Randomized Trial of Lenalidomide, Bortezomib, Dexamethasone vs High-Dose Treatment With SCT in MM Patients up to Age 65



Status:Active, not recruiting
Conditions:Blood Cancer, Hematology
Therapuetic Areas:Hematology, Oncology
Healthy:No
Age Range:18 - 65
Updated:6/16/2018
Start Date:September 2010
End Date:September 2018

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A Randomized, Phase III Study Comparing Conventional Dose Treatment Using a Combination of Lenalidomide, Bortezomib, and Dexamethasone (RVD) to High-Dose Treatment With Peripheral Stem Cell Transplant in the Initial Management of Myeloma in Patients Up to 65 Years of Age

The drugs, lenalidomide, bortezomib, and dexamethasone, are approved by the FDA. They have
not been approved in the combination for multiple myeloma or any other type of cancer.
Bortezomib is currently approved by the FDA for the treatment of multiple myeloma.
Lenalidomide is approved for use with dexamethasone for patients with multiple myeloma who
have received at least one prior therapy and for the treatment of certain types of
myelodysplastic syndrome (another type of cancer affecting the blood). Dexamethasone is
commonly used, either alone, or in combination with other drugs, to treat multiple myeloma.
Please note that Bortezomib and Lenalidomide are provided to patients participating in this
trial at no charge. Melphalan and cyclophosphamide, the drugs used during stem cell
collection and transplant, are also approved by the FDA. Melphalan is an FDA-approved
chemotherapy for multiple myeloma and is used as a high-dose conditioning treatment prior to
stem cell transplantation. Cyclophosphamide is used, either alone, or in combination with
other drugs, to treat multiple myeloma. These drugs have been used in other multiple myeloma
studies and information from those studies suggests that this combination of therapy may help
to treat newly diagnosed multiple myeloma.

In this research study, we are looking to explore the drug combination, lenalidomide,
bortezomib and dexamethasone alone or when combined with autologous stem cell transplantation
to see what side effects it may have and how well it works for treatment of newly diagnosed
multiple myeloma. Specifically, the objective of this trial is to determine if, in the era of
novel drugs, high dose therapy (HDT) is still necessary in the initial management of multiple
myeloma in younger patients. In this study, HDT as compared to conventional dose treatment
would be considered superior if it significantly prolongs progression-free survival by at
least 9 months or more, recognizing that particular subgroups may benefit more compared to
others.

After screening procedures determine if a patient is eligible for this research study, the
patient will be randomized into one of the study groups: lenalidomide, bortezomib and
dexamethasone without autologous stem cell transplantation, followed by lenalidomide
maintenance (Arm A) or lenalidomide, bortezomib and dexamethasone with autologous stem cell
transplantation, followed by lenalidomide maintenance (Arm B). There is an equal chance of
being placed in either group.

All participants will receive one cycle of lenalidomide, bortezomib and dexamethasone
treatment before being randomized to Arm A or Arm B.

Participants in Arm A will receive two additional cycles of lenalidomide, bortezomib and
dexamethasone prior to stem cell collection. If randomized to Arm A, the subject will undergo
stem cell collection, followed by five cycles of lenalidomide, bortezomib and dexamethasone.
This will be followed by lenalidomide maintenance treatment until disease progression.

Participants in Arm B will receive two additional cycles of lenalidomide, bortezomib and
dexamethasone prior to stem cell collection. If randomized to Arm B, the subject will undergo
stem cell collection and autologous stem cell transplantation, followed by two cycles of
lenalidomide, bortezomib and dexamethasone. This will be followed by lenalidomide maintenance
treatment until disease progression.

Inclusion Criteria:

- Diagnosis of Multiple Myeloma, according to the International Myeloma Foundation 2003
Diagnostic Criteria

- Documented symptomatic myeloma, with organ damage related to myeloma with laboratory
assessments performed within 21 days of registration

- Myeloma that is measurable by either serum or urine evaluation of the monoclonal
component or by assay of serum free light chains.

- ECOG performance status
- Negative HIV blood test

- Voluntary written informed consent

Exclusion Criteria:

- Pregnant or lactating female

- Prior systemic therapy for MM (localized radiotherapy allowed if at least 7 days
before study entry, corticosteroids allowed if dose dexamethasone over 2 weeks)

- Primary amyloidosis (AL) or myeloma complicated by amylosis

- Receiving any other investigational agents

- Known brain metastases

- Poor tolerability or allergy to any of the study drugs or compounds of similar
composition

- Platelet count <50,000/mm3, within 21 days of registration

- ANC <1,000 cells/mm3, within 21 days of registration

- Hemoglobin <8 g/dL, within 21 days of registration

- Hepatic impairment (>/= 1.5 x institutional ULN or AST (SGOT), ALT (SGPT), or alkaline
phosphatase >2 x ULN). Patients with benign hyperbilirubinemia are eligible.

- Renal insufficiency (serum creatinine >2.0 mg/dl or creatinine clearance <50 ml/min,
within 21 days of registration)

- Respiratory compromise (DLCO < 50%)

- Clinical signs of heart or coronary failure or LVEF < 40%. Myocardial infarction
within 6 months prior to enrollment, NYHA Class III or IV heart failure, uncontrolled
angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence
of acute ischemia or active conductive system abnormalities

- Intercurrent illness including, but not limited to ongoing or active severe infection,
known infection with hepatitis B or C virus, poorly controlled diabetes, severe
uncontrolled psychiatric disorder or psychiatric illness/social situations that would
limit compliance with study requirements

- Previous history of another malignant condition except for basal cell carcinoma and
stage I cervical cancer. If malignancy was experienced more than 2 years ago and
confirmed as cured, these participants may be considered for the study on case by case
basis with PI discussion.

- Inability to comply with an anti-thrombotic treatment regimen

- Peripheral neuropathy >/= Grade 2
We found this trial at
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Laconia, New Hampshire 03246
Principal Investigator: Douglas Weckstein, MD
Phone: 603-622-6484
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201 Dowman Dr
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Emory University Emory University, recognized internationally for its outstanding liberal artscolleges, graduate and professional schools,...
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1720 2nd Ave S
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185 Cambridge Street
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330 Brookline Ave
Boston, Massachusetts 02215
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666 Elm Street
Buffalo, New York 14263
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5801 South Ellis Avenue
Chicago, Illinois 60637
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4100 John R
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Durham, North Carolina 27710
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Gainesville, Florida 32610
(352) 392-3261
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1200 Moursund Street
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2500 N State St
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1 Gustave L Levy Pl # 271
New York, New York 10029
 (212) 241-6500
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116th St and Broadway
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601 Elmwood Avenue
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450 Brookline Ave
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Concord, New Hampshire 03301
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1801 Inwood Rd
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Hooksett, New Hampshire 03106
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9500 Gilman Dr
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2201 West End Ave
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1275 York Ave
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2014 Washington St
Newton, Massachusetts 02462
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Philadelphia, Pennsylvania 19111
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450 Serra Mall
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