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Phase II Study of V-BEAM Conditioning Regimen Prior to Second Autologous Stem Cell Transplantation (V-BEAM)

Primary Purpose

Multiple Myeloma

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Bortezomib
Carmustine
Etoposide
Cytarabine
Melphalan
Stem cell infusion
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Myeloma

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patient must have a histologically confirmed diagnosis of multiple myeloma.
  • Patient must have received a prior autologous stem cell transplantation with melphalan conditioning for multiple myeloma with subsequent disease progression and repeat autologous stem cell transplantation is deemed appropriate by the treating physicians.
  • Patient must receive induction chemotherapy including 2 to 4 cycles of anti-myeloma therapy including bortezomib, with or without immune modulating agents and/or corticosteroids, Completion of induction therapy will occur within 30 days of first study drug dose.
  • Patient must have ≥ 2x106/kg CD34+ autologous stem cells available for transplantation.
  • Patient must be ≥ 18 years of age.
  • Patient must have life expectancy of greater than 6 months.
  • Patient must have an ECOG performance status ≤ 2 or Karnofsky performance status ≥ 60% (see Appendices A and B)
  • Patient must have normal bone marrow and organ function as defined below within 14 days prior to first study drug dose (conditioning regimen):

    • Absolute neutrophil count ≥500/mm3
    • Platelets ≥ 50,000/mm3
    • Hemoglobin ≥ 8 g/dl
    • Total bilirubin ≤ 1.5 x IULN
    • AST(SGOT)/ALT(SGPT) ≤ 3.0 x IULN
    • Creatinine clearance (Appendix C) ≥30 mL/min/1.73m2
  • Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry through Day +100 visit. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately.
  • Patient must be able to understand and willing to sign an IRB approved written informed consent document.

Exclusion Criteria:

  • Patient must not be refractory to induction therapy. Refractory is defined as disease progression while on therapy or within 30 days following completion of therapy.
  • Patient must not have had disease progression requiring active treatment within 12 months of previous autologous stem cell transplant. Maintenance therapy is not considered active treatment.
  • Patient must not have peripheral neuropathy ≥ grade 3 based on NCI CTCAE v 4.0 (Appendix D).
  • Patient must not be receiving renal replacement therapy, hemodialysis, or peritoneal dialysis.
  • Patient must not have another concurrent malignancy requiring treatment.
  • Patient must not be receiving any other investigational agents within 14 days prior to the first dose of study drug.
  • Patient must not have known brain metastases. Patients with known brain metastases must be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
  • Patient must not have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to bortezomib, carmustine, etoposide, cytarabine, and melphalan, or other agents used in the study.
  • Patient must not have an uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Patient must not be pregnant and/or breastfeeding.

Inclusion of Women and Minorities

-Both men and women and members of all races and ethnic groups are eligible for this trial.

Sites / Locations

  • Washington University School of Medicine

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

V-BEAM + Stem Cell Infusion

Arm Description

Bortezomib IV or SC (1.3mg/m2) on Days -6, -3, +1 and +4 Carmustine IV (300mg/m2) on Day -7 Etoposide IV twice daily (100 mg/m2) on Days -6, -5, -4, and -3 Cytarabine IV twice daily (100 mg/m2) on Days -6, -5, -4, and -3 Melphalan IV (140 mg/m2) on Day-2 Stem cell infusion on Day 0

Outcomes

Primary Outcome Measures

Complete Response Rate (Complete Response + Stringent Complete Response)
Defined by the International Myeloma Working Group (IMWG) criteria

