Using Romiplostim to Treat Low Platelet Counts Following Chemotherapy and Autologous Hematopoietic Cell Transplantation in People With Blood Cancer
Multiple Myeloma, Hodgkin Lymphoma, Non-Hodgkin Lymphoma
About this trial
This is an interventional treatment trial for Multiple Myeloma focused on measuring High-Dose Therapy, Autologous Hematopoietic Cell Transplantation, Romiplostim, Thrombocytopenia, 20-180
Eligibility Criteria
Inclusion Criteria:
Adult patients ≥ 18 years old diagnosed with multiple myeloma (MM), any subtype of Hodgkin lymphoma (HL), or any subtype of non-Hodgkin lymphoma (NHL)
- For MM, the conditioning regimen used will be high-dose melphalan.°For HL and NHL, the conditioning will be one of the following high-dose regimens: BEAM, CBV, or TBC.
- Other conditioning regimens not listed above, or variations of the above conditioning regimens, may be allowed at the discretion of the principal investigator if the regimen is considered myeloablative.
Adequate organ function is required, defined as follows:
- Serum bilirubin ≤ 2 mg/dL, unless benign congenital hyperbilirubinemia.
- AST, ALT, and alkaline phosphatase < 3 times the upper limit of normal.
- Creatinine clearance ≥ 40 ml/min (calculated by Cockcroft Gault)
- LVEF ≥ 45% by MUGA or resting echocardiogram
- Pulmonary function (FEV1 and corrected DLCO) ≥ 45% predicted.
- Adequate performance status ECOG ≤ 2.
- Ability to provide written informed consent.
- Patients undergoing HDT-AHCT.
Exclusion Criteria:
- Patients with a previous diagnosis of a myeloid malignancy.
- Patients for whom the treating oncologist will be using a non-standard platelet transfusion threshold during the AHCT.
Patients with a history of a prior symptomatic or incidental venous thromboembolic event (such as DVT or pulmonary embolism) within the prior 6 months are eligible if they are on and tolerating anti-coagulation, or greater than 6 months ago are eligible if they completed or are on and tolerating anti-coagulation.
°A venous thrombotic event associated with a central venous catheter will not make the patient ineligible.
- Patients with a history of symptomatic arterial thrombotic events such as myocardial infarction, ischemic cerebral vascular accident or transient ischemic attack in the past 6 months are ineligible.
- Patients who had been diagnosed with Immune Thrombocytopenic Purpura (ITP) at any time prior to the AHCT are ineligible.
- Patients with a serious concomitant medical condition that could interfere with the conduct of the clinical trial, such as unstable angina, renal failure requiring hemodialysis, or active infection requiring IV antibiotics.
- Previous use of romiplostim, PEGylated recombinant human megakaryocyte growth and development factor, eltrombopag, recombinant human TPO, any other TPO receptor agonist, or any investigational platelet producing agent.
- Females who are pregnant or breastfeeding or planning to become pregnant or breastfeed during treatment and for an additional 30 days after treatment discontinuation or longer if required by prescribing information for chemotherapy received during the study.
- Patients unwilling to use highly effective contraception during the study period and for the duration required by prescribing information for chemotherapy(ies) administered during the study.
Sites / Locations
- Memorial Sloan Kettering at Basking Ridge (Limited Protocol Activities)
- Memorial Sloan Kettering Monmouth (Limited Protocol Activities)
- Memorial Sloan Kettering Bergen (Limited Protocol Activities)
- Memorial Sloan Kettering Commack (Limited Protocol Activities)
- Memorial Sloan Kettering Westchester (Limited Protocol Activities)
- Memorial Sloan Kettering Cancer Center (All Protocol Activities)
- Memorial Sloan Kettering Nassau (Limited Protocol Activities)
Arms of the Study
Arm 1
Experimental
romiplostim
Patients will be enrolled prior to admission for High-Dose Therapy and Autologous Hematopoietic Cell Transplantation (HDT-AHCT), and they will undergo their planned HDT-AHCT for their respective hematologic malignancy as per institutional standards. Regardless of the conditioning regimen received, all patients will receive romiplostim 3.0 mcg/kg SC on Day +1 and romiplostim 2.0 mcg/kg SC on Day +8 after HDT-AHCT. Beyond Day +8, patients will be treated until platelet count is >50,000/mcL, without any platelet transfusions in the prior 48 hours. All doses after the second romiplostim dose will be titrated as per Table 3, based on weekly CBC/platelet counts. No patient will receive more than six doses of romiplostim, even if platelets have not corrected by Day +42.