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Melphalan and Busulfan Followed By Donor Peripheral Stem Cell Transplant, Tacrolimus, and Methotrexate in Treating Patients With Multiple Myeloma

Primary Purpose

Multiple Myeloma and Plasma Cell Neoplasm

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
busulfan
melphalan
methotrexate
tacrolimus
allogeneic hematopoietic stem cell transplantation
peripheral blood stem cell transplantation
Sponsored by
Fred Hutchinson Cancer Center
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Myeloma and Plasma Cell Neoplasm focused on measuring stage I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma, refractory multiple myeloma

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Diagnosis of multiple myeloma Stage I disease with disease progression during the second of ≥ 2 lines of prior therapy Stage II or III disease, meeting 1 of the following criteria: Failed to achieve at least a partial response after ≥ 2 courses of prior therapy Progressive disease after ≥ 2 courses of prior therapy Presented with high-risk features at diagnosis, including any of the following: Cytogenetic abnormality Del 13 or 4,14 by fluorescent in situ hybridization (FISH) Elevated lactic dehydrogenase Beta 2 microglobulin > 5.5 Circulating peripheral blood plasma cells Any stage disease with disease progression > 6 months after prior autologous stem cell transplantation Availability of an HLA-matched, related donor between 12 and 75 years of age* No bone marrow donors NOTE: *Donors > 75 years of age are eligible at the discretion of the principal investigator PATIENT CHARACTERISTICS: Karnofsky performance status 70-100% Creatinine clearance > 60 mL/min Bilirubin ≤ 2.5 mg/dL ALT/AST < 2 times upper limit of normal Cardiac ejection fraction ≥ 49% DLCO ≥ 50% corrected FEV_1 ≥ 60% Not pregnant or nursing Fertile patients must use effective contraception HIV negative No cirrhosis No chronic inflammatory or fibrotic liver disease PRIOR CONCURRENT THERAPY: See Disease Characteristics At least 6 months since prior autologous transplantation

Sites / Locations

  • Fred Hutchinson Cancer Research Center

Outcomes

Primary Outcome Measures

Transplant-related mortality at 180 days

Secondary Outcome Measures

Disease response (complete response)
Progression-free survival
Overall survival at 1 year

Full Information

First Posted
April 11, 2006
Last Updated
September 20, 2010
Sponsor
Fred Hutchinson Cancer Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00313625
Brief Title
Melphalan and Busulfan Followed By Donor Peripheral Stem Cell Transplant, Tacrolimus, and Methotrexate in Treating Patients With Multiple Myeloma
Official Title
A Phase II Study of Intravenous Melphalan and Busulfan Followed by HLA-Matched, Allogeneic Peripheral Blood Stem Cell Transplant for the Treatment of Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
September 2010
Overall Recruitment Status
Completed
Study Start Date
September 2005 (undefined)
Primary Completion Date
July 2007 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Name of the Sponsor
Fred Hutchinson Cancer Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Giving chemotherapy, such as melphalan and busulfan, before a donor peripheral blood stem cell transplant helps stop the growth of cancer cells. It also helps stop the patient's immune system from rejecting the donor's stem cells. When the healthy stem cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells. Giving tacrolimus and methotrexate before or after transplant may stop this from happening. PURPOSE: This phase II trial is studying how well giving melphalan together with busulfan followed by donor peripheral stem cell transplant, tacrolimus, and methotrexate works in treating patients with multiple myeloma.
Detailed Description
OBJECTIVES: Primary Evaluate transplant-related mortality in patients with multiple myeloma treated with a myeloablative conditioning regimen comprising melphalan and busulfan followed by HLA-matched, allogeneic peripheral blood stem cell transplantation (PBSCT) and graft-vs-host disease prophylaxis with tacrolimus and methotrexate. Secondary Determine the disease response in patients treated with this regimen. Determine the 1-year progression-free survival and overall survival in patients treated with this regimen. OUTLINE: Conditioning regimen: Patients receive melphalan IV over 30 minutes on day -6 and busulfan IV over 3 hours on days -5 to -3. Peripheral blood stem cell transplantation (PBSCT): Patients undergo HLA-matched, related donor, allogeneic PBSCT on day 0. Graft-versus-host disease (GVHD) prophylaxis: Patients receive tacrolimus IV continuously or orally twice daily beginning on day -2 and continuing until day 80 followed by a taper until day 180 in the absence of GVHD or disease progression. Patients also receive methotrexate IV on days 1, 3, 6, and 11. After completion of study treatment, patients are followed every 6 months for 2 years and then annually thereafter. PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma and Plasma Cell Neoplasm
Keywords
stage I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma, refractory multiple myeloma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Masking
None (Open Label)
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
busulfan
Intervention Type
Drug
Intervention Name(s)
melphalan
Intervention Type
Drug
Intervention Name(s)
methotrexate
Intervention Type
Drug
Intervention Name(s)
tacrolimus
Intervention Type
Procedure
Intervention Name(s)
allogeneic hematopoietic stem cell transplantation
Intervention Type
Procedure
Intervention Name(s)
peripheral blood stem cell transplantation
Primary Outcome Measure Information:
Title
Transplant-related mortality at 180 days
Secondary Outcome Measure Information:
Title
Disease response (complete response)
Title
Progression-free survival
Title
Overall survival at 1 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Diagnosis of multiple myeloma Stage I disease with disease progression during the second of ≥ 2 lines of prior therapy Stage II or III disease, meeting 1 of the following criteria: Failed to achieve at least a partial response after ≥ 2 courses of prior therapy Progressive disease after ≥ 2 courses of prior therapy Presented with high-risk features at diagnosis, including any of the following: Cytogenetic abnormality Del 13 or 4,14 by fluorescent in situ hybridization (FISH) Elevated lactic dehydrogenase Beta 2 microglobulin > 5.5 Circulating peripheral blood plasma cells Any stage disease with disease progression > 6 months after prior autologous stem cell transplantation Availability of an HLA-matched, related donor between 12 and 75 years of age* No bone marrow donors NOTE: *Donors > 75 years of age are eligible at the discretion of the principal investigator PATIENT CHARACTERISTICS: Karnofsky performance status 70-100% Creatinine clearance > 60 mL/min Bilirubin ≤ 2.5 mg/dL ALT/AST < 2 times upper limit of normal Cardiac ejection fraction ≥ 49% DLCO ≥ 50% corrected FEV_1 ≥ 60% Not pregnant or nursing Fertile patients must use effective contraception HIV negative No cirrhosis No chronic inflammatory or fibrotic liver disease PRIOR CONCURRENT THERAPY: See Disease Characteristics At least 6 months since prior autologous transplantation
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
William I. Bensinger, MD
Organizational Affiliation
Fred Hutchinson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Fred Hutchinson Cancer Research Center
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109-1024
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Melphalan and Busulfan Followed By Donor Peripheral Stem Cell Transplant, Tacrolimus, and Methotrexate in Treating Patients With Multiple Myeloma

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