- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00054353
Reduced-Intensity Conditioning Followed By Donor Peripheral Blood Stem Cell Transplant in Treating Patients With Multiple Myeloma
Reduced-Intensity Allogeneic HSC Transplantation From HLA-Matched Related and Unrelated Donors for Patients With Multiple Myeloma - A Multi-Center Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
PRIMARY OBJECTIVES:
I. To evaluate the efficacy of this approach by determining the 1-year progression-free survival (PFS) and overall survival (OS).
II. To evaluate day 100 non-relapse mortality.
III. To determine the incidences of grades II-IV acute graft-versus-host disease (GVHD) and chronic extensive GVHD.
OUTLINE:
PREPARATIVE REGIMEN: Patients receive fludarabine phosphate intravenously (IV) over 30 minutes on days -5 to -3 and intermediate-dose melphalan IV over 15-20 minutes on day -2. Patients also undergo low-dose TBI on day 0.
TRANSPLANTATION: Patients undergo allogeneic PBSCT on day 0.
IMMUNOSUPPRESSION: Patients receive cyclosporine orally (PO) twice daily (BID) on days -3 to 80 with taper to day 180 (related donors) or on days -3 to 100 with taper to day 180 (unrelated donors). Patients also receive mycophenolate mofetil PO BID on days 0-27 (related donors) or thrice daily (TID) on days 0-40 with taper to day 96 (unrelated donors).
After completion of study treatment, patients are followed up at 3, 6, 12, 18, and 24 months, and then annually thereafter for 5 years.
Study Type
Enrollment (Actual)
Phase
- Phase 2
- Phase 1
Contacts and Locations
Study Locations
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-
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Torino, Italy, 10126
- University of Torino
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-
-
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Washington
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Seattle, Washington, United States, 98109
- Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Meet Salmon and Durie criteria for initial diagnosis of MM; transplant will be offered to patients with previously treated MM who meet one of the following criteria:
- Patient received at least one prior autologous or syngeneic hematopoietic SCT (HSCT) and now has progressive disease (PD) (greater than 25% increase in serum or urine paraprotein levels compared to best response status after autograft or appearance of new lytic bone lesions or plasmocytomas)
- Patient is not able to collect autologous PBSC due to poor marrow reserve (insufficient HSC-mobilization: < 2.5 x 10^6 cluster of differentiation [CD]34+ cells/kg); or contraindications to undergoing HSC-mobilization; patient now has PD and has received at least 4 cycles of standard chemotherapy (e.g. vincristine sulfate, doxorubicin hydrochloride, and dexamethasone [VAD]) in the past
- Patients must have the capacity to give informed consent
- DONOR: Human leukocyte antigen (HLA) genotypically identical sibling or phenotypically matched relative
DONOR: HLA phenotypically matched unrelated donor (according to Standard Practice HLA matching criteria)
- Matched for serologically recognized HLA-A or B or C antigens and at least five of six HLA-A or B or C alleles
- Matched for HLA DRB1 and DQB1 alleles (defined by high-resolution typing) at the allele level
- DONOR: Donor must consent to filgrastim (G-CSF) administration and leukapheresis for PBSC collection
- DONOR: Donor must have adequate veins for leukapheresis or agree to placement of a temporary central venous catheter
Exclusion Criteria:
- Karnofsky score < 60%
- Left ventricular ejection fraction < 40% or symptomatic heart failure; ejection fraction is required if age > 50 years or there is a history of anthracycline exposure or history of cardiac disease
- Patients with clinical or laboratory evidence of liver disease would be evaluated for the cause of liver disease, its clinical severity in terms of liver function, and the degree of portal hypertension; patients will be excluded if they are found to have fulminant liver failure, cirrhosis of the liver with evidence of portal hypertension, alcoholic hepatitis, esophageal varices, a history of bleeding esophageal varices, hepatic encephalopathy, uncorrectable hepatic synthetic dysfunction evinced by prolongation of the prothrombin time, ascites related to portal hypertension, bridging fibrosis, bacterial or fungal liver abscess, biliary obstruction, chronic viral hepatitis with total serum bilirubin > 3 mg/dL,or symptomatic biliary disease
- Diffusion capacity of carbon monoxide (DLCO) < 50% (corrected) or receiving continuous supplemental oxygen
- Creatinine clearance < 40 mL/min
- Patients with poorly controlled hypertension
- Seropositive for the human immunodeficiency virus (HIV)
- Patients with a history of non-hematologic malignancies (except non-melanoma skin cancers) currently in a complete remission, who are less than 5 years from the time of complete remission, and have a > 20% risk of disease recurrence
- Pregnancy or breastfeeding
- Fertile men or women unwilling to use contraceptive techniques during and for 12 months following treatment
Not fully recovered from previous high-dose therapy:
- Persistent mucositis and gastrointestinal symptoms requiring hyperalimentation and/or intravenous hydration
- On steroids for autologous/syngeneic GVHD
- On IV antibiotics for documented infections
- Cytomegalovirus (CMV)-antigenemia positive
- On ganciclovir or foscarnet for previous CMV reactivation/infection; off of this therapy for less than two weeks despite documented CMV-antigenemia- negativity (identification [ID] should be consulted if there is persistent CMV antigenemia post autograft)
- Ongoing radiotherapy
- Patients who meet any of these criteria may be discussed with the principal investigator for recommendations as to the timing of the allograft
- Patients with active bacterial or fungal infections unresponsive to medical therapy
- DONOR: Identical twin
- DONOR: Donors unwilling to donate PBSC
- DONOR: Pregnancy
- DONOR: Infection with HIV
- DONOR: Inability to achieve adequate venous access
- DONOR: Known allergy to G-CSF
- DONOR: Current serious systemic illness
- DONOR: Failure to meet Fred Hutchinson Cancer Research Center (FHCRC) criteria for stem cell donation
- DONOR: Age < 12 years
- DONOR: A positive anti-donor cytotoxic crossmatch is an absolute donor exclusion
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: NON_RANDOMIZED
- Interventional Model: SINGLE_GROUP
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Related Donor
PREPARATIVE REGIMEN: Patients receive fludarabine phosphate IV over 30 minutes on days -5 to -3 and intermediate-dose melphalan IV over 15-20 minutes on day -2. Patients also undergo low-dose TBI on day 0. TRANSPLANTATION: Patients undergo allogeneic PBSCT on day 0. IMMUNOSUPPRESSION: Patients receive cyclosporine PO BID on days -3 to 80 with taper to day 180 (related donors) or on days -3 to 100 with taper to day 180 (unrelated donors). Patients also receive mycophenolate mofetil PO BID on days 0-27 (related donors) or TID on days 0-40 with taper to day 96 (unrelated donors). |
Correlative studies
Given IV
Other Names:
Given IV
Other Names:
Undergo TBI
Other Names:
Given PO
Other Names:
Given PO
Other Names:
Undergo reduced-intensity allogeneic PBSCT
Undergo reduced-intensity allogeneic PBSCT
Other Names:
|
EXPERIMENTAL: Unrelated Donor
PREPARATIVE REGIMEN: Patients receive fludarabine phosphate IV over 30 minutes on days -5 to -3 and intermediate-dose melphalan IV over 15-20 minutes on day -2. Patients also undergo low-dose TBI on day 0. TRANSPLANTATION: Patients undergo allogeneic PBSCT on day 0. IMMUNOSUPPRESSION: Patients receive cyclosporine PO BID on days -3 to 80 with taper to day 180 (related donors) or on days -3 to 100 with taper to day 180 (unrelated donors). Patients also receive mycophenolate mofetil PO BID on days 0-27 (related donors) or TID on days 0-40 with taper to day 96 (unrelated donors). |
Correlative studies
Given IV
Other Names:
Given IV
Other Names:
Undergo TBI
Other Names:
Given PO
Other Names:
Given PO
Other Names:
Undergo reduced-intensity allogeneic PBSCT
Undergo reduced-intensity allogeneic PBSCT
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
PFS
Time Frame: At 1 year post-transplant
|
PFS will be calculated for all patients from the date of transplant until the time of progression, relapse, death, or the date the patient was last known to be in remission.
Progressive disease is defined as greater than 25% increase in serum or urine M proteins compared to best response status after autologous transplant and/or appearance of new lytic bone lesions or plasmocytomas.
|
At 1 year post-transplant
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Non-relapse Mortality
Time Frame: At day 100
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Early NRM will be monitored in a sequential fashion.
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At day 100
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Incidence of Acute GVHD (Grades III-IV)
Time Frame: Up to 5 years
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Number of patients with Grade III-IV acute GVHD post-transplant.
Severe GVHD will be monitored in a sequential fashion.
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Up to 5 years
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Incidence of Chronic (Extensive) GVHD
Time Frame: Up to 5 years
|
Number of subjects with chronic extensive GVHD post-transplant.
Severe GVHD will be monitored in a sequential fashion.
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Up to 5 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
OS
Time Frame: At 6 months and then every year thereafter, up to 5 years
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Number of subjects surviving.
OS will be estimated by the method of Kaplan and Meier.
Confidence intervals will be estimated.
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At 6 months and then every year thereafter, up to 5 years
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Engraftment
Time Frame: Up to 5 years
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Number of subjects who engrafted post-transplant.
Engraftment will be monitored in a sequential fashion.
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Up to 5 years
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Relapse Rate
Time Frame: Up to 5 years
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Number of subjects who relapsed after achieving CR post-transplant.
Relapse rate will be summarized using cumulative incidence estimates.
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Up to 5 years
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Response Rate
Time Frame: Up to 5 years
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Number of subjects who achieved CR post-transplant.
Response rate will be summarized using cumulative incidence estimates.
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Up to 5 years
|
Collaborators and Investigators
Sponsor
Collaborators
Study record dates
Study Major Dates
Study Start
Primary Completion (ACTUAL)
Study Completion (ACTUAL)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ESTIMATE)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Immune System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Lymphoproliferative Disorders
- Immunoproliferative Disorders
- Hematologic Diseases
- Hemorrhagic Disorders
- Hemostatic Disorders
- Paraproteinemias
- Blood Protein Disorders
- Multiple Myeloma
- Neoplasms, Plasma Cell
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Enzyme Inhibitors
- Antirheumatic Agents
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Myeloablative Agonists
- Dermatologic Agents
- Anti-Bacterial Agents
- Antibiotics, Antineoplastic
- Antifungal Agents
- Antitubercular Agents
- Antibiotics, Antitubercular
- Calcineurin Inhibitors
- Melphalan
- Fludarabine
- Fludarabine phosphate
- Mycophenolic Acid
- Cyclosporine
- Cyclosporins
Other Study ID Numbers
- 1743.00 (OTHER: Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium)
- P30CA015704 (U.S. NIH Grant/Contract)
- NCI-2011-00386 (REGISTRY: CTRP (Clinical Trial Reporting Program))
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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