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A Trial of Single Autologous Transplant With or Without Consolidation Therapy Versus Tandem Autologous Transplant With Lenalidomide Maintenance for Patients With Multiple Myeloma (BMT CTN 0702)


Phase 3
N/A
70 Years
Open (Enrolling)
Both
Multiple Myeloma

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Trial Information

A Trial of Single Autologous Transplant With or Without Consolidation Therapy Versus Tandem Autologous Transplant With Lenalidomide Maintenance for Patients With Multiple Myeloma (BMT CTN 0702)


The primary objective of the randomized trial is to compare three-year progression-free
survival (PFS) between the three treatment arms as a pairwise comparison. Mobilization
therapy will not be specified for the study. Randomization to three treatment arms will be
done prior to the first transplants. All patients will undergo a first autologous peripheral
blood stem cell (PBSC) transplant with high-dose melphalan (200 mg/m^2 IV) given on Day -2.
Upon recovery from the first transplant patients will receive either a second autologous
PBSC transplant with the same conditioning regimen as the first transplant or consolidation
therapy with RVD (lenalidomide 15 mg/day on Days 1-14, dexamethasone 40 mg on Days 1, 8 and
15, and bortezomib 1.3mg/m^2 on Days 1, 4, 8 and 11 of every 21 day cycle, patients will
receive four cycles) or maintenance with lenalidomide (15 mg daily). All patients will also
receive maintenance lenalidomide which will start after the second transplant, after the
first autologous transplant or after consolidation therapy depending on the treatment arm.
Maintenance therapy with lenalidomide will start at 10 mg daily for three months and
increase to 15 mg daily. The duration of maintenance will be three years in all treatment
arms.


Inclusion Criteria:



- Patients meeting the criteria for symptomatic multiple myeloma (MM).

- Patients who are 70 years of age, or younger, at time of enrollment.

- Patients who have received at least two cycles of any regimen as initial systemic
therapy and are within 2 - 12 months of the first dose of initial therapy.

- Cardiac function: left ventricular ejection fraction at rest greater than 40 percent.

- Hepatic: bilirubin less than 1.5x the upper limit of normal and ALT and AST less than
2.5x the upper limit of normal. (Patients who have been diagnosed with Gilbert's
Disease are allowed to exceed the defined bilirubin value of 1.5x the upper limit of
normal.)

- Renal: Creatinine clearance of grater than or equal to 40 mL/min, estimated or
calculated.

- Pulmonary: DLCO, FEV1, FVC grater than 50 percent of predicted value (corrected for
hemoglobin).

- Patients with an adequate autologous graft defined as a cryopreserved PBSC graft
containing greater than or equal to 4 x 10^6 CD34+ cells/kg patient weight. The graft
may not be CD34+ selected or otherwise manipulated to remove tumor or other cells.
The graft can be collected at the transplanting institution or by a referring center.
The autograft must be stored so that there are two products each containing at least
2 x 10^6 CD34+ cells/kg patient weight.

- Signed informed consent form.

Exclusion Criteria:

- Patients who never fulfill the criteria for symptomatic MM.

- Patients with purely non-secretory MM [absence of a monoclonal protein (M protein) in
serum as measured by electrophoresis and immunofixation and the absence of Bence
Jones protein in the urine defined by use of conventional electrophoresis and
immunofixation techniques]. Patients with light chain MM detected in the serum by
free light chain assay are eligible.

- Patients with plasma cell leukemia.

- Karnofsky performance score less than 70 percent.

- Patients with greater than grade 2 sensory neuropathy (CTCAE).

- Patients with uncontrolled bacterial, viral or fungal infections (currently taking
medication and progression of clinical symptoms).

- Patients seropositive for the human immunodeficiency virus (HIV).

- Myocardial infarction within 6 months prior to enrollment or has New York Heart
Association (NYHA) Class III or IV heart failure, uncontrolled angina, severe
uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute
ischemia or active conduction system abnormalities. Prior to study entry, any ECG
abnormality at Screening has to be documented by the investigator as not medically
relevant.

- Patient has hypersensitivity to bortezomib, boron or mannitol.

- Patient has received other investigational drugs with 14 days before enrollment.

- Patients with prior malignancies except resected basal cell carcinoma or treated
cervical carcinoma in situ. Cancer treated with curative intent less than 5 years
previously will not be allowed unless approved by the Protocol Officer or one of the
Protocol Chairs. Cancer treated with curative intent greater than 5 years previously
is allowed.

- Female patients who are pregnant (positive B-HCG) or breastfeeding.

- Females of childbearing potential (FCBP) or men who have sexual contact with FCBP
unwilling to use contraceptive techniques during the length of lenalidomide
maintenance therapy.

- Prior allograft or prior autograft.

- Patients who have received mid-intensity melphalan (greater than 50 mg IV) as part of
prior therapy.

- Patients unable or unwilling to provide informed consent.

- Prior organ transplant requiring immunosuppressive therapy.

- Patients with disease progression prior to enrollment.

- Patients who have received lenalidomide as initial therapy for MM and have
experienced toxicities resulting in treatment discontinuation.

- Patients who experienced thromboembolic events while on full anticoagulation during
prior therapy with lenalidomide or thalidomide.

- Patients unwilling to take DVT prophylaxis.

- Patients who cannot undergo an intervention in any treatment arm due to a priori
denial of medical costs coverage by third party payers.

- Patients unable to unwilling to return to the transplant center for their assigned
treatments.

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Three-year progression-free survival (PFS)

Outcome Description:

The primary objective of the randomized trial is to compare PFS between the two single transplant arms and between each single transplant arm and the tandem transplant arm.

Outcome Time Frame:

Measured at 3 years

Safety Issue:

Yes

Principal Investigator

Amrita Krishnan, MD

Investigator Role:

Study Chair

Investigator Affiliation:

City of Hope National Medical Center

Authority:

United States: Food and Drug Administration

Study ID:

690

NCT ID:

NCT01109004

Start Date:

May 2010

Completion Date:

May 2020

Related Keywords:

  • Multiple Myeloma
  • Symptomatic multiple myeloma
  • Multiple Myeloma
  • Neoplasms, Plasma Cell

Name

Location

Arizona Cancer Center Tucson, Arizona  85724
Fred Hutchinson Cancer Research Center Seattle, Washington  98109
Memorial Sloan-Kettering Cancer Center New York, New York  10021
University of Iowa Hospitals and Clinics Iowa City, Iowa  52242
University of Pennsylvania Cancer Center Philadelphia, Pennsylvania  19104
Geisinger Medical Center Danville, Pennsylvania  17822-0001
Medical College of Wisconsin Milwaukee, Wisconsin  53226
University Hospitals of Cleveland Cleveland, Ohio  44106
Rush University Medical Center Chicago, Illinois  60612-3824
Cedars-Sinai Medical Center Los Angeles, California  90048
North Shore University Hospital Manhasset, New York  11030
University of Rochester Medical Center Rochester, New York  14642
University of Nebraska Medical Center Omaha, Nebraska  68198-3330
Hackensack University Medical Center Hackensack, New Jersey  07601
Florida Hospital Cancer Institute Orlando, Florida  32804
Thompson Cancer Survival Center Knoxville, Tennessee  37916
Mount Sinai Medical Center New York, New York  10029
Montefiore Medical Center Bronx, New York  10467-2490
City of Hope National Medical Center Los Angeles, California  91010
Cancer Centers of the Carolinas Greenville, South Carolina  29605
Vanderbilt University Medical Center Nashville, Tennessee  37232-2516
University of Oklahoma Oklahoma City, Oklahoma  73190
University of Minnesota Minneapolis, Minnesota  55455
University of California, San Francisco San Francisco, California  94143
Oregon Health & Science University Portland, Oregon  97201
Duke University Medical Center Durham, North Carolina  27710
University of Michigan Medical Center Ann Arbor, Michigan  48104-0914
SUNY Upstate Medical University Syracuse, New York  13210
H. Lee Moffitt Cancer Center Tampa, Florida  33612
University of Wisconsin Hospital & Clinics Madison, Wisconsin  53792
Roswell Park Cancer Center Buffalo, New York  14263
Louisiana State University Health Sciences Center Shreveport, Louisiana  71130
University of Chicago Chicago, Illinois  60637
University of Texas Southwestern Medical Center Dallas, Texas  
University of Kentucky Lexington, Kentucky  40536-0098
Wichita CCOP Wichita, Kansas  67214-3882
Texas Transplant Institute San Antonio, Texas  78229
University of California, San Diego Medical Center San Diego, California  
University of Miami Miami, Florida  33136
St. Louis University St. Louis, Missouri  63110
Stanford Hospital and Clinics Stanford, California  94305
Karmanos Cancer Institute/BMT Detroit, Michigan  48201
Wake Forest University Health Sciences Winston-Salem, North Carolina  27157
University of Kansas Hospital Kansas City, Kansas  66160
University of Oklahoma Medical Center Oklahoma City, Oklahoma  73104
Baylor College of Medicine/The Methodist Hospital Houston, Texas  77030-2399
Columbia River Oncology Program Portland, Oregon  97225
University of Illinois Chicago, Illinois  60612
Blood and Marrow Transplant Program at Northside Hospital Atlanta, Georgia  30342
Advocate Lutheran General Hospital Park Ridge, Illinois  60068
University of Texas, MD Anderson CRC Houston, Texas  77030
St. Lukes Mountain States Tumor Institute Boise, Idaho  83712
University of North Carolina Hospital at Chapel Hill Chapel Hill, North Carolina  27599
West Virginia University Hospital Morgantown, West Virginia  26506-9162
University of Florida College of Medicine Gainesville, Florida  32610
Colorado Blood Cancer Institute Denver, Colorado  80218
Christiana Care Health System Newark, Delaware  19713
DFCI, Massachusetts General Hospital Boston, Massachusetts  02114
Washington University, Barnes Jewish Hospital St. Louis, Missouri  63110
Georgia Health Sciences University Augusta, Georgia  30912
Jewish Hospital BMT Program Cincinnati, Ohio  45236
Banner Research Institute Phoenix, Arizona  85006
Lahey Clinic Burlington, Maine  01805
DFCI, Brigham and Womens Hospital Boston, Massachusetts  02114
Ohio State Columbus, Ohio  43210
Penn State College of Medicine, The Milton S. Hershey Medical Center Hershey, Pennsylvania  17033
VA Tennessee Valley Healthcare Nashville, Tennessee  53792-5156
Sarah Cannon Blood & Marrow Transplant Program Nashville, Tennessee  37203