Lenalidomide and Dexamethasone With or Without Thalidomide in Treating Patients With Multiple Myeloma
DS Stage I Multiple Myeloma, DS Stage II Multiple Myeloma, DS Stage III Multiple Myeloma
About this trial
This is an interventional treatment trial for DS Stage I Multiple Myeloma
Eligibility Criteria
Inclusion Criteria: Patients must be diagnosed with symptomatic multiple myeloma within the past 90 days confirmed by the following: Bone marrow plasmacytosis with >= 10% plasma cells or sheets of plasma cells or biopsy proven plasmacytoma which must be obtained within 4 weeks prior to randomization Measurable levels of monoclonal protein (M protein): >= 1.0 g/dL on serum protein electrophoresis or >= 200 mg of monoclonal light chain on a 24 hour urine protein electrophoresis which must be obtained within 4 weeks prior to randomization; both serum protein electrophoresis (SPEP) and urine protein electrophoresis (UPEP) are required to be performed within 28 days prior to randomization; please note that if both serum and urine m-components are present, both must be followed in order to evaluate response Hemoglobin > 7 g/dL Platelet count > 75,000 cells/mm^3 Absolute neutrophil count > 1000 cells/mm^3 Creatinine < 2.5 mg/dL and creatinine clearance (measured or calculated) >= 60 mL/min Bilirubin =< 1.5 mg/dL Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) and serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) =< 2.5 times the upper limit of normal Prior palliative and/or localized radiation therapy is permitted provided at least 4 weeks have passed from date of last radiation therapy to date of registration; patients with prior solitary plasmacytoma treated with radiation therapy with curative intent are eligible if the disease has now progressed to active multiple myeloma meeting all the eligibility criteria for this protocol Eastern Cooperative Oncology Group (ECOG) performance status 0, 1, or 2 Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL within 10-14 days and again within 24 hours prior to starting cycle 1 of lenalidomide; further, they must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control: one highly effective method (intrauterine device [IUD], birth control pills, tubal ligation or partner's vasectomy) and one additional effective method (condom, diaphragm or cervical cap); FCBP must also agree to ongoing pregnancy testing; men must agree to use a latex condom during sexual contact with a FCBP, even if they have had a successful vasectomy starting 4 weeks prior to and while taking CC5013 or thalidomide and for four weeks after discontinuing this therapy; a FCBP is a sexually mature woman who: has not undergone a hysterectomy or bilateral oophorectomy; or has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months); all patients must be counseled by a trained counselor every 28 days about pregnancy precautions and risks of fetal exposure Patients with a history of prior malignancy are eligible provided there is no active malignancy and a low expectation of recurrence within 6 months Exclusion Criteria: No prior systemic therapy with the exception of bisphosphonates for multiple myeloma Prior glucocorticosteroid therapy for the treatment of multiple myeloma is not permitted; prior systemic glucocorticosteroid use for the treatment of non-malignant disorders is permitted; concurrent use after registration on the study should be restricted to the equivalent of prednisone 10 mg per day; prior or concurrent topical or localized glucocorticosteroid therapy to treat non-malignant comorbid disorders is permitted Patients must not have active, uncontrolled seizure disorder; patients must have had no seizures in the last 6 months Patients must not have uncontrolled intercurrent illness including uncontrolled hypertension, symptomatic congestive heart failure, unstable angina, uncontrolled cardiac arrhythmia, uncontrolled psychiatric illness or social situation that would limit compliance with the study, or a prior history of Stevens Johnson syndrome Patients with smoldering myeloma or monoclonal gammopathy of undetermined significance are not eligible Patients must not have grade 2 or higher peripheral neuropathy due to other medical conditions at the time of randomization Patients must not have active, uncontrolled infection Patients must not have a history of current or previous deep vein thrombosis or pulmonary embolism regardless of whether or not the patient is receiving anticoagulation therapy For patients registered prior to activation of Addendum # 6; patients must be willing and able to take prophylaxis with either aspirin at 325 mg/day or alternative prophylaxis with either low molecular weight heparin or Coumadin For patients registered after activation of Addendum # 6; patients entering the expansion phase of the protocol, which tests anticoagulant prophylaxis, must be able and willing to be randomized between aspirin at 325 mg/day and Coumadin Female patients MUST NOT be pregnant or breastfeeding; due to the potential teratogenic properties of CC 5013, and the known teratogenicity associated with thalidomide, the use of these drugs in this patient population is ABSOLUTELY CONTRAINDICATED
Sites / Locations
- University of Alabama at Birmingham Cancer Center
- Huntsville Hospital
- Providence Alaska Medical Center
- Mayo Clinic in Arizona
- Providence Saint Joseph Medical Center/Disney Family Cancer Center
- Saint Jude Medical Center
