Melphalan and Amifostine Followed By One or Two Autologous or Syngeneic Stem Cell Transplants and Maintenance Therapy in Treating Patients With Stage II-III Multiple Myeloma

Condition(s) targeted: Refractory Multiple Myeloma; Stage II Multiple Myeloma; Stage III Multiple Myeloma

Intervention: melphalan (Drug); amifostine trihydrate (Drug); peripheral blood stem cell transplantation (Procedure); fluorescence in situ hybridization (Genetic); bone marrow ablation with stem cell support (Procedure)

Phase: Phase 3

Status: Recruiting

Sponsored by: Fred Hutchinson Cancer Research Center

Official(s) and/or principal investigator(s):
William Bensinger, Principal Investigator, Affiliation: Fred Hutchinson Cancer Research Center

RATIONALE: Giving chemotherapy drugs, such as melphalan, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemoprotective drugs, such as amifostine, may protect normal cells from the side effects of chemotherapy. Giving chemotherapy with a peripheral stem cell transplant once or twice, using stem cells from the patient or an identical brother or sister, may allow more chemotherapy to be given so more cancer cells are killed. Giving maintenance therapy after a stem cell transplant may kill any cancer cells that remain. It is not yet known which dose of melphalan is more effective in treating multiple myeloma (MM).

PURPOSE: This randomized phase III trial is studying two different doses of melphalan to compare how well they work when given together with amifostine followed by one or two autologous or syngeneic stem cell transplants and maintenance therapy in treating patients with stage II-III MM

Official title: A Multi-Center Phase III Study of Autologous Transplantation for Patients With Multiple Myeloma Comparing Melphalan 280 mg/m2 + Amifostine With Melphalan 200 mg/m2 + Amifostine

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: CR and near CR rates

Secondary outcome: Relative toxicities between melphalan 280 mg/m^2 or melphalan 200 mg/m^2

Detailed description: PRIMARY OBJECTIVES:

I. Compare the complete response (CR) and near CR rate in patients undergoing autologous stem cell transplant (ASCT) using melphalan 280 mg/m^2 or melphalan 200 mg/m^2.

SECONDARY OBJECTIVES:

I. Compare toxicities between patients receiving amifostine and melphalan 280 mg/m^2 or melphalan 200 mg/m^2.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

INDUCTION THERAPY:

ARM I (HIGH DOSE MELPHALAN AND AMIFOSTINE): Patients receive amifostine intravenously (IV)

over 3-5 minutes on days - 3 and -2 followed by high-dose melphalan IV over 15-30 minutes on

day 2.

ARM II (LOW DOSE MELPHALAN AND AMIFOSTINE): Patients receive amifostine as in arm I and melphalan as in arm I at a lower dose.

AUTOLOGOUS OR SYNGENEIC PERIPHERAL BLOOD STEM CELL TRANSPLANTATION (PBSCT): At least 20 hours after completion of melphalan, patients undergo autologous or syngeneic PBSCT on day 0.

Patients undergo restaging of the disease between days 80-90. Patients with progressive disease are removed from the study. Patients who achieve a CR or near-CR can proceed to optional maintenance therapy. Patients who do not achieve a CR or near-CR may undergo additional induction therapy as in arm I followed by a second autologous or syngeneic PBSCT.

Patients again undergo restaging of the disease 80-90 days later. Patients with progressive disease are removed from the study. Patients without progressive disease can proceed to maintenance therapy.

After completion of study treatment, patients are followed up every 3 months for 5 years.

Minimum age: 18 Years. Maximum age: 70 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Patients who have MM undergoing autologous or syngeneic hematopoietic transplantation

- Patients must meet Salmon and Durie criteria for initial diagnosis of MM

- Transplant will be offered to patients with stage II or III MM

- Measurable disease, defined as serum monoclonal protein >= 0. 2 g/dl or Bence Jones

protein >= 200 mg/24 h

- Karnofsky >= 70 or Eastern Cooperative Oncology Group (ECOG) 0-2

- Life expectancy is not severely limited by concomitant illness

- Left ventricular ejection fraction >= 50%

- No uncontrolled arrhythmias or symptomatic cardiac disease

- Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and

diffusion capacity of carbon monoxide (DLCO) >= 50%

- No symptomatic pulmonary disease

- Human immunodeficiency virus (HIV) negative

- Bilirubin < 2 mg/dl

- Serum glutamic pyruvate transaminase (SGPT) < 2. 5 x normal

- Creatinine clearance >= 60 cc/min, estimated or measured

- Signed informed consent

Exclusion Criteria:

- Pregnant or lactating females

- Uncontrolled infection

- Planned tandem autologous/reduced intensity allograft

- Insufficient PBSC for an autologous transplant (< 3. 0 x 10^6 CD34+ cells/kg total)

- Prior autologous transplant

- Non-secretory myeloma and patients who are in a complete response or near complete

response after conventional therapy

- Patients unwilling to practice adequate forms of contraception if clinically

indicated

- Male patients on study need to be consulted to use latex condoms, even if they have

had a vasectomy, every time they have sex with a woman who is able to have children

- Patients with history of seizures

- Patients receiving antihypertensive therapy that cannot be stopped for 24 hours

preceding amifostine treatment

Cedars-Sinai Medical Center, Los Angeles, California 90048, United States; Recruiting
Michael Charles C. Lill, Phone: 310-423-2997
Michael Charles C. Lill, Principal Investigator

Memorial Cancer Institute, Pembroke Pines, Florida 33028, United States; Recruiting
Lyle C. Feinstein, Phone: 954-443-4747
Lyle C. Feinstein, Principal Investigator

University of Rochester, Rochester, New York 14642, United States; Recruiting
Gordon L. Phillips, Phone: 585-273-4399
Gordon L. Phillips, Principal Investigator

Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium, Seattle, Washington 98109, United States; Recruiting
William I. Bensinger, Phone: 206-667-4933
William I. Bensinger, Principal Investigator

VA Puget Sound Health Care System, Seattle, Washington 98101, United States; Recruiting
Thomas R. Chauncey, Phone: 206-764-2709
Thomas R. Chauncey, Principal Investigator

Starting date: July 2005
Last updated: July 11, 2011