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UARK 2008-03 Phase II Trial for Patients Not Qualifying for TT4 and TT5 Protocols Because of Prior Therapy (No Prior Transplant)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00871013
Recruitment Status : Active, not recruiting
First Posted : March 30, 2009
Last Update Posted : May 5, 2020
Information provided by (Responsible Party):
University of Arkansas

Brief Summary:

There have been four previous Total Therapy (TT1 through IIIB) studies for multiple myeloma at the MIRT from 1989 to present. Results have shown that participants treated on these studies had better outcomes (meaning they have lived longer and had better responses to treatment) when compared to individuals treated with standard chemotherapy.

Past studies conducted at the MIRT have shown that participants presenting to MIRT who have already received treatment for myeloma tend to have shorter remissions (disappearance of signs and symptoms of myeloma) and do not survive as long as participants who come to MIRT with untreated myeloma. Researchers at MIRT think that one reason for this is may be that the myeloma cells re-grow in the time when participants are not receiving treatment because they are recovering from high-dose chemotherapy. In this study, participants will receive several chemotherapy drugs previously shown to be effective in myeloma, but in lower doses and in shorter cycles. It is hoped that by giving the drugs in this way, myeloma cells will not have time to re-grow between cycles, therefore resulting in longer remissions. This study is being done in an attempt to improve the remission rate and the survival time for participants with high-risk myeloma.

Condition or disease Intervention/treatment Phase
Myeloma Drug: Melphalan Drug: Velcade Drug: Thalidomide Drug: Dexamethasone Drug: Cisplatin Drug: Adriamycin Drug: Cyclophosphamide Drug: Etoposide Phase 2

Detailed Description:
  • To find out if giving multi-agent chemotherapy in lower and more frequent doses to make the timely delivery of chemotherapy cycles possible, will result in better myeloma responses
  • To find out if changing the way the drugs are given during the transplant phase will also result in fewer side effects, while still being effective
  • To find out if giving treatment between transplants (called "inter-therapy") will prevent the myeloma from re-growing between transplants
  • To find out if long-term maintenance therapy will result in longer remissions
  • To find out what the effects (good and bad) of this overall treatment will be
  • To learn more about the biology and genetics of multiple myeloma by performing imaging tests and collecting blood, bone marrow aspirate and biopsies, and biopsies of lesions seen on MRI or PET scans. Bone marrow aspirates and biopsies are tissue sample collected from the bone cavity.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 160 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase II Trial for Patients Not Qualifying for TT4 and TT5 Protocols Because of Prior Therapy (No Prior Transplant)
Study Start Date : March 2009
Estimated Primary Completion Date : December 2020
Estimated Study Completion Date : December 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Multiple Myeloma

Arm Intervention/treatment
Experimental: MEL-VTD-PACE
Melphalan, Velcade, Thalidomide, Dexamethasone, CisPlatin, Adriamycin, Cyclophosphamide, Etoposide
Drug: Melphalan

Given by vein, Day 3

First Inter-Therapy Treatment Bortezomib (Velcade) By vein Days 1 and 4

Second Inter-Therapy Treatment Bortezomib (Velcade) By vein Days 1 and 4

Second Transplant Bortezomib (Velcade) By vein Day -5 and Day -2

Year 1 Maintenance Velcade (bortezomib) By vein Days 1, 8, 15, 22(weekly) Every 28 days

Years 2 & 3 Maintenance Velcade (bortezomib) By vein Days 1, 8, 15, 22(weekly) Every 56 days

Other Name: Alkeran

Drug: Velcade
Given by vein, Days 1, 5, 8, 11
Other Name: Bortezomib, PS-341

Drug: Thalidomide
Given by mouth at bedtime, Days 5-8
Other Name: Thalomid

Drug: Dexamethasone
Given by mouth, once per day Days 5-8
Other Name: Decadron

Drug: Cisplatin
Given by vein, Days 5-8 continuous infusion
Other Name: Platinol, CDDP

Drug: Adriamycin
Given by vein, days 5-8 continuous infusion
Other Name: Doxorubicin

Drug: Cyclophosphamide
Given by vein days 5-8 continuous infusion
Other Name: Cytoxan

Drug: Etoposide
Given by vein days 5-8 continuous infusion
Other Name: Vepesid, VP-16

