Autologous or Syngeneic Stem Cell Transplant Followed by Donor Stem Cell Transplant and Bortezomib in Treating Patients With Newly Diagnosed High-Risk, Relapsed, or Refractory Multiple Myeloma
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|ClinicalTrials.gov Identifier: NCT00793572|
Recruitment Status : Active, not recruiting
First Posted : November 19, 2008
Results First Posted : May 18, 2017
Last Update Posted : June 23, 2017
|Condition or disease||Intervention/treatment||Phase|
|Refractory Plasma Cell Myeloma||Procedure: Autologous Hematopoietic Stem Cell Transplantation Drug: Bortezomib Drug: Cyclosporine Drug: Fludarabine Phosphate Other: Laboratory Biomarker Analysis Drug: Melphalan Drug: Mycophenolate Mofetil Procedure: Nonmyeloablative Allogeneic Hematopoietic Stem Cell Transplantation Procedure: Peripheral Blood Stem Cell Transplantation Procedure: Syngeneic Bone Marrow Transplantation Radiation: Total-Body Irradiation||Phase 2|
I. Progression-free survival (PFS) at 2 years after the autograft (=< 50% in historic controls).
I. Overall survival (OS) at 2 years after the autograft.
II. Non-relapse mortality (NRM) at 200 days and 1 year after allograft.
III. Incidence of grades II-IV acute graft-versus-host-disease (GVHD) and chronic extensive GVHD.
IV. Safety of bortezomib maintenance therapy after stem cell transplantation.
PERIPHERAL BLOOD STEM CELL (PBSC) MOBILIZATION: Patients undergo PBSC mobilization and collection using the preferred regimens at the participating institution.
CONDITIONING CHEMOTHERAPY AND AUTOLOGOUS OR SYNGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT): Patients receive high-dose melphalan intravenously (IV) on day -2 followed by an autologous or syngeneic HSCT on day 0.
NON-MYELOABLATIVE ALLOGENEIC HSCT: Beginning 40-180 days after autologous HSCT, patients receive 1 of the following regimens:
- HLA-IDENTICAL RELATED DONOR: Patients receive cyclosporine IV or orally (PO) twice daily (BID) starting on days -3 to 56, and taper until day 180. Patients then undergo total-body irradiation (TBI) and non-myeloablative allogeneic HSCT on day 0. Four to six hours after completion of allogeneic HSCT, patients receive mycophenolate mofetil (MMF) PO BID on days 0-27.
- HLA-UNRELATED DONOR: Patients receive fludarabine phosphate IV on days -4 to -2. Patients also receive cyclosporine IV or PO BID starting on days -3 to 100 and taper until day 180. Patients then undergo TBI and non-myeloablative allogeneic HSCT on day 0. Four to six hours after completion of allogeneic HSCT, patients receive MMF PO thrice daily (TID) on days 0-27 and then BID on days 27-40 with taper of MMF on days 40-96.
MAINTENANCE THERAPY: Beginning 60-120 days after allogeneic HSCT, patients receive bortezomib subcutaneously (SC) on days 1 and 4 of 14-day cycles for 9 months or for up to 18 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for 1 year and then annually for up to 5 years.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||32 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Tandem Autologous HCT/Nonmyeloablative Allogeneic HCT From HLA-Matched Related and Unrelated Donors Followed by Bortezomib Maintenance Therapy for Patients With High-Risk Multiple Myeloma|
|Study Start Date :||October 2008|
|Actual Primary Completion Date :||October 2016|
Experimental: Tandem Auto-/Nonmyeloablative Allo-HCT and Maintenance Therapy
See Detailed Description
Procedure: Autologous Hematopoietic Stem Cell Transplantation
Other Name: Autologous Stem Cell TransplantationDrug: Bortezomib
Other Names:Drug: Cyclosporine
Other Names:Drug: Cyclosporine
Other Names:Drug: Fludarabine Phosphate
Other Names:Other: Laboratory Biomarker Analysis
Correlative studiesDrug: Melphalan
Other Names:Drug: Mycophenolate Mofetil
Other Names:Procedure: Nonmyeloablative Allogeneic Hematopoietic Stem Cell Transplantation
Other Names:Procedure: Peripheral Blood Stem Cell Transplantation
Other Names:Procedure: Syngeneic Bone Marrow Transplantation
Undergo transplantationRadiation: Total-Body Irradiation
- Progression-free Survival [ Time Frame: At 2 years after the autograft ]
Confidence intervals will be estimated.
- Greater than 25% increase in serum (absolute increase must be ≥0.5 g/dL) or urine (absolute increase must be ≥200 mg/24h) M proteins compared to best response status after autologous transplant.
- Appearance of new lytic bone lesions or plasmacytomas.
- Incidence of Grades II-IV Acute GVHD [ Time Frame: 100 days post allo ]Confidence intervals will be estimated.
- Incidence of Chronic GVHD [ Time Frame: 1 year post allo ]Confidence intervals will be estimated.
- Incidence of Toxicities Related to Bortezomib Maintenance Therapy After the Stem Cell Transplantation [ Time Frame: Up to 100 days after the autograft or allograft ]Confidence intervals will be estimated.
- Non-relapse Mortality [ Time Frame: 200 and 365 days after allo ]Confidence intervals will be estimated. Assessed at 200 days and 1 year after allograft.
- OS [ Time Frame: At 2 years after the autograft ]Estimated by the method of Kaplan and Meier. Confidence intervals will be estimated.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00793572
|United States, Washington|
|Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium|
|Seattle, Washington, United States, 98109|
|Principal Investigator:||Marco Mielcarek||Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium|