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High-Dose Melphalan and Autologous Peripheral Stem Cell Transplantation in Treating Patients With Multiple Myeloma or Primary Systemic Amyloidosis
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), November 2009
First Received: July 8, 2003   Last Updated: November 7, 2009   History of Changes
Sponsor: Southwest Oncology Group
Collaborator: National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00064337
  Purpose

RATIONALE: Drugs used in chemotherapy such as melphalan work in different ways to stop cancer cells from dividing so they stop growing or die. Combining chemotherapy with donor peripheral stem cell transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more cancer cells.

PURPOSE: This phase II trial is studying how well giving melphalan together with autologous stem cell transplantation works in treating patients with multiple myeloma or primary systemic amyloidosis.


Condition Intervention Phase
Multiple Myeloma and Plasma Cell Neoplasm
Biological: filgrastim
Drug: cyclophosphamide
Drug: dexamethasone
Drug: melphalan
Drug: thalidomide
Procedure: peripheral blood stem cell transplantation
Phase II

Study Type: Interventional
Study Design: Treatment, Open Label
Official Title: A Phase II Trial Evaluating Modified High Dose Melphalan (100 mg/m) And Autologous Peripheral Blood Stem Cell Supported Transplant (SCT) For High Risk Patients With Multiple Myeloma And/Or Light Chain Amyloidosis (AL Amyloidosis) (A BMT Study)

Resource links provided by NLM:


Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Overall survival [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Hematologic response [ Designated as safety issue: No ]
  • Qualitative and quantitative toxicity [ Designated as safety issue: Yes ]
  • Prognostic significance of cytogenetic markers [ Designated as safety issue: No ]

Estimated Enrollment: 100
Study Start Date: January 2004
Estimated Primary Completion Date: July 2014 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

  • Determine overall survival of patients with high-risk multiple myeloma, primary systemic amyloidosis, or light chain deposition disease treated with two courses of modified high-dose melphalan and autologous peripheral blood stem cell transplantation.
  • Determine the hematologic response in patients treated with this regimen.
  • Determine the qualitative and quantitative toxic effects of this regimen in these patients.
  • Determine the prognostic significance of cytogenetic markers in these patients.

OUTLINE: This is a multicenter study. Patients are stratified according to disease (high-risk multiple myeloma vs primary systemic amyloidosis vs both).

  • Induction therapy (multiple myeloma patients only): Patients receive oral dexamethasone on days 1-4, 9-12, and 17-20 and oral thalidomide daily on days 1-35. Treatment repeats every 35 days for 2 courses in the absence of disease progression or unacceptable toxicity.
  • Mobilization and stem cell collection:

    • Multiple myeloma patients: Within 28-35 days after completion of induction therapy, patients receive cyclophosphamide IV over 2-3 hours on day 1 and filgrastim (G-CSF) subcutaneously (SC) daily beginning on day 2 and continuing through the day before the last leukapheresis. Usage of mesna IV on day 1 (prior to and twice after cyclophosphamide administration is recommended).
    • Primary systemic amyloidosis patients: Patients receive G-CSF SC daily beginning on day 1 and continuing through the day before the last leukapheresis.

All patients undergo leukapheresis for the collection of stem cells until the target number of CD34+ cells is reached.

  • Conditioning regimen: Within 1-4 weeks after mobilization, patients receive modified high-dose melphalan IV over 20 minutes on day -2.
  • Peripheral blood stem cell (PBSC) reinfusion: PBSCs are reinfused on day 0. Patients receive G-CSF SC daily beginning on day 1 and continuing until blood counts recover.

Patients undergo a second autologous PBSC transplantation within 3-6 months, but no later than 12 months, after the first transplantation.

  • Second conditioning regimen: Patients receive modified high-dose melphalan IV over 20 minutes on day -2.
  • Second PBSC infusion: PBSCs are infused on day 0.
  • Maintenance regimen (multiple myeloma patients only): Between 4-8 weeks after the second transplantation, patients with no progressive disease receive oral dexamethasone once daily on days 1-4 and oral thalidomide once daily on days 1-28. Courses repeat every 28 days for 2 years in the absence of disease progression or unacceptable toxicity.

Patients are followed at 3 and 6 months and then annually thereafter.

