Now Available: Final Rule for FDAAA 801 and NIH Policy on Clinical Trial Reporting

High-Dose Melphalan and a Second Stem Cell Transplant or Low-Dose Cyclophosphamide in Treating Patients With Relapsed Multiple Myeloma After Chemotherapy

The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.
Verified June 2009 by National Cancer Institute (NCI).
Recruitment status was:  Recruiting
Information provided by:
National Cancer Institute (NCI) Identifier:
First received: September 4, 2008
Last updated: August 9, 2013
Last verified: June 2009

RATIONALE: Giving chemotherapy and bortezomib before a peripheral stem cell transplant stops the growth of cancer 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 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 and bortezomib. It is not yet known whether high-dose melphalan given together with a second stem cell transplant is more effective than low-dose cyclophosphamide in treating patients with relapsed multiple myeloma.

PURPOSE: This randomized phase III trial is studying giving high-dose melphalan together with a second stem cell transplant to see how well it works compared with low-dose cyclophosphamide in treating patients with relapsed multiple myeloma after chemotherapy.

Condition Intervention Phase
Multiple Myeloma and Plasma Cell Neoplasm
Drug: cyclophosphamide
Drug: melphalan
Procedure: autologous hematopoietic stem cell transplantation
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Masking: Open Label
Primary Purpose: Treatment
Official Title: Myeloma X Relapse (Intensive): A Phase III Study to Determine the Role of a Second Autologous Stem Cell Transplant as Consolidation Therapy in Patients With Relapsed Multiple Myeloma Following Prior High-dose Chemotherapy and Autologous Stem Cell Rescue.

Resource links provided by NLM:

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Time to disease progression [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Response rate to bortezomib, doxorubicin hydrochloride, and dexamethasone (PAD) [ Designated as safety issue: No ]
  • Overall response rate following randomized treatments [ Designated as safety issue: No ]
  • Overall survival [ Designated as safety issue: No ]
  • Progression-free survival [ Designated as safety issue: No ]
  • Toxicity and safety of autologous stem cell transplantation [ Designated as safety issue: Yes ]
  • Toxicity and safety of weekly cyclophosphamide [ Designated as safety issue: Yes ]
  • Toxicity and safety of PAD therapy [ Designated as safety issue: Yes ]
  • Feasibility of stem cell collection [ Designated as safety issue: No ]
  • Pain [ Designated as safety issue: No ]
  • Quality of life [ Designated as safety issue: No ]

Estimated Enrollment: 460
Study Start Date: April 2008
Estimated Primary Completion Date: April 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm I
Patients receive high-dose melphalan IV on day -1 followed by autologous stem cell transplantation (ASCT) on day 0.
Drug: melphalan
Given IV
Procedure: autologous hematopoietic stem cell transplantation
Patients undergo autologous hematopoietic stem cell transplantation on day 0.
Experimental: Arm II
Patients receive low-dose cyclophosphamide IV or orally once a week for 12-20 weeks for a total of 12 courses.
Drug: cyclophosphamide
Given orally

Detailed Description:



  • To determine the effect on freedom from disease progression in patients with relapsed multiple myeloma treated with re-induction therapy comprising bortezomib, doxorubicin hydrochloride, and dexamethasone (PAD) followed by a second autologous stem cell transplantation (ASCT) with high-dose melphalan vs low-dose cyclophosphamide consolidation therapy.


  • To assess the response rate of PAD in patients following a previous autograft.
  • To compare the overall response rate of patients following high-dose melphalan chemotherapy and autologous stem cell transplantation with low-dose cyclophosphamide consolidation therapy.
  • To assess the overall survival of patients treated with this regimen.
  • To assess the safety and toxicity of a second ASCT in these patients.
  • To assess the safety and toxicity of PAD in these patients.
  • To assess the feasibility of stem cell collection following PAD in these patients.
  • To determine the impact of this regimen on pain and quality of life in these patients.

OUTLINE: This is a multicenter study.

  • Re-induction (PAD) therapy: Patients receive bortezomib IV on days 1, 4, 8, and 11, doxorubicin hydrochloride IV continuously on days 1-4, and oral dexamethasone on days 1-4 (and days 8-11 and 15-18 of course 1 only). Treatment repeats every 21 days for up to 4 courses in the absence of disease progression or unacceptable toxicity.
  • Peripheral blood stem cell (PBSC) mobilization and harvest: Within 6-12 weeks, some patients receive cyclophosphamide IV on day 0 and filgrastim (G-CSF) subcutaneously (SC) beginning on day 1 and continuing to time of PBSC harvest. PBSCs are then collected.

