Anti-thymocyte Globulin and Melphalan in Treating Patients With Relapsed Multiple Myeloma

This study has been terminated.
(Due to competing trials, this study is permanenlty closed to patient acrrual.)
National Cancer Institute (NCI)
Information provided by:
Mayo Clinic Identifier:
First received: March 12, 2008
Last updated: August 19, 2011
Last verified: August 2011

RATIONALE: Biological therapies, such as anti-thymocyte globulin, may stimulate the immune system in different ways and stop cancer cells from growing. Drugs used in chemotherapy, such as melphalan, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Anti-thymocyte globulin may also make cancer cells more sensitive to melphalan. Giving anti-thymocyte globulin together with melphalan may kill more cancer cells.

PURPOSE: This phase II trial is studying how well giving anti-thymocyte globulin together with melphalan works in treating patients with relapsed multiple myeloma.

Condition Intervention Phase
Multiple Myeloma and Plasma Cell Neoplasm
Biological: anti-thymocyte globulin
Drug: melphalan
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase II Trial of Thymoglobulin and Melphalan in Patients With Relapsed Multiple Myeloma

Resource links provided by NLM:

Further study details as provided by Mayo Clinic:

Primary Outcome Measures:
  • Hematological Response Rate Defined as the Number of Participants Who Achieve a Confirmed Response [ Time Frame: 4 months ] [ Designated as safety issue: No ]

    Response that was confirmed on 2 consecutive evaluations during the first 4 months of treatment.

    Complete Response(CR): Disappearance of M-protein from serum and urine, normalization of Free Light Chain (FLC) ratio and <5% plasma cells in bone marrow.

    Very Good Partial Response(VGPR): >=90% reduction in serum M-component; Urine M-Component <100mg per 24hours.

    Partial Response(PR): >=50% reduction in serum M-component and/or Urine M-Component >=90% reduction or <200mg per 24hours; or >=50% decrease in difference between involved and uninvolved FLC levels.

Secondary Outcome Measures:
  • Overall Survival (OS) [ Time Frame: up to 2 years ] [ Designated as safety issue: No ]
    OS was defined as the time from registration to death of any cause.

  • Progression-free Survival (PFS) [ Time Frame: up to 2 years ] [ Designated as safety issue: No ]

    PFS was defined as the time from registration to progression or death due to any cause.

    Progression was defined as any one or more of the following:

    An increase of 25% from lowest confirmed response in:

    • Serum M-component (absolute increase >= 0.5g/dl)
    • Urine M-component (absolute increase >= 200mg/24hour
    • Difference between involved and uninvolved Free Light Chain levels (absolute increase >= 10mg/dl)
    • Bone marrow plasma cell percentage (absolute increase of >=10%)
    • Definite development of new bone lesion or soft tissue plasmacytomas

  • Duration of Response (DOR) [ Time Frame: up to 2 years ] [ Designated as safety issue: No ]
    DOR was calculated from the documentation of response (CR, VGPR or PR) until the date of progression in the subset of patients who responded.

  • Number of Participants With Severe Non-hematological Adverse Events [ Time Frame: every month during treatment, up to 12 months ] [ Designated as safety issue: Yes ]
    Severe non-hematologic adverse events were defined as adverse events grade 3 or higher, regardless of attribution to study drug. Adverse events were graded according to the National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTCAE version 3.0)

Enrollment: 1
Study Start Date: May 2008
Study Completion Date: November 2010
Primary Completion Date: July 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Anti-thymocyte Globulin/Melphalan
Anti-thymocyte Globulin (2.5 mg/Kg)and Melphalan (16 mg/m^2)
Biological: anti-thymocyte globulin
2.5 mg/kg
Drug: melphalan
16 mg/m^2

Detailed Description:



* To evaluate the hematological response rate of anti-thymocyte globulin given in combination with melphalan in patients with relapsed multiple myeloma.


  • To assess the toxicity and tolerability of this combination in these patients.
  • To assess time to disease progression in patients treated with these drugs.
  • To assess survival of patients treated with these drugs. OUTLINE: Patients receive anti-thymocyte globulin IV over 6 hours and melphalan IV on day 1. Treatment repeats every 28 days for 6 courses. Patients then receive melphalan alone as above for another 6 courses. Treatment continues in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed every 3 months until disease progression and then every 6 months for up to 2 years.


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


  • Diagnosis of multiple myeloma

    - Relapsed disease

  • Must not be a candidate for stem cell transplantation, has refused transplantation, or has had stem cells collected previously
  • Measurable disease, defined by ≥ 1 of the following:

    • Serum monoclonal protein ≥ 1.0 g by protein electrophoresis
    • More than 200 mg of monoclonal protein in the urine on 24 hour electrophoresis
    • Serum immunoglobulin free light chain ≥ 10 mg/dL AND abnormal serum immunoglobulin kappa to lambda free light chain ratio
    • Monoclonal bone marrow plasmacytosis ≥ 30% (evaluable disease)


  • Eastern Cooperative Oncology Group (ECOG) performance status 0-3
  • Absolute neutrophil count ≥ 1,000/μL
  • Platelet count ≥ 75,000/μL
  • Hemoglobin ≥ 8.0 g/dL
  • CD4 > 100/μL
  • Creatinine ≤ 3 mg/dL
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • No active malignancy with the exception of nonmelanoma skin cancer or in situ cervical or breast cancer
  • No uncontrolled infection
  • No other co-morbidity that would interfere with patient's ability to participate in trial


  • No limit to prior therapy
  • At least 4 weeks since prior melphalan or other myelosuppressive agents
  • At least 2 weeks since prior non-myelosuppressive agents (e.g., thalidomide or high-dose corticosteroids)
  • No concurrent high-dose corticosteroids

    • Concurrent chronic steroids (maximum dose 20 mg/day prednisone equivalent) allowed if they are being given for disorders other than amyloid (e.g., adrenal insufficiency or rheumatoid arthritis)
    • Concurrent continuation of low level/stable steroid doses for replacement or inhalation therapy allowed
  • Concurrent bisphosphonates allowed
  • No concurrent immunosuppressive medications such as cyclosporine
  • No other concurrent investigational treatment
  • No concurrent cytotoxic chemotherapy or external-beam radiotherapy>
  • No other concurrent systemic anti-neoplastic therapy including, but not limited to, immunotherapy, hormonal therapy, or monoclonal antibody therapy
  • No concurrent prophylactic hematopoietic growth factors (unless for treatment of an established cytopenia)
  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: NCT00635024

United States, Minnesota
Mayo Clinic
Rochester, Minnesota, United States, 55905
Sponsors and Collaborators
Mayo Clinic
National Cancer Institute (NCI)
Study Chair: Shaji K. Kumar, MD Mayo Clinic
  More Information

Responsible Party: Shaji K. Kumar, Mayo Clinic Cancer Center Identifier: NCT00635024     History of Changes
Other Study ID Numbers: CDR0000589032  P30CA015083  MC0687  06-005792 
Study First Received: March 12, 2008
Results First Received: August 27, 2010
Last Updated: August 19, 2011
Health Authority: United States: Food and Drug Administration

Keywords provided by Mayo Clinic:
refractory multiple myeloma
stage I multiple myeloma
stage II multiple myeloma
stage III multiple myeloma

Additional relevant MeSH terms:
Multiple Myeloma
Neoplasms, Plasma Cell
Blood Protein Disorders
Cardiovascular Diseases
Hematologic Diseases
Hemorrhagic Disorders
Hemostatic Disorders
Immune System Diseases
Immunoproliferative Disorders
Lymphoproliferative Disorders
Neoplasms by Histologic Type
Vascular Diseases
Antilymphocyte Serum
Alkylating Agents
Antineoplastic Agents
Antineoplastic Agents, Alkylating
Immunologic Factors
Immunosuppressive Agents
Molecular Mechanisms of Pharmacological Action
Myeloablative Agonists
Physiological Effects of Drugs processed this record on May 26, 2016