PROJECTED ACCRUAL: A total of 100 patients will be accrued for this study within 20-25 months.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • At least 1 of the following diagnoses:

    • Multiple myeloma

      • Stage II or III disease
      • At least 1 of the following must be present:

        • Serum M-protein of IgG, IgA, IgD, IgE greater than 1.0 g/dL
        • Urinary M-protein (Bence-Jones) at least 200 mg/24 hours
      • No IgM peaks except in patients who have physiologic criteria to support a diagnosis of multiple myeloma (e.g., bony lesions, myeloma kidney-cast nephropathy, absence of adenopathy [unless pathology-proven to be plasma cell infiltration])
      • No monoclonal gammopathy of undetermined significance
      • No indolent or smoldering myeloma
      • No disease progression on prior thalidomide or dexamethasone
    • Histologically confirmed primary systemic amyloidosis

      • No senile, secondary, localized, dialysis-related, or familial amyloidosis
      • No severe cardiac involvement

        • No pre-exertional syncope, ventricular arrhythmia, or symptomatic pleural effusions associated with cardiac involvement
    • Light Chain Deposition Disease alone or in combination with multiple myeloma meeting the following criteria:

      • Deposition of granular material containing free light chains/immunoglobulins that did not bind Congo red
      • Evidence of plasma cell dyscrasia (i.e., monoclonal gammopathy in the serum or urine by immunofixation electrophoresis and/or clonal plasmacytosis) on bone marrow biopsy by immunohistochemistry and/or elevated serum-free light chain concentration
  • Must have been diagnosed within the past year
  • Concurrent enrollment in the myeloma repository protocol SWOG-S0309 must be offered

PATIENT CHARACTERISTICS:

Age

  • 18 and over (patients with amyloidosis only OR patients with amyloidosis and multiple myeloma OR patients with multiple myeloma only with poor renal function) OR
  • 70 and over (patients with multiple myeloma only with or without poor renal function)

Performance status

  • Zubrod 0-2

Life expectancy

  • Not specified

Hematopoietic

  • Absolute neutrophil count at least 1,000/mm^3
  • Platelet count at least 100,000/mm^3

Hepatic

  • Bilirubin no greater than 2.5 times upper limit of normal (ULN)
  • SGOT or SGPT no greater than 2.5 times ULN

Renal

  • No hemodialysis within 2 hours of melphalan or stem cell infusion

Cardiovascular

  • See Disease Characteristics
  • Hemodynamically stable (i.e., systolic blood pressure > 90 mm Hg in a lying position within the past 42 days)
  • No myocardial infarction within the past 6 months
  • No congestive heart failure
  • No arrhythmia refractory to medical therapy
  • LVEF greater than 45% by echocardiogram or MUGA

Pulmonary

  • See Disease Characteristics
  • No history of chronic obstructive or chronic restrictive pulmonary disease
  • Pulmonary function studies (e.g., FEV_1 and FVC) at least 50% of predicted
  • DLCO at least 50% of predicted
  • Normal high resolution CT scan of the chest and acceptable arterial blood gases (i.e., PO_2 greater than 70) required for patients unable to complete pulmonary function tests due to bone pain or fracture

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception

    • Multiple myeloma patients receiving thalidomide must use 2 methods of effective contraception for at least 4 weeks before, during, and for at least 4 weeks after discontinuation of thalidomide
  • HIV negative
  • No other concurrent significant medical condition
  • No concurrent uncontrolled life-threatening infection
  • No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer, carcinoma in situ of the cervix, or adequately treated stage I or II cancer currently in complete remission

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • See Disease Characteristics

Chemotherapy

  • See Disease Characteristics
  • Prior cumulative melphalan dose no more than 200 mg
  • No other concurrent chemotherapy

Endocrine therapy

  • See Disease Characteristics
  • No concurrent hormonal therapy

Radiotherapy

  • No concurrent radiotherapy

Surgery

  • Not specified

Other

  • Recovered from prior therapy
  • Prior or concurrent bisphosphonates allowed
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00064337