Primary Outcome Measures :
  1. The primary objective of this study is to assess the continued complete and near complete response rate (CR/nCR) at two years after initiation of therapy. . [ Time Frame: Two years ]

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients with symptomatic multiple myeloma (MM), with at least one prior line of chemotherapy.
  • Zebroid ≤ 2, unless solely due to symptoms of MM-related bone disease (Appendix 4).
  • Patients must be at least 18 years of age and not older than 75 years of age at the time of registration.
  • Patient must not have had a prior auto- or allotransplant.
  • Patient must have signed an IRB-approved informed consent and understand the investigational nature of the study.
  • Patients must have adequate pulmonary function studies > 50% of predicted on mechanical aspects (FEV1, FVC, etc) and diffusion capacity (DLCO) > 50% of predicted, within 60 days prior to enrollment. Patients unable to complete pulmonary function tests because of myeloma-related chest pain, must have a high resolution CT scan of the chest and must also have acceptable arterial blood gases defined as P02 greater than 70.
  • Ejection fraction by ECHO or MUGA must be > 40% and must be performed within 60 days prior to enrollment, unless the patient has received chemotherapy within that period of time (dexamethasone and thalidomide excluded), in which case the LVEF must be repeated.
  • Patients must not have prior malignancy, except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer for which the patient has not received treatment for one year prior to enrollment. Other cancers will only be acceptable if the patient's life expectancy exceeds five years.
  • Patients must be able to receive full doses of Mel-VRD-PACE, in the opinion of the treating investigator, with the exception that patients with creatinine clearance 30-50 ml/min will receive only 50% of the cisplatin dose.

Exclusion Criteria:

  • Fever or active infection requiring intravenous antibiotic, defined as fever or antibiotics within 72 hours from registration.
  • Severe renal dysfunction, defined as a creatinine > 3mg/dl or a creatinine clearance of < 30ml/min.
  • Significant neurotoxicity, defined as grade > 3 neurotoxicity per NCI Common Toxicity Criteria (See Appendix).
  • Platelet count < 30,000/mm3, and ANC < 1,000/μl
  • POEMS Syndrome: (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes
  • Clinically significant hepatic dysfunction as noted by direct bilirubin or AST >3 times the upper normal limit or clinically significant concurrent hepatitis.
  • New York Heart Association (NYHA) Class III or Class IV heart failure (Appendix 4).
  • Recent (< 6 months) myocardial infarction, unstable angina, difficult to control congestive heart failure, uncontrolled hypertension, or difficult to control cardiac arrhythmias are ineligible.
  • Patients with a history of treatment for clinically significant ventricular cardiac arrhythmias.
  • Poorly-controlled hypertension, diabetes mellitus, or other serious medical illness or psychiatric illness that could potentially interfere with the completion of treatment according to this protocol.
  • Prior cumulative total of Adriamycin exposure >450 mg/m2.
  • Prior exposure to thalidomide which resulted in severe toxicity requiring drug discontinuation.
  • Prior exposure to Revlimid which resulted in severe toxicity requiring drug discontinuation
  • Hypersensitivity to boron, or Mannitol. Prior exposure to bortezomib which resulted in severe toxicity requiring drug discontinuation.
  • Pregnant or nursing women may not participate. Women of childbearing potential must have a negative pregnancy documented within one week of registration. Women/men of reproductive potential may not participate unless they have agreed to use an effective contraceptive method.

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To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00871013

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United States, Arkansas
University of Arkansas for Medical Sciences
Little Rock, Arkansas, United States, 72205
Sponsors and Collaborators
University of Arkansas
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Principal Investigator: Maurizio Zangari, MD University of Arkansas
Additional Information:
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: University of Arkansas Identifier: NCT00871013    
Other Study ID Numbers: 108053
First Posted: March 30, 2009    Key Record Dates
Last Update Posted: May 5, 2020
Last Verified: May 2020
Keywords provided by University of Arkansas:
This study is being done in an attempt to improve the remission rate and the survival time for participants with high-risk myeloma
Additional relevant MeSH terms:
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Liposomal doxorubicin
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Anti-Inflammatory Agents
Autonomic Agents
Peripheral Nervous System Agents
Gastrointestinal Agents
Hormones, Hormone Substitutes, and Hormone Antagonists
Antineoplastic Agents, Hormonal
Antibiotics, Antineoplastic
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors