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Bendamustine in Combination With Lenalidomide and Dexamethasone in Refractory or Relapsed Multiple Myeloma

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: NCT01042704
Recruitment Status : Completed
First Posted : January 5, 2010
Last Update Posted : July 31, 2017
Information provided by (Responsible Party):
Robert Redner, MD, University of Pittsburgh

Brief Summary:
The purpose of this study is to see if the combination of bendamustine, lenalidomide and dexamethasone will help people with multiple myeloma that has returned after standard treatment or has been resistant to other treatments.

Condition or disease Intervention/treatment Phase
Myeloma Drug: Bendamustine Drug: Lenalidomide Drug: Dexamethasone Drug: Aspirin Drug: Prophylaxis Drug: Antibiotic Other: Biweekly Follow Up Other: Cyclical Follow Up Other: Restaging Other: Post-Treatment Follow Up Phase 1

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 29 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I Study of Bendamustine in Combination With Lenalidomide (CC-5013) and Dexamethasone in Patients With Refractory or Relapsed Multiple Myeloma
Study Start Date : February 2008
Actual Primary Completion Date : January 2011
Actual Study Completion Date : March 2015

Arm Intervention/treatment
Experimental: Bendamustine, Lenalidomide and Dexamethasone
Treatment with Bendamustine in combination with Lenalidomide and Dexamethasone will be administered on an outpatient basis. Each treatment cycle will be 28 days dosed according to the Dose Escalation Schema.
Drug: Bendamustine
Bendamustine is given intravenously (into a vein or IV infusion) on days 1 and 2 of each cycle. Each bendamustine infusion will take 60 minutes

Drug: Lenalidomide
Lenalidomide is taken orally (by mouth) in the morning on days 1 through 21 of each cycle.

Drug: Dexamethasone
Dexamethasone is taken orally (by mouth) on days 1, 8, 15, and 22 of each cycle.

Drug: Aspirin
All patients will receive enteric coated aspirin, 325 mg, QD while on study. If patient is unable to tolerate aspirin, patient should receive other types of anti-coagulation like Coumadin or low molecular weight heparin.

Drug: Prophylaxis
All patients will receive prophylaxis with either an H-2 blocker or proton pump inhibitor (PPI) while on study medications. Suggested medications included ranitidine 150 mg PC BID or omeprazole 20 mg PO QD or equivalent.

Drug: Antibiotic
PCP antibiotic prophylaxis with a Bactrim will be recommended. In case of history of zoster or fungal infection a prophylaxis with Acyclovir or Diflucan should be also considered.

Other: Biweekly Follow Up
Vital signs (heart rate, breathing rate, blood pressure, and temperature) will be measured, and Blood tests to check CBC, Calcium, Electrolytes, serum, creatinine, and BUN. This follow up will take place at the Hillman Cancer Center, or whichever cancer center in which the subject is treated.

Other: Cyclical Follow Up
At the beginning of each treatment cycle subjects will undergo a Physical exam, a Performance status check, Recording of any new symptoms or side effects and any new medications, Blood tests (including blood chemistry, organ function and indicators of disease), Urine test, and pregnancy test (if applicable).

Other: Restaging
Every other cycle subjects' disease will be restaged. This will be accomplished by their treatment physician. Re-staging procedures includes a regular office visit, x-ray, and a bone marrow biopsy. Subjects will spend approximately 4 hours at the Hillman Cancer Center or the UPMC Cancer Center location where they are being treated for this re-staging.

Other: Post-Treatment Follow Up

After subjects stop receiving the study drugs, they will be followed every 3 months for the first two years, every 6 months for years 2-5, and annually thereafter. The following procedures, which are considered routine for their cancer care, will be done as part of this follow-up:

  • Physical exam
  • Performance status (check of ability to perform daily functions)
  • Recording of any new symptoms and any new medications being taken
  • Blood tests to check blood counts (numbers of red and white blood cells and platelets), blood chemistry (to check organ function), and indicators of disease (immunoglobulins)
  • Urine test (24hr urine)
  • Women who are able to have children will have a pregnancy test (4 weeks after their last dose of lenalidomide).
  • A check of the status of disease (includes bone marrow biopsy, skeletal survey, and blood and urine tests). Bone marrow biopsy will be done at the end of treatment, if subjects have a complete response, and their disease gets worse.

Primary Outcome Measures :
  1. To establish the dose of each drug recommended for a future Phase II protocol with the combination [ Time Frame: 1 year ]

Secondary Outcome Measures :
  1. To explore anti-tumor activity of the combination of Bendamustine plus Lenalidomide and dexamethasone [ Time Frame: 2.5 years ]
  2. Toxicity, time to progression, overall survival. [ Time Frame: 2.5 years ]

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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

Inclusion Criteria:

  • Patients must have histologically or cytologically confirmed symptomatic Multiple Myeloma, Salmon-Durie Stage II or III or International Staging System II or III that has been previously treated with at least one cycle of a specific therapy; after which the patient has shown progressive or refractory disease, and must meet at least one of the following parameters of measurable disease:
  • Bone marrow plasmacytosis with > 10% plasma cells, or sheets of plasma cells, or biopsy proven plasