Stem Cell Transplant With Lenalidomide Maintenance in Patients With Multiple Myeloma (BMT CTN 0702)



Status:Completed
Conditions:Blood Cancer, Hematology
Therapuetic Areas:Hematology, Oncology
Healthy:No
Age Range:Any - 70
Updated:8/12/2018
Start Date:May 2010
End Date:March 3, 2018

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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)

The study is designed as a Phase III, multicenter trial of tandem autologous transplants plus
maintenance therapy versus the strategy of single autologous transplant plus consolidation
therapy with lenalidomide, bortezomib and dexamethasone (RVD) followed by maintenance therapy
or single autologous transplant plus maintenance therapy as part of upfront treatment of
multiple myeloma (MM). Lenalidomide will be used as maintenance therapy for three years in
all arms.

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 alanine
aminotransferase (ALT) and aspartate aminotransferase (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: Diffusing capacity of the lung for carbon monoxide (DLCO), forced
expiratory volume in one second (FEV1), or forced vital capacity (FVC) greater 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 deep vein thrombosis (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.
We found this trial at
54
sites
601 Elmwood Avenue
Rochester, New York 14642
(585) 275-2100
Univ of Rochester Medical Center One of the nation's top academic medical centers, the University...
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Minneapolis, Minnesota 55455
(612) 625-5000
Univ of Minnesota With a flagship campus in the heart of the Twin Cities, and...
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1211 Medical Center Dr
Nashville, Tennessee 37232
(615) 322-5000
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1 Gustave L Levy Pl # 271
New York, New York 10029
 (212) 241-6500
Mount Sinai Med Ctr Founded in 1852, The Mount Sinai Hospital is a 1,171-bed, tertiary-care...
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3181 Southwest Sam Jackson Park Road
Portland, Oregon 97239
503 494-8311
Oregon Health and Science University In 1887, the inaugural class of the University of Oregon...
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1100 Fairview Avenue North
Seattle, Washington 98109
(206) 667-5000
Fred Hutchinson Cancer Research Center At Fred Hutchinson Cancer Research Center, our interdisciplinary teams of...
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Ann Arbor, Michigan 48109
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1459 Laney-Walker Blvd
Augusta, Georgia 30901
(706) 721-3052
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Boise, ID
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Boston, Massachusetts 02114
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Boston, Massachusetts 02114
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Buffalo, New York 14263
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101 Manning Dr
Chapel Hill, North Carolina 27599
(919) 966-4131
University of North Carolina Hospital at Chapel Hill The UNC Health Care System is a...
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1200 West Harrison Stree
Chicago, Illinois 60607
(312) 996-4350
Univ of Illinois A major research university in the heart of one of the world's...
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1653 W. Congress Parkway
Chicago, Illinois 60612
(312) 942-5000
Rush University Medical Center Rush University Medical Center encompasses a 664-bed hospital serving adults and...
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Cincinnati, Ohio 45236
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11100 Euclid Ave
Cleveland, Ohio 44106
(216) 844-1000
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1801 Inwood Rd
Dallas, Texas 75390
(214) 645-3300
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1721 East 19th Ave., Suite #200 & #300
Denver, Colorado 80218
720-754-4800
Colorado Blood Cancer Institute When patients come to the Colorado Blood Cancer Institute, the entire...
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Detroit, Michigan 48201
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1500 East Duarte Road
Duarte, California 91010
626-256-HOPE (4673)
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2301 Erwin Rd
Durham, North Carolina 27710
919-684-8111
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3450 Hull Road
Gainesville, Florida 32610
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30 Prospect Ave
Hackensack, New Jersey 07601
(201) 996-2000
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Kansas City, Kansas 66160
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1915 White Ave.
Knoxville, Tennessee 37916
(865) 541-1678
Thompson Cancer Survival Center The Thompson Cancer Survival Center Downtown facility has pioneered many advances...
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La Jolla, California 92093
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Lake Success, New York 11042
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Lexington, Kentucky
859) 257-9000
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600 Highland Ave
Madison, Wisconsin 53792
(608) 263-6400
University of Wisconsin Hospital and Clinics UW Health strives to meet the health needs of...
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8701 W Watertown Plank Rd
Milwaukee, Wisconsin
(414) 955-8296
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Morgantown, West Virginia
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1275 York Ave
New York, New York 10021
(212) 639-2000
Memorial Sloan Kettering Cancer Center Memorial Sloan Kettering Cancer Center — the world's oldest and...
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Newark, Delaware 19713
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Oklahoma City, Oklahoma 73104
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Emile St
Omaha, Nebraska 68198
(402) 559-4000
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Orlando, Florida 32804
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1775 West Dempster Street
Park Ridge, Illinois 60068
(847) 723-2210
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Philadelphia, Pennsylvania 19104
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Saint Louis, Missouri 63110
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San Antonio, Texas 78229
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San Francisco, California 94143
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Stanford, California 94305
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Tampa, Florida 33612
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Tucson, Arizona
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929 N St Francis Street
Wichita, Kansas 67214
(316) 262-4467
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1 Medical Center Blvd
Winston-Salem, North Carolina 27157
336-716-2011
Wake Forest University Health Sciences Welcome to Wake Forest Baptist Medical Center, a fully integrated...
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