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Bortezomib Plus Tacrolimus and Methotrexate to Prevent Graft Versus Host Disease (GVHD) After Mismatched Allogeneic Non-Myeloablative Blood Stem Cell Transplantation

This study has been completed.
Brigham and Women's Hospital
Millennium Pharmaceuticals, Inc.
Information provided by (Responsible Party):
John Koreth, MD, Dana-Farber Cancer Institute Identifier:
First received: August 24, 2006
Last updated: June 19, 2013
Last verified: June 2013
The purpose of this study is to determine if Velcade (also known as bortezomib) can help prevent graft versus host disease (GVHD) developing after transplantation. This is done by using a combination of three immune suppressive medications: Velcade, tacrolimus and methotrexate. Stem cell transplantation is one of the options for patients with cancer of the blood or blood forming organs. Recently, allogeneic stem cell transplants have been performed using lower doses of chemotherapy and radiotherapy: non-myeloablative or "mini" transplants. GVHD is a significant problem that may occur even after "mini" transplantations. Information from other research studies, suggests that Velcade may help to reduce the risk of developing GVHD when given early after transplantation.

Condition Intervention Phase
Hematologic Malignancies
Drug: Bortezomib (Velcade)
Drug: Tacrolimus
Drug: Methotrexate
Procedure: blood stem cell transplantation
Phase 1
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Prevention
Official Title: Phase I/II Trial of Bortezomib (Velcade) in Addition to Tacrolimus and Methotrexate to Prevent Graft Versus Host Disease (GVHD) After Mismatched Allogeneic Non-Myeloablative Peripheral Blood Stem Cell Transplantation

Resource links provided by NLM:

Further study details as provided by Dana-Farber Cancer Institute:

Primary Outcome Measures:
  • The Maximally Tolerated Dose (MTD) of Bortezomib (Velcade) That Can be Administered With Tacrolimus and Methotrexate After Mismatched Allogeneic Non-myeloablative Peripheral Blood Stem Cell (PBSC) Transplantation [ Time Frame: by day 45 post PBSC infusion ]

    The MTD of bortezomib was evaluated at 3 dose levels:

    Dose level 1: 1.0 mg/m^2 Dose level 2: 1.3 mg/m^2 Dose level 3: 1.5 mg/m^2 Cohorts of 3-5 pts were enrolled at each dose level. At any dose level, if no DLT in the first 3, 4, or 5 pts, then dose escalation would occur.

    If 3 evaluable pts in cohort, and 1 of 3 experiences DLT then 2 additional pts treated at the same dose level. If >=1 of 2 additional pts experience DLT then previous dose level will be MTD. If no DLT in additional 2 pts then dose escalation will occur. If 4 evaluable pts in cohort, and 1 of the 4 experiences DLT then 1 additional pt treated at same dose level. If this additional pt experiences DLT then the previous dose will be declared to be the MTD. If additional pt does not experience DLT, then dose escalation will take place. If 5 evaluable pts in cohort, and 1 experiences DLT, then dose escalation will take place. If >=2 of first 3, 4, or 5 pts experience DLT then the previous dose will be declared MTD.

  • Successful Initial Engraftment by Day 45 Post Peripheral Blood Stem Cell (PBSC) Infusion and Administration of Bortezomib (Velcade), Tacrolimus and Methotrexate [ Time Frame: by day 45 post PBSC infusion ]
    Percentage of participants who did not experience failure to engraft or relapse or death before assessment.

  • Incidence of Grade II-IV Acute Graft Versus Host Disease (GVHD) by Day 100. [ Time Frame: by day 100 after peripheral blood stem cell (PBSC) infusion ]

Secondary Outcome Measures:
  • Sustained Engraftment Following Transplant. [ Time Frame: by day 100 post transplant ]
    As measured by median total donor chimerism at day 100.

  • Incidence of Chronic Graft Versus Host Disease (Chronic GVHD). [ Time Frame: by 1 year after PBSC infusion ]
    Number of participants with chronic GVHD at 1 year post transplant.

  • Overall Survival and Progression-free Survival. [ Time Frame: by 1 year after PBSC infusion ]
    Progression is defined as disease relapse or disease progression since transplant.

