cycles of CarCyDex |
Primary outcome
Response rate
Time frame: Within 4 weeks of the end of induction treatment
Major response rate (sCR, CR \& VGPR) to 4 cycles of CarCyDex
PFS
Time frame: 2 years after randomisation
Progression free survival at 2 years for both ASCT and non-ASCT (consolidation) arms
6 secondary outcomes
To assess toxicity and tolerability of CarCyDex and carfilzomib as maintenance therapy in untreated patients with symptomatic multiple myeloma
Time frame: From start of treatment until 30 days post end of maintenance treatment
Disease response rate
Time frame: Within 4 weeks of the end of induction treatment
PFS
Time frame: Assessed every 6 months from the end of treatment until 36 months post induction
Overall survival
Time frame: Assessed every 6 months from the end of treatment until 36 months post induction
MRD conversion following treatment
Time frame: Baseline, Day 100 post ASCT or within 4 weeks of the end of consolidation treatment
MRD conversion following maintenance
Time frame: Baseline, after 6 months of maintenance
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 6 Dec 2024.
- Derived from this study: PubMed 36529145Yong K, Wilson W, de Tute RM, Camilleri M, Ramasamy K, Streetly M, Sive J, Bygrave CA, Benjamin R, Chapman M, Chavda SJ, Phillips EH, Del Mar Cuadrado M, Pang G, Jenner R, Dadaga T, Kamora S, Cavenagh J, Clifton-Hadley L, Owen RG, Popat R. Upfront autologous haematopoietic stem-cell transplantation versus carfilzomib-cyclophosphamide-dexamethasone consolidation with carfilzomib maintenance in patients with newly diagnosed multiple myeloma in England and Wales (CARDAMON): a randomised, phase 2, non-inferiority trial. Lancet Haematol. 2023 Feb;10(2):e93-e106. doi: 10.1016/S2352-3026(22)00350-7. Epub 2022 Dec 15.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Kwee Yong principal investigator
University College, London
20 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Autologous Stem Cell Transplant (ASCT) and Consolidation with 4 cycles of CarCyDex in people with Multiple Myeloma, run by University College, London at 20 sites in United Kingdom.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 21 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 6 Dec 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 20 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Response rate (time frame: Within 4 weeks of the end of induction treatment). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02315716, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Dec 2024.