Tandem Transplantation in Multiple Myeloma (MM) Patients With <12 Months of Prior Treatment - Full Text View

Sponsor:	University of Utah
Information provided by:	University of Utah
ClinicalTrials.gov Identifier:	NCT00670631

Purpose

The two objectives of this study are:

To increase the 2-year event-free survival from 55%, established with Total Therapy II (UARK 98-026), to 75% in myeloma patients with cytogenetic abnormalities, and from 80%, established with the Total Therapy II regimen, to 95% in myeloma patients without cytogenetic abnormalities.
To determine whether bortezomib, thalidomide, and dexamethasone can be safely incorporated with transplant 1 into the established pre-transplant regimen of high-dose melphalan (used in Total Therapy II) and whether Velcade and gemcitabine can be safely added to the transplant 2 high-dose chemotherapy regimen of combination melphalan and BCNU.

Condition	Intervention	Phase
Multiple Myeloma	Other: tandem autologous transplantation	Phase III

Study Type:	Interventional
Study Design:	Treatment, Non-Randomized, Open Label, Historical Control, Single Group Assignment, Safety/Efficacy Study
Official Title:	Tandem Autotransplantation for Multiple Myeloma Patients With Less Than 12 Months of Preceding Therapy, Incorporating Bortezomib With the Transplant Chemotherapy and During Maintenance

Resource links provided by NLM:

Genetics Home Reference related topics: aceruloplasminemia hemophilia

MedlinePlus related topics: Multiple Myeloma

Drug Information available for: Bortezomib

U.S. FDA Resources

Further study details as provided by University of Utah:

Primary Outcome Measures:

The primary analysis will compare unadjusted Event-Free Survival (EFS; rates between UARK 98-026 (TT2)and new study cohorts. [ Time Frame: After enrollment of 450 subjects is completed ] [ Designated as safety issue: No ]
In assessing patient safety, we will examine treatment toxicity related mortality and SAEs. Historical study results indicate that a mortality rate of greater than 10% is not acceptable in this population, nor is an SAE rate of greater than 15%. [ Time Frame: Interim analyses for safety will be performed after 20, 100, 200, and 300 patients have been enrolled. ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

Overall survival will be compared to a historical control (UARK 98-026, TT2)as a secondary outcome. [ Time Frame: After 450 patients have been enrolled ] [ Designated as safety issue: No ]

Estimated Enrollment:	450
Study Start Date:	February 2008
Estimated Study Completion Date:	August 2012
Estimated Primary Completion Date:	August 2012 (Final data collection date for primary outcome measure)

Intervention Details:

DPACE: dexamethasone 20 mg days 1-4 and 8-11, cisplatin 10 mg/m2 days 1-4, Adriamycin 10 mg/m2 days 1-4, cyclophosphamide 400 mg/m2 days 1-4, etoposide 40 mg/m2 days 1-4.

Transplant 1: Dexamethasone 20 mg days -4 to -1 and +2 to +5. Velcade 1mg/m2 on days -4,-1, +2, and +5. Thalidomide 100mg on day -4 to day +5. Melphalan, 100 mg/m2 on days -4 and -1.

Transplant 2: Dexamethasone 20 mg on days -4 to -1 and +2 to +5. BCNU 300mg/m2 on day -4. Melphalan 140 mg/m2 on day -1. Velcade 1mg/m2 on days -4, -1, +2, +5. Gemcitabine 1000 mg/m2 on days -4 + -1.

Maintenance year 1: Bortezomib 1.0 mg/m2 on days 1, 4, 15,18 every cycle. Thalidomide, 100 mg . Dexamethasone,20 mg,on days 1-4 & 15-18 every cycle.

Maintenance year 2: Dexamethasone, 20 mg,days 1-4 every cycle.

Detailed Description:

This study is targeted towards patients who have been diagnosed with Multiple Myeloma and have had no prior autologous or allogeneic transplant. Furthermore, only up to 12 months of prior treatment are allowed in this patient population. The study schema consists of one round of induction chemotherapy, two transplants, one round of consolidation chemotherapy, and two years of maintenance treatment. This study design differs from its historical predecessors in the following manner:

In contrast to Total Therapy II and III, which only allow enrollment of patients with at most one cycle or one month of treatment prior to enrollment, the proposed study allows enrollment of patients with up to 12 months of prior treatment. No statistically significant difference in outcome between patients with one or no cycle of preceding therapy and those with up to 12 months of prior therapy. This should allow enrollment of significantly more myeloma patients.
Induction therapy has been reduced to a single cycle.
Bortezomib and thalidomide have been added to the transplant regimen.
BCNU is added to the second transplant to high dose melphalan.
Gemcitabine is added to the second transplant regimen.
Consolidation treatment has been reduced to a single cycle.
The first year of maintenance is with bortezomib, thalidomide and dexamethasone, and the second year of maintenance therapy consists of dexamethasone only.
The novel agents thalidomide and bortezomib are not introduced upfront, but only with transplantation and maintenance.