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Locations
United States, Arkansas
Arkansas Cancer Research Center at University of Arkansas for Medical Sciences Recruiting
Little Rock, Arkansas, United States, 72205
Contact: Clinical Trial Office - Arkansas Cancer Research Center at Uni     501-686-8274        
United States, California
Alta Bates Summit Comprehensive Cancer Center Recruiting
Berkeley, California, United States, 94704
Contact: Clinical Trials Office - Alta Bates Summit Comprehensive Cance     510-204-3428        
California Pacific Medical Center - California Campus Recruiting
San Francisco, California, United States, 94118
Contact: David H. Irwin, MD     510-204-1591        
Marin Cancer Institute at Marin General Hospital Recruiting
Greenbrae, California, United States, 94904
Contact: David H. Irwin, MD     510-204-1591        
Sutter Solano Medical Center Recruiting
Vallejo, California, United States, 94589
Contact: David H. Irwin, MD     510-204-1591        
Scripps Cancer Center - San Diego Recruiting
La Jolla, California, United States, 92037
Contact: James R. Mason, MD     858-554-8597        
Sutter Health - Western Division Cancer Research Group Recruiting
Greenbrae, California, United States, 94904
Contact: David H. Irwin, MD     510-204-1591        
Peninsula Medical Center Recruiting
Burlingame, California, United States, 94010
Contact: David H. Irwin, MD     510-204-1591        
University of California Davis Cancer Center Recruiting
Sacramento, California, United States, 95817
Contact: Clinical Trials Office - University of California Davis Cancer     916-734-3089        
United States, Idaho
Mountain States Tumor Institute at St. Luke's Regional Medical Center Recruiting
Boise, Idaho, United States, 83712
Contact: William H. Kreisle, MD     208-381-2711        
United States, Kansas
Tammy Walker Cancer Center at Salina Regional Health Center Recruiting
Salina, Kansas, United States, 67401
Contact: William F. Cathcart-Rake, MD     785-452-4860        
Wesley Medical Center Recruiting
Wichita, Kansas, United States, 67214
Contact: Shaker R. Dakhil, MD, FACP     316-262-4467        
United States, Louisiana
Tulane Cancer Center Office of Clinical Research Recruiting
Alexandria, Louisiana, United States, 71315-3198
Contact: Clinical Trials Office - Tulane Cancer Center     504-988-6121        
United States, Massachusetts
Boston University Cancer Research Center Recruiting
Boston, Massachusetts, United States, 02118
Contact: Clinical Trials Office - Boston University Cancer Research Cen     617-353-7571        
United States, Michigan
Barbara Ann Karmanos Cancer Institute Recruiting
Detroit, Michigan, United States, 48201-1379
Contact: Clinical Trials Office - Barbara Ann Karmanos Cancer Institute     313-576-9363        
Josephine Ford Cancer Center at Henry Ford Hospital Recruiting
Detroit, Michigan, United States, 48202
Contact: Robert A. Chapman, MD     313-916-1332        
United States, Missouri
Saint Louis University Cancer Center Recruiting
Saint Louis, Missouri, United States, 63110
Contact: Clinical Trials Office - Saint Louis University Cancer Center     314-977-4440        
United States, Montana
Big Sky Oncology Recruiting
Great Falls, Montana, United States, 59405-5309
Contact: Clinical Trail Office - Big Sky Oncology     406-731-8217        
Billings Clinic - Downtown Recruiting
Billings, Montana, United States, 59107-7000
Contact: Clinical Trials Office - Billings Clinic - Downtown     800-996-2663     research@billingsclinic.org    
Bozeman Deaconess Cancer Center Recruiting
Bozeman, Montana, United States, 59715
Contact: Benjamin T. Marchello, MD     406-238-6290        
CCOP - Montana Cancer Consortium Recruiting
Billings, Montana, United States, 59101
Contact: Benjamin T. Marchello, MD     406-238-6290        
Community Medical Center Recruiting
Missoula, Montana, United States, 59801
Contact: Benjamin T. Marchello, MD     406-238-6290        
Glacier Oncology, PLLC Recruiting
Kalispell, Montana, United States, 59901
Contact: Benjamin T. Marchello, MD     406-238-6290        
Great Falls Clinic - Main Facility Recruiting
Great Falls, Montana, United States, 59405
Contact: Benjamin T. Marchello, MD     406-238-6290        
Guardian Oncology and Center for Wellness Recruiting
Missoula, Montana, United States, 59804
Contact: Benjamin T. Marchello, MD     406-238-6290        
Northern Rockies Radiation Oncology Center Recruiting
Billings, Montana, United States, 59101
Contact: Benjamin T. Marchello, MD     406-238-6290        
Kalispell Medical Oncology at KRMC Recruiting
Kalispell, Montana, United States, 59901
Contact: Benjamin T. Marchello, MD     406-238-6290        
Kalispell Regional Medical Center Recruiting
Kalispell, Montana, United States, 59901
Contact: Benjamin T. Marchello, MD     406-238-6290        
Recruiting
Great Falls, Montana, United States, 59405
Contact: Benjamin T. Marchello, MD     406-238-6290        
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center Recruiting
Missoula, Montana, United States, 59807
Contact: Clinical Trials Office - Montana Cancer Center at St. Patrick     406-329-7029        
Montana Cancer Specialists at Montana Cancer Center Recruiting
Missoula, Montana, United States, 59807-7877
Contact: Clinical Trials Office - Montana Cancer Specialists at Montana     406-238-6962        
Northern Montana Hospital Recruiting
Havre, Montana, United States, 59501
Contact: Benjamin T. Marchello, MD     406-238-6290        
Hematology-Oncology Centers of the Northern Rockies - Billings Recruiting
Billings, Montana, United States, 59101
Contact: Benjamin T. Marchello, MD     406-238-6290        
Sletten Cancer Institute at Benefis Healthcare Recruiting
Great Falls, Montana, United States, 59405
Contact: Grant W. Harrer, MD, FACP, CCTI     406-731-8100        