Secondary Outcome Measures

Number of Participants With Progression-free Survival (PFS)
PFS is defined as the duration from transplant to time of first progression, death, relapse after CR, or the date the patient was last known to be in remission. Response will be assessed per the International Myeloma Working Group (IMWG) Response Criteria.
Overall Response Rate (ORR)
ORR includes Partial Response (PR) + Very Good Partial Response (VGPR) + Complete Response (CR) Response will be assessed per the International Myeloma Working Group (IMWG) Response Criteria.
Very Good Partial Response Rate (VGPR+nCR+sCR+CR)
Response will be assessed per the International Myeloma Working Group (IMWG) Response Criteria.
Toxicity of V-BEAM
Graded per the NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Patients are evaluated from first receiving study treatment until a 30-day follow-up after the conclusion of treatment for adverse events not resulting in death. Adverse events resulting in death will be evaluated through Day +100. This outcomes measures the common toxicities observed. Please refer to the Serious Adverse Event and Other Adverse Event sections of the results for further details.
Time to Neutrophil Engraftment After V-BEAM.
Time to neutrophil engraftment is defined as duration between Day 0 to the first day of ANC > 0.5x109/L post transplant when it is sustained for more than three consecutive days.
Number of Participants With Overall Survival (OS)
OS is defined as the duration from the time of transplant to death or last follow-up.
Treatment Related Mortality (TRM) of V-BEAM
Time to Platelet Engraftment After V-BEAM.
Time to platelet engraftment is defined as the duration between Day 0 to the first day of platelet count sustained at > 20x109/L without transfusion. The median time to neutrophil and platelet engraftment will be reported.

Full Information

First Posted
July 23, 2012
Last Updated
October 8, 2014
Sponsor
Washington University School of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT01653418
Brief Title
Phase II Study of V-BEAM Conditioning Regimen Prior to Second Autologous Stem Cell Transplantation
Acronym
V-BEAM
Official Title
A Phase II Study of V-BEAM (Bortezomib, Carmustine, Etoposide, Cytarabine, and Melphalan) as Conditioning Regimen Prior to Second Autologous Stem Cell Transplantation for Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
October 2014
Overall Recruitment Status
Terminated
Why Stopped
Due to the high rate of morbidity and mortality
Study Start Date
September 2012 (undefined)
Primary Completion Date
August 2013 (Actual)
Study Completion Date
December 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
BEAM regimen (BCNU, etoposide, cytarabine, and melphalan) is the most commonly used conditioning regimen for relapsed/refractory lymphoma patients needing autologous stem cell transplantation. Since these components are all effective in myeloma and bortezomib has shown promising results in the transplant setting, here the investigators propose a phase II study to investigate the combination of bortezomib and BEAM as a new conditioning regimen for patients who relapse or progress after the first autologous transplantation and for whom a second autologous transplant is considered.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Myeloma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
10 (Actual)

8. Arms, Groups, and Interventions

Arm Title
V-BEAM + Stem Cell Infusion
Arm Type
Experimental
Arm Description
Bortezomib IV or SC (1.3mg/m2) on Days -6, -3, +1 and +4 Carmustine IV (300mg/m2) on Day -7 Etoposide IV twice daily (100 mg/m2) on Days -6, -5, -4, and -3 Cytarabine IV twice daily (100 mg/m2) on Days -6, -5, -4, and -3 Melphalan IV (140 mg/m2) on Day-2 Stem cell infusion on Day 0
Intervention Type
Drug
Intervention Name(s)
Bortezomib
Other Intervention Name(s)
Velcade
Intervention Type
Drug
Intervention Name(s)
Carmustine
Other Intervention Name(s)
BCNU, BiCNU®
Intervention Type
Drug
Intervention Name(s)
Etoposide
Other Intervention Name(s)
Vepesid, VP-16
Intervention Type
Drug
Intervention Name(s)
Cytarabine
Other Intervention Name(s)
Ara-C, Cytosar-U, 1-β-Arabinofuranosylcytosine, Arabinosylcytosine, Cytosine arabinoside
Intervention Type
Drug
Intervention Name(s)
Melphalan
Other Intervention Name(s)
Alkeran®, L-PAM
Intervention Type
Procedure
Intervention Name(s)
Stem cell infusion
Primary Outcome Measure Information:
Title
Complete Response Rate (Complete Response + Stringent Complete Response)
Description
Defined by the International Myeloma Working Group (IMWG) criteria
Time Frame
Day +100
Secondary Outcome Measure Information:
Title
Number of Participants With Progression-free Survival (PFS)
Description
PFS is defined as the duration from transplant to time of first progression, death, relapse after CR, or the date the patient was last known to be in remission. Response will be assessed per the International Myeloma Working Group (IMWG) Response Criteria.
Time Frame
Median follow-up of 6 months (range: 6.0-12.0 months)
Title
Overall Response Rate (ORR)
Description
ORR includes Partial Response (PR) + Very Good Partial Response (VGPR) + Complete Response (CR) Response will be assessed per the International Myeloma Working Group (IMWG) Response Criteria.
Time Frame
3 months following Day +100 visit
Title
Very Good Partial Response Rate (VGPR+nCR+sCR+CR)
Description
Response will be assessed per the International Myeloma Working Group (IMWG) Response Criteria.
Time Frame
Day +100
Title
Toxicity of V-BEAM
Description
Graded per the NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Patients are evaluated from first receiving study treatment until a 30-day follow-up after the conclusion of treatment for adverse events not resulting in death. Adverse events resulting in death will be evaluated through Day +100. This outcomes measures the common toxicities observed. Please refer to the Serious Adverse Event and Other Adverse Event sections of the results for further details.
Time Frame
30 days after end of treatment / Day +100
Title
Time to Neutrophil Engraftment After V-BEAM.
Description
Time to neutrophil engraftment is defined as duration between Day 0 to the first day of ANC > 0.5x109/L post transplant when it is sustained for more than three consecutive days.
Time Frame
Day +100
Title
Number of Participants With Overall Survival (OS)
Description
OS is defined as the duration from the time of transplant to death or last follow-up.
Time Frame
Median follow-up of 6 months (range: 6-12 months)
Title
Treatment Related Mortality (TRM) of V-BEAM
Time Frame
Day +100
Title
Time to Platelet Engraftment After V-BEAM.
Description
Time to platelet engraftment is defined as the duration between Day 0 to the first day of platelet count sustained at > 20x109/L without transfusion. The median time to neutrophil and platelet engraftment will be reported.
Time Frame
Day +100