Enrollment: 45
Study Start Date: August 2006
Study Completion Date: September 2011
Primary Completion Date: July 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Bortezomib/Tacrolimus/Methotrexate post HSCT Drug: Bortezomib (Velcade)
Infusion for a total of 3 doses
Drug: Tacrolimus
Taken until Doctor determines it is not necessary any more
Drug: Methotrexate
Infusion for a total of 4 doses
Procedure: blood stem cell transplantation
Allogeneic Non-myeloablative peripheral blood stem cell transplantation

Detailed Description:
  • In this study we are looking for the highest dose of Velcade that can be given to people safely when given with tacrolimus and methotrexate. Not everyone who participates in the study will receive the same amount of the study drug. The dose the participant will receive depends upon the number of subjects enrolled on the study and how well they have tolerated their doses of the drug.
  • Before Transplant: In addition to the chemotherapy drugs, fludarabine and busulfex, for the participants non-myeloablative transplant, they will also start taking tacrolimus orally three days before their transplant.
  • After Transplant Medication: Methotrexate; Intravenously on days 1, 3, 6 & 11 after transplant for a total of 4 doses. Tacrolimus; Continue taking orally once daily. Velcade: Intravenously on days 1, 4 & 7 after transplant, a total of 3 doses. Filgrastim: Subcutaneous injection daily starting the day after transplant and continuing until the participant blood counts have recovered.
  • After Transplant Physical Exams & Tests: Participants will have physical exams and blood tests every week for 1 month. After 1 month, a none marrow biopsy will be performed to look for evidence of the donor's cells in the participants bone marrow.
  • Following the 1 month period of time, participants will be seen every few weeks. Another bone marrow biopsy, as well as blood tests, will be taken 3-4 months after the transplant to review the disease status. At this point, participants will come into the clinic about every 3 months, or as determined by their physician for about one year.
  • While the study ends at 12 months after transplant, we would like to keep track of the participants medical condition for the rest of their life.

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients with hematologic malignancies including myelodysplastic syndrome (MDS), who are at a high risk of complications after myeloablative transplantation
  • Patients have a donor (both related and unrelated) who are mismatched according to protocol criteria
  • 18 years of age or older
  • Performance status 0-2
  • Life expectancy of > 100 days
  • Female subject is either post-menopausal or sterilized or willing to use an acceptable form of birth control
  • Male subject agrees to use an acceptable form of birth control

Exclusion Criteria:

  • Evidence of HIV infection
  • Total bilirubin > 2.0mg/dl that is due to hepatocellular dysfunction
  • Aspartate aminotransferase (AST) > 90
  • Known active hepatitis B or C
  • Serum creatinine > 2.0
  • Greater than or equal to Grade 2 peripheral neuropathy within 21 days of enrollment
  • Prior allogeneic stem cell transplant
  • Patients with myeloproliferative disease (e.g. myelofibrosis, essential thrombocythemia, polycythemia vera, chronic myeloid leukemia)
  • Myocardial infarction within 6 months prior to enrollment or has NYHA Class III or IV hear failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities
  • Hypersensitivity to Velcade, boron or mannitol
  • Pregnant or breast feeding
  • Patient has received other investigational drugs 14 days before enrollment
  • Serious medical or psychiatric illness
  • Another active solid tumor malignancy at the time of study entry
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00369226

United States, Massachusetts
Brigham and Women's Hospital
Boston, Massachusetts, United States, 02115
Dana-Farber Cancer Institute
Boston, Massachusetts, United States, 02115
Sponsors and Collaborators
Dana-Farber Cancer Institute
Brigham and Women's Hospital
Millennium Pharmaceuticals, Inc.
Principal Investigator: John Koreth, MD Dana-Farber Cance Institute
  More Information

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: John Koreth, MD, Principal Investigator, Dana-Farber Cancer Institute Identifier: NCT00369226     History of Changes
Other Study ID Numbers: 06-065
Study First Received: August 24, 2006
Results First Received: August 8, 2012
Last Updated: June 19, 2013

Keywords provided by Dana-Farber Cancer Institute:
Allogeneic Stem Cell Transplant

Additional relevant MeSH terms:
Graft vs Host Disease
Immune System Diseases
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Calcineurin Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Abortifacient Agents, Nonsteroidal
Abortifacient Agents
Reproductive Control Agents
Antimetabolites, Antineoplastic
Dermatologic Agents
Folic Acid Antagonists
Antirheumatic Agents
Nucleic Acid Synthesis Inhibitors processed this record on May 23, 2017