Patients who successfully complete re-induction therapy and have adequate PBSC mobilization are stratified according to length of first remission or plateau (≤ vs ≥ 24 months) and response to PAD re-induction therapy (stable disease vs ≥ partial response). Patients are randomized to 1 of 2 arms.

  • Arm I (high-dose melphalan consolidation therapy): Patients receive high-dose melphalan IV on day -1 followed by autologous stem cell transplantation (ASCT) on day 0.
  • Arm II (low-dose cyclophosphamide consolidation therapy): Patients receive low-dose cyclophosphamide IV or orally once a week for 12-20 weeks for a total of 12 courses.

Patients complete the EORTC QLQ-C30 and EORTC QLQ-MY20, the Brief Pain Inventory Short Form (BPI-SF), and the Leeds Assessment of Neuropathic Symptoms and Signs (Self Assessment) Pain Scale (S-LANSS) questionnaires at baseline and after completion of re-induction therapy.

Patients are followed monthly for up to 100 days after ASCT or at 30 days after low-dose cyclophosphamide and then every 3 months for 5 years.


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


  • Diagnosis of relapsed multiple myeloma

    • Symptomatic disease, including non-secretory
  • Previously treated with standard chemotherapy and autologous stem cell transplantation
  • Requires therapy for first progressive disease AND at least 18 months since first stem cell transplantation

    • Patients who were previously immunofixation-negative and are now immunofixation-positive must have > 5 g/L absolute increase in paraprotein
  • Registered in the Myeloma X Relapse (Intensive) Trial and received 2-4 courses of PAD re-induction chemotherapy according to the protocol (consolidation phase)
  • Adequate stem cell mobilization available for transplantation defined as ≥ 2x10^6 CD34 + cells/kg or ≥ 2x10^8 PBMC/kg including cells stored from a previous harvest (consolidation phase)


  • ECOG performance status 0-2
  • ANC ≥ 1 x 10^9/L
  • Platelet count ≥ 50 x 10^9/L
  • Creatinine clearance ≥ 30 mL/min
  • Total bilirubin < 2 times upper limit of normal (ULN)
  • ALT or AST < 2.5 times ULN
  • History of pulmonary disease allowed provided carbon monoxide diffusion in the lungs (KCO/DLCO) is ≥ 50% and/or no requirement for supplementary continuous oxygen
  • Left ventricular ejection fraction ≥ 40% by ECG or MUGA scan
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 6 months after completion of study treatment
  • No peripheral neuropathy ≥ grade 2
  • No known HIV or Hepatitis B or C positivity (testing is not required)
  • No known resistance to combined bortezomib, doxorubicin hydrochloride, and dexamethasone therapy
  • No known history of allergy to compounds containing boron or mannitol
  • No other previous or concurrent malignancies except for appropriately treated localized epithelial skin cancer or carcinoma in situ of the cervix, or remote histories of other cured tumors within the past 5 years
  • No medical or psychiatric condition which, in the opinion of the investigator, contraindicates the patient's participation in the study
  • No other contra-indication to treatment that would make the patient ineligible for consolidation phase


  • See Disease Characteristics
  • No other prior therapy for relapsed disease except for local radiotherapy, therapeutic plasma exchange, or ≤ 200 mg of dexamethasone

    • Radiotherapy since prior transplantation sufficient to alleviate or control pain of local invasion is permitted
  • No hemi-body radiation since prior transplantation (consolidation phase)
  • At least 4 weeks since prior and no concurrent investigational drugs
  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: NCT00747877

