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Melphalan, Bortezomib, and Stem Cell Transplant in Treating Patients With Primary Systemic Amyloidosis

This study has been completed.
Information provided by (Responsible Party):
Vaishali Sanchorawala, Boston Medical Center Identifier:
First received: November 12, 2008
Last updated: January 14, 2016
Last verified: March 2015

RATIONALE: Giving melphalan and bortezomib before and after a stem cell transplant stops the growth of abnormal cells by stopping them from dividing or killing them. Giving colony-stimulating factors, such as G-CSF, and certain chemotherapy drugs, helps stem cells move from the bone marrow to the blood so they can be collected and stored. Chemotherapy and monoclonal antibody therapy is then given to prepare the bone marrow for the stem cell transplant. The stem cells are then returned to the patient to replace the blood-forming cells that were destroyed by the chemotherapy.

PURPOSE: This phase II trial is studying how well giving melphalan together with bortezomib followed by stem cell transplant works in treating patients with primary systemic amyloidosis.

Condition Intervention Phase
Multiple Myeloma
Biological: filgrastim
Drug: bortezomib
Drug: melphalan
Procedure: Stem Cell Infusion
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase II Trial of High-dose Melphalan and Bortezomib and Stem Cell Transplantation in Patients With AL Amyloidosis

Resource links provided by NLM:

Further study details as provided by Boston Medical Center:

Primary Outcome Measures:
  • Hematologic response (complete and partial) [ Time Frame: one year ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Tolerability [ Time Frame: 100 Days from transplant date ] [ Designated as safety issue: Yes ]
  • Survival at 1 and 2 years [ Time Frame: year one and two ] [ Designated as safety issue: No ]

Enrollment: 10
Study Start Date: June 2008
Study Completion Date: November 2014
Primary Completion Date: December 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: SCT with Bortezomib and Melphalan
Mobilization with Filgrastim Stem Cell Collection Bortezomib Melphalan Stem Cell infusion
Biological: filgrastim
16 mcg/kg daily beginning 3 days before SCC through day before final SCC
Other Name: G-CSF, neupogen
Drug: bortezomib
1.0 mg/m2/dose D -6, D-3, D +1, D + 4
Other Name: velcade
Drug: melphalan
100 mg/m2/dose D -2, D -1
Other Name: alkeran
Procedure: Stem Cell Infusion
infusion of previously collected autologous stem cells

Detailed Description:


  • To determine if hematologic responses to high-dose melphalan and autologous stem cell transplantation increase with addition of bortezomib in the conditioning regimen in patients with primary systemic amyloidosis.


  • Autologous stem cell mobilization and collection: Patients receive filgrastim (G-CSF) to mobilize stem cells, which are then collected.
  • Conditioning regimen: Patients receive bortezomib IV on days -6, -3, 1, and 4 and oral high-dose melphalan on days -2 and -1.
  • Stem cell transplantation: Patients undergo autologous stem cell transplantation on day 0.

After completion of study therapy, patients are followed every 6 months for 1 year and annually thereafter.


Ages Eligible for Study:   18 Years to 65 Years   (Adult)
Genders Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion criteria:


  • Histologically confirmed primary systemic amyloidosis based on the following criteria:

    • Amyloid light-chain disease
    • Deposition of amyloid material by congo red stain showing characteristic green birefringence
    • Monoclonal light chain protein (Bence Jones protein) in the serum or urine, immunohistochemical studies, or serum free light chain assay
    • Evidence of tissue involvement other than carpal tunnel syndrome (i.e., positive immunohistochemical staining of bone marrow demonstrating clonal plasma cells); tissue amyloid deposits with anti-kappa or anti-lambda anti-serum; evidence for a PCD by serum/urine or bone marrow; or overwhelmingly convincing clinical features (e.g., macroglossia) associated with other systemic manifestations


  • SWOG performance status 0-1
  • Fertile patients must use effective contraception
  • LVEF ≥ 45% by ECHO within the past 60 days
  • DLCO ≥ 50%


  • Prior chemotherapy with alkylating agent allowed provided there is no morphological or cytogenetic evidence of myelodysplastic syndromes
  • Prior total cumulative dose of oral melphalan < 300 mg
  • At least 4 weeks since prior cytotoxic therapy and fully recovered

Exclusion criteria:

  • No senile, secondary, localized, dialysis-related, or familial amyloidosis
  • No overt multiple myeloma (> 30% of bone marrow plasmacytosis, extensive [> 2] lytic lesions, or hypercalcemia)
  • Not pregnant or nursing
  • No myocardial infarction within the past 6 months, congestive heart failure, or arrhythmia refractory to therapy
  • No prior malignancy except for any of the following:

    • Adequately treated basal cell or squamous cell skin cancer
    • In situ cervical cancer
    • Adequately treated stage I or II cancer currently in complete remission
    • Any cancer from which the patient has been disease-free ≥ 5 years
  • No advanced (grade 3-4) pre-existing neuropathy
  • No HIV positivity
  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: NCT00790647

United States, Massachusetts
Boston University Cancer Research Center
Boston, Massachusetts, United States, 02118
Sponsors and Collaborators
Boston Medical Center
Principal Investigator: Vaishali Sanchorawala, MD Boston Medical Center
  More Information

Responsible Party: Vaishali Sanchorawala, Principal Investigator, Boston Medical Center Identifier: NCT00790647     History of Changes
Other Study ID Numbers: CDR0000618857  BUMC-H-27277 
Study First Received: November 12, 2008
Last Updated: January 14, 2016
Health Authority: United States: Food and Drug Administration

Keywords provided by Boston Medical Center:
primary systemic amyloidosis

Additional relevant MeSH terms:
Multiple Myeloma
Neoplasms, Plasma Cell
Neoplasms by Histologic Type
Hemostatic Disorders
Vascular Diseases
Cardiovascular Diseases
Blood Protein Disorders
Hematologic Diseases
Hemorrhagic Disorders
Lymphoproliferative Disorders
Immunoproliferative Disorders
Immune System Diseases
Proteostasis Deficiencies
Metabolic Diseases
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Adjuvants, Immunologic processed this record on January 17, 2017