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient must have a histologically confirmed diagnosis of multiple myeloma. Patient must have received a prior autologous stem cell transplantation with melphalan conditioning for multiple myeloma with subsequent disease progression and repeat autologous stem cell transplantation is deemed appropriate by the treating physicians. Patient must receive induction chemotherapy including 2 to 4 cycles of anti-myeloma therapy including bortezomib, with or without immune modulating agents and/or corticosteroids, Completion of induction therapy will occur within 30 days of first study drug dose. Patient must have ≥ 2x106/kg CD34+ autologous stem cells available for transplantation. Patient must be ≥ 18 years of age. Patient must have life expectancy of greater than 6 months. Patient must have an ECOG performance status ≤ 2 or Karnofsky performance status ≥ 60% (see Appendices A and B) Patient must have normal bone marrow and organ function as defined below within 14 days prior to first study drug dose (conditioning regimen): Absolute neutrophil count ≥500/mm3 Platelets ≥ 50,000/mm3 Hemoglobin ≥ 8 g/dl Total bilirubin ≤ 1.5 x IULN AST(SGOT)/ALT(SGPT) ≤ 3.0 x IULN Creatinine clearance (Appendix C) ≥30 mL/min/1.73m2 Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry through Day +100 visit. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately. Patient must be able to understand and willing to sign an IRB approved written informed consent document. Exclusion Criteria: Patient must not be refractory to induction therapy. Refractory is defined as disease progression while on therapy or within 30 days following completion of therapy. Patient must not have had disease progression requiring active treatment within 12 months of previous autologous stem cell transplant. Maintenance therapy is not considered active treatment. Patient must not have peripheral neuropathy ≥ grade 3 based on NCI CTCAE v 4.0 (Appendix D). Patient must not be receiving renal replacement therapy, hemodialysis, or peritoneal dialysis. Patient must not have another concurrent malignancy requiring treatment. Patient must not be receiving any other investigational agents within 14 days prior to the first dose of study drug. Patient must not have known brain metastases. Patients with known brain metastases must be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events. Patient must not have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to bortezomib, carmustine, etoposide, cytarabine, and melphalan, or other agents used in the study. Patient must not have an uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. Patient must not be pregnant and/or breastfeeding. Inclusion of Women and Minorities -Both men and women and members of all races and ethnic groups are eligible for this trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ravi Vij, M.D.
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
St. Louis
State/Province
Missouri
ZIP/Postal Code
63122
Country
United States

12. IPD Sharing Statement

Links:
URL
http://www.siteman.wustl.edu
Description
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

Learn more about this trial

Phase II Study of V-BEAM Conditioning Regimen Prior to Second Autologous Stem Cell Transplantation

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