- El Camino Hospital
- Kaiser Permanente-San Diego Mission
- The Medical Center of Aurora
- Penrose-Saint Francis Healthcare
- SCL Health Saint Joseph Hospital
- Swedish Medical Center
- Poudre Valley Hospital
- McKee Medical Center
- Danbury Hospital
- Eastern Connecticut Hematology and Oncology Associates
- Holy Cross Hospital
- University of Florida Health Science Center - Gainesville
- Baptist MD Anderson Cancer Center
- Mayo Clinic in Florida
- Martin Hospital South
- Phoebe Putney Memorial Hospital
- Emory University Hospital/Winship Cancer Institute
- Atlanta Regional CCOP
- Augusta Oncology Associates PC-D'Antignac
- Dekalb Medical Center
- Medical Center of Central Georgia
- Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
- University of Hawaii Cancer Center
- Saint Luke's Cancer Institute - Boise
- Saint Anthony's Health
- Northwestern University
- John H Stroger Jr Hospital of Cook County
- Decatur Memorial Hospital
- Ascension Alexian Brothers - Elk Grove Village
- Edward Hines Jr VA Hospital
- Midwest Center for Hematology Oncology
- Duly Health and Care Joliet
- Swedish American Hospital
- SwedishAmerican Regional Cancer Center/ACT
- Edward H Kaplan MD and Associates
- Elkhart General Hospital
- Fort Wayne Medical Oncology and Hematology Inc-Parkview
- Indiana University/Melvin and Bren Simon Cancer Center
- Franciscan Health Indianapolis
- IU Health Arnett Cancer Care
- Saint Joseph Regional Medical Center-Mishawaka
- Memorial Hospital of South Bend
- McFarland Clinic - Ames
- University of Iowa Healthcare Cancer Services Quad Cities
- Iowa Methodist Medical Center
- Siouxland Regional Cancer Center
- MercyOne Waterloo Cancer Center
- Kansas City NCI Community Oncology Research Program
- Harold Alfond Center for Cancer Care
- Greater Baltimore Medical Center
- HealthAlliance Hospital - Leominster
- Ascension Saint John Hospital
- West Michigan Cancer Center
- Mercy Hospital
- Fairview Southdale Hospital
- Unity Hospital
- Saint John's Hospital - Healtheast
- Mayo Clinic in Rochester
- Regions Hospital
- United Hospital
- Mercy Hospital Saint Louis
- Saint Louis-Cape Girardeau CCOP
- Montana Cancer Consortium NCORP
- Great Falls Clinic
- Nebraska Cancer Research Center
- Nebraska Methodist Hospital
- Alegent Health Immanuel Medical Center
- Alegent Health Bergan Mercy Medical Center
- Midlands Community Hospital
- Hackensack University Medical Center
- The Cancer Institute of New Jersey Hamilton
- Morristown Medical Center
- Virtua Memorial
- Jersey Shore Medical Center
- Rutgers Cancer Institute of New Jersey
- Robert Wood Johnson University Hospital Somerset
- Garnet Health Medical Center
- NYU Winthrop Hospital
- Mount Sinai Union Square
- Stony Brook University Medical Center
- Mission Hospital
- Wayne Memorial Hospital
- Southeast Clinical Oncology Research Consortium NCORP
- Sanford Bismarck Medical Center
- Essentia Health Cancer Center-South University Clinic
- Sanford Broadway Medical Center
- Summa Health System - Akron Campus
- MetroHealth Medical Center
- Miami Valley Hospital
- Miami Valley Hospital North
- Atrium Medical Center-Middletown Regional Hospital
- Kettering Medical Center
- Saint Charles Hospital
- Firelands Regional Medical Center
- ProMedica Flower Hospital
- Mercy Hospital of Tiffin
- Toledo Community Hospital Oncology Program CCOP
- Toledo Clinic Cancer Centers-Toledo
- Kaiser Permanente Northwest
- Jefferson Abington Hospital
- Penn State Milton S Hershey Medical Center
- Lancaster General Hospital
- Saint Mary Medical and Regional Cancer Center
- University of Pennsylvania/Abramson Cancer Center
- Pennsylvania Hospital
- Thomas Jefferson University Hospital
- Fox Chase Cancer Center
- Chestnut Hill Health System
- Einstein Medical Center Philadelphia
- Guthrie Medical Group PC-Robert Packer Hospital
- Grand View Hospital
- Mount Nittany Medical Center
- Reading Hospital
- Lankenau Medical Center
- WellSpan Health-York Hospital
- McLeod Regional Medical Center
- Rapid City Regional Hospital
- Sanford Cancer Center Oncology Clinic
- Sentara Martha Jefferson Hospital
- University of Virginia Cancer Center
- Centra Lynchburg Hematology-Oncology Clinic Inc
- Virginia Commonwealth University/Massey Cancer Center
- Swedish Medical Center-First Hill
- West Virginia University Healthcare
- ThedaCare Regional Cancer Center
- Gundersen Lutheran Medical Center
- Dean Hematology and Oncology Clinic
- University of Wisconsin Carbone Cancer Center
- Marshfield Medical Center-Marshfield
- Medical College of Wisconsin
- ProHealth Oconomowoc Memorial Hospital
- ProHealth Waukesha Memorial Hospital
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Active Comparator
Experimental
Active Comparator
Experimental
Arm I (lenalidomide, dexamethasone)
Arm II (lenalidomide, low-dose dexamethasone)
Arm III (thalidomide, dexamethasone)
Arm IV (thalidomide, low-dose dexamethasone)
Patients receive lenalidomide PO QD on days 1-21 and standard-dose dexamethasone PO QD on days 1-4, 9-12, and 17-20.
Patients receive lenalidomide and acetylsalicylic acid as in Arm I and low-dose dexamethasone PO QD on days 1, 8, 15, and 22.
Patients with no response after treatment on Arm I: Patients receive thalidomide PO QD on days 1-28 and standard-dose dexamethasone PO QD on days 1-4, 9-12, and 17-20
Patients with no response after treatment on Arm II: Patients receive thalidomide as in arm III and low-dose dexamethasone PO QD on days 1, 8, 15, and 22.