Eligibility

Ages Eligible for Study:	18 Years to 75 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Patients must have the diagnosis of active MM requiring treatment. Patients with a previous history of smoldering myeloma will be eligible if there is evidence of progressive disease requiring chemotherapy.
Protein criteria must be present (quantifiable M-component of IgG, IgA, IgD, or IgE and/or urinary kappa or lambda light chain, Bence-Jones protein, or Free Kappa Light Chain or Free Lambda Light Chain) in order to evaluate response. Non-secretory patients are eligible provided the patient has > 20% plasmacytosis OR multiple (>3) focal plasmacytomas or focal lesions on MRI.
Patients must have received no more than 12 months of prior chemotherapy for this disease. Patients may have received prior radiotherapy provided approval has been obtained by the Principal Investigator.
Patients must be 18-75 years of age at the time of initial registration.
Ejection fraction by ECHO or MUGA ≥ 40% performed within 60 days prior to registration.
Patients must have adequate pulmonary function studies > 50% of predicted on mechanical aspects (FEV1, FVC) and diffusion capacity (DLCO) > 50% of predicted, within 60 days of registration. If the patient is unable to complete pulmonary function tests due to MM related pain or condition, exception may be granted if the principal investigator documents that the patient is a candidate for high dose therapy.
Patients must have a creatinine < 3 mg/dl and a creatinine clearance >30mL/min
Patients must have a performance status of 0-2 based on SWOG criteria. Patients with a poor performance status (3-4), based solely on bone pain will be eligible.
All patients must be informed of the investigational nature of this study and must have signed an IRB-approved informed consent in accordance with institutional and federal guidelines.

Exclusion Criteria:

Platelet count < 30 x 109/L, unless myeloma-related.
Greater than a grade 2 peripheral neuropathy.
Hypersensitivity to bortezomib, boron, or mannitol.
Uncontrolled diabetes.
Recent (< 6 months) myocardial infarction, unstable angina, difficult to control congestive heart failure, uncontrolled hypertension, or difficult to control cardiac arrhythmias.
Evidence of chronic obstructive or chronic restrictive pulmonary disease.
Patients must not have light chain deposition disease-related renal failure or creatinine > 3 mg/dl.
Patients must not have prior malignancy, except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer for which the patient has not received treatment for one year prior to enrollment. Other cancers will only be acceptable if the patient's life expectancy exceeds five years.
Patients must not have significant co-morbid medical conditions or uncontrolled life threatening infection.
Pregnant or nursing women. Women of child-bearing potential must have a negative pregnancy test documented within one week of registration. Women and men of reproductive potential may not participate unless they have agreed to use an effective contraceptive method.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00670631

Contacts

Contact: Annick E Tricot, BA	801-587-4482	annick.tricot@hci.utah.edu
Contact: Ashlie Finlayson	801-587-4021	ashlie.finlayson@hsc.utah.edu

Locations

United States, Utah
University of Utah	Recruiting
Salt Lake City, Utah, United States, 84132

Sponsors and Collaborators

University of Utah

Investigators

Principal Investigator:

Guido J Tricot, MD, PhD

University of Utah

More Information

Additional Information:

University of Utah myeloma program website This link exits the ClinicalTrials.gov site

No publications provided

Responsible Party:	University of Utah ( Guido Tricot, MD, PhD/Director of the BMT and Myeloma program )
Study ID Numbers:	25009, 59306670 7R01CA115399
Study First Received:	April 3, 2008
Last Updated:	June 4, 2009
ClinicalTrials.gov Identifier:	NCT00670631 History of Changes
Health Authority:	United States: Institutional Review Board

Keywords provided by University of Utah:

Multiple Myeloma
myeloma

Additional relevant MeSH terms:

Neoplasms by Histologic Type
Immunoproliferative Disorders
Immune System Diseases
Blood Protein Disorders
Hematologic Diseases
Vascular Diseases
Paraproteinemias

Hemostatic Disorders
Multiple Myeloma
Neoplasms
Hemorrhagic Disorders
Cardiovascular Diseases
Lymphoproliferative Disorders
Neoplasms, Plasma Cell

ClinicalTrials.gov processed this record on November 27, 2009