  Hide Study Locations
United Kingdom
Basingstoke and North Hampshire NHS Foundation Trust
Basingstoke, England, United Kingdom, RG24 9NA
Queen Elizabeth Hospital at University Hospital of Birmingham NHS Trust
Birmingham, England, United Kingdom, B15 2TH
Birmingham Heartlands Hospital
Birmingham, England, United Kingdom, B9 5SS
Royal Bournemouth Hospital
Bournemouth, England, United Kingdom, BH7 7DW
Bradford Royal Infirmary
Bradford, England, United Kingdom, BD9 6RJ
Frenchay Hospital
Bristol, England, United Kingdom, BS16 1LE
Bristol Haematology and Oncology Centre
Bristol, England, United Kingdom, BS2 8ED
Addenbrooke's Hospital
Cambridge, England, United Kingdom, CB2 2QQ
St. Helier Hospital
Carshalton, England, United Kingdom, SM5 1AA
Gloucestershire Oncology Centre at Cheltenham General Hospital
Cheltenham, England, United Kingdom, GL53 7AN
Saint Richards Hospital
Chichester, England, United Kingdom, P019 4SE
Colchester General Hospital
Colchester, England, United Kingdom, CO4 5JL
Dorset County Hospital
Dorchester, England, United Kingdom, DT1 2JY
Russells Hall Hospital
Dudley, England, United Kingdom, DY1 2HQ
Royal Devon and Exeter Hospital
Exeter, England, United Kingdom, EX2 5DW
Gloucestershire Royal Hospital
Gloucester, England, United Kingdom, GL1 3NN
Ipswich Hospital
Ipswich, England, United Kingdom, IP4 5PD
Leeds Cancer Centre at St. James's University Hospital
Leeds, England, United Kingdom, LS9 7TF
Royal Liverpool University Hospital
Liverpool, England, United Kingdom, L7 8XP
Aintree University Hospital
Liverpool, England, United Kingdom, L9 7AL
Saint Bartholomew's Hospital
London, England, United Kingdom, EC1A 7BE
Guy's Hospital
London, England, United Kingdom, SE1 9RT
King's College Hospital
London, England, United Kingdom, SE5 9RS
St. George's Hospital
London, England, United Kingdom, SW17 0QT
University College of London Hospitals
London, England, United Kingdom, WIT 3AA
Manchester Royal Infirmary
Manchester, England, United Kingdom, M13 9WL
Christie Hospital
Manchester, England, United Kingdom, M20 4BX
James Cook University Hospital
Middlesbrough, England, United Kingdom, TS4 3BW
Royal Victoria Infirmary
Newcastle-Upon-Tyne, England, United Kingdom, NE1 4LP
Norfolk and Norwich University Hospital
Norwich, England, United Kingdom, NR4 7UY
Nottingham City Hospital
Nottingham, England, United Kingdom, NG5 1PB
Oxford Radcliffe Hospital
Oxford, England, United Kingdom, 0X3 9DU
Derriford Hospital
Plymouth, England, United Kingdom, PL6 8DH
Berkshire Cancer Centre at Royal Berkshire Hospital
Reading, England, United Kingdom, RG1 5AN
Rotherham General Hospital
Rotherham, England, United Kingdom, S60 2UD
Salisbury District Hospital
Salisbury, England, United Kingdom, SP2 8BJ
Royal Hallamshire Hospital
Sheffield, England, United Kingdom, S1O 2JF
Southampton General Hospital
Southampton, England, United Kingdom, SO16 6YD
Royal Marsden - Surrey
Sutton, England, United Kingdom, SM2 5PT
Musgrove Park Hospital
Taunton, England, United Kingdom, TA1 5DA
Torbay Hospital
Torquay, England, United Kingdom, TQ2 7AA
Arrowe Park Hospital
Wirral, England, United Kingdom, CH49 5PE
Belfast City Hospital Trust Incorporating Belvoir Park Hospital
Belfast, Northern Ireland, United Kingdom, BT8 8JR
Aberdeen Royal Infirmary
Aberdeen, Scotland, United Kingdom, AB25 2ZN
Ayr Hospital
Ayr, Scotland, United Kingdom, KA6 6DX
Ninewells Hospital
Dundee, Scotland, United Kingdom, DD1 9SY
Beatson West of Scotland Cancer Centre
Glasgow, Scotland, United Kingdom, G12 0YN
Raigmore Hospital
Inverness, Scotland, United Kingdom, 1V2 3UJ
Crosshouse Hospital
Kilmarnock, Scotland, United Kingdom, KA2 OBE
Pinderfields General Hospital
Wakefield, Scotland, United Kingdom, WF1 4DG
Ysbyty Gwynedd
Bangor, Wales, United Kingdom, LL57 2PW
Glan Clwyd Hospital
Rhyl, Denbighshire, Wales, United Kingdom, LL 18 5UJ
Singleton Hospital
Swansea, Wales, United Kingdom, SA2 8QA
Sponsors and Collaborators
Leeds Cancer Centre at St. James's University Hospital
Principal Investigator: Gordon Cook, MD, PhD Leeds Cancer Centre at St. James's University Hospital
  More Information

Publications automatically indexed to this study by Identifier (NCT Number): Identifier: NCT00747877     History of Changes
Other Study ID Numbers: LCC-HM05/7287  CDR0000612567  EU-20873  ISRCTN60123120  EudraCT-2006-005890-24 
Study First Received: September 4, 2008
Last Updated: August 9, 2013
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
stage II multiple myeloma
stage III multiple myeloma
refractory multiple myeloma
stage I multiple myeloma

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
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists processed this record on January 17, 2017