St. James Healthcare Cancer Care Recruiting
Butte, Montana, United States, 59701
Contact: Benjamin T. Marchello, MD     406-238-6290        
St. Peter's Hospital Recruiting
Helena, Montana, United States, 59601
Contact: Benjamin T. Marchello, MD     406-238-6290        
St. Vincent Healthcare Cancer Care Services Recruiting
Billings, Montana, United States, 59101
Contact: Benjamin T. Marchello, MD     406-238-6290        
United States, New York
James P. Wilmot Cancer Center at University of Rochester Medical Center Recruiting
Rochester, New York, United States, 14642
Contact: Richard I. Fisher, MD     585-275-0842        
United States, Ohio
Cleveland Clinic Taussig Cancer Center Recruiting
Cleveland, Ohio, United States, 44195
Contact: Clinical Trials Office - Cleveland Clinic Taussig Cancer Cente     866-223-8100        
United States, Oregon
Adventist Medical Center Recruiting
Portland, Oregon, United States, 97216
Contact: Keith S. Lanier, MD     503-299-6500        
CCOP - Columbia River Oncology Program Recruiting
Portland, Oregon, United States, 97225
Contact: Keith S. Lanier, MD     503-299-6500        
Knight Cancer Institute at Oregon Health and Science University Recruiting
Portland, Oregon, United States, 97239-3098
Contact: Clinical Trials Office - Knight Cancer Institute at Oregon Hea     503-494-1080     trials@ohsu.edu    
Providence St. Vincent Medical Center Recruiting
Portland, Oregon, United States, 97225
Contact: Clinical Trials Office - Providence St. Vincent Medical Center     503-215-6412        
Legacy Good Samaritan Hospital & Comprehensive Cancer Center Recruiting
Portland, Oregon, United States, 97210
Contact: Clinical Trials Office - Legacy Good Samaritan Hospital & Com     503-413-1742        
Legacy Meridian Park Hospital Recruiting
Tualatin, Oregon, United States, 97062
Contact: Clinical Trials Office - Legacy Meridian Park Hospital     503-413-1742        
Legacy Mount Hood Medical Center Recruiting
Gresham, Oregon, United States, 97030
Contact: Clinical Trials Office - Legacy Mount Hood Medical Center     503-413-2150        
Northwest Cancer Specialists at Rose Quarter Cancer Center Recruiting
Portland, Oregon, United States, 97227
Contact: Kasra Karamlou     503-228-6509        
Providence Cancer Center at Providence Portland Medical Center Recruiting
Portland, Oregon, United States, 97213-2967
Contact: Clinical Trials Office - Providence Cancer Center at Providenc     503-215-6412        
Providence Milwaukie Hospital Recruiting
Milwaukie, Oregon, United States, 97222
Contact: Keith S. Lanier, MD     503-299-6500        
Legacy Emanuel Hospital and Health Center and Children's Hospital Recruiting
Portland, Oregon, United States, 97227
Contact: Clinical Trials Office - Legacy Emanuel Hospital and Health Ce     503-413-8199        
United States, Tennessee
Thompson Cancer Survival Center Recruiting
Knoxville, Tennessee, United States, 37916
Contact: Clinical Trials Office - Thompson Cancer Survival Center     865-541-1812        
United States, Washington
Cancer Care Northwest - Spokane South Recruiting
Spokane, Washington, United States, 99202
Contact: Clinical Trials Office - Cancer Care Northwest - Spokane South     509-228-1083        
Columbia Basin Hematology Recruiting
Kennewick, Washington, United States, 99336
Contact: Saul E. Rivkin, MD     206-386-2441        
Fred Hutchinson Cancer Research Center Recruiting
Seattle, Washington, United States, 98104
Contact: Saul E. Rivkin, MD     206-386-2441        
Group Health Central Hospital Recruiting
Seattle, Washington, United States, 98112
Contact: Clinical Trials Office - Group Health Central Hospital     206-287-2900        
Olympic Hematology and Oncology Recruiting
Bremerton, Washington, United States, 98310
Contact: Saul E. Rivkin, MD     206-386-2441        
Legacy Salmon Creek Medical Center Recruiting
Vancouver, Washington, United States, 98686
Contact: Kasra Karamlou     360-487-1000        
Minor and James Medical, PLLC Recruiting
Seattle, Washington, United States, 98104
Contact: Saul E. Rivkin, MD     206-386-2441        
Harborview Medical Center Recruiting
Seattle, Washington, United States, 98104
Contact: Saul E. Rivkin, MD     206-386-2441        
Polyclinic First Hill Recruiting
Seattle, Washington, United States, 98122
Contact: Saul E. Rivkin, MD     206-386-2441        
Southwest Washington Medical Center Cancer Center Recruiting
Vancouver, Washington, United States, 98668
Contact: Keith S. Lanier, MD     503-299-6500        
St. Joseph Cancer Center Recruiting
Bellingham, Washington, United States, 98225
Contact: Saul E. Rivkin, MD     206-386-2441        
Swedish Cancer Institute at Swedish Medical Center - First Hill Campus Recruiting
Seattle, Washington, United States, 98122-4307
Contact: Saul E. Rivkin, MD     206-386-2441        
University Cancer Center at University of Washington Medical Center Recruiting
Seattle, Washington, United States, 98195-6043
Contact: Clinical Trials Office - University Cancer Center at Universit     206-616-8289        
United States, West Virginia
Community Comprehensive Cancer Center at Camden-Clark Memorial Hospital Recruiting
Parkersburg, West Virginia, United States, 26102
Contact: Clinical Trials Office - Community Comprehensive Cancer Center     304-424-2585        
United States, Wyoming
Rocky Mountain Oncology Recruiting
Casper, Wyoming, United States, 82609
Contact: Benjamin T. Marchello, MD     406-238-6290        
Welch Cancer Center at Sheridan Memorial Hospital Recruiting
Sheridan, Wyoming, United States, 82801
Contact: Benjamin T. Marchello, MD     406-238-6290        
Sponsors and Collaborators
Southwest Oncology Group
Investigators
Investigator: Vaishali Sanchorawala, MD Boston Medical Center
Investigator: David C. Seldin, MD, PhD Boston Medical Center
  More Information

Additional Information:
No publications provided

Responsible Party: Southwest Oncology Group - Group Chair's Office ( Laurence H. Baker )
Study ID Numbers: CDR0000315382, SWOG-S0115
Study First Received: July 8, 2003
Last Updated: November 7, 2009
ClinicalTrials.gov Identifier: NCT00064337     History of Changes
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
primary systemic amyloidosis
stage II multiple myeloma
stage III multiple myeloma

Additional relevant MeSH terms:
Dexamethasone
Anti-Inflammatory Agents
Anti-Infective Agents
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Hormones, Hormone Substitutes, and Hormone Antagonists
Antiemetics
Hormones
Hemorrhagic Disorders
Therapeutic Uses
Cardiovascular Diseases
Angiogenesis Modulating Agents
Immunoproliferative Disorders
Metabolic Diseases
Immune System Diseases
Antineoplastic Agents, Hormonal
Hematologic Diseases
Glucocorticoids
Multiple Myeloma
Neoplasms
Leprostatic Agents
Melphalan
Immunologic Factors
Thalidomide
Blood Protein Disorders
Antineoplastic Agents
Paraproteinemias
Cyclophosphamide
Hemostatic Disorders
Anti-Bacterial Agents

ClinicalTrials.gov processed this record on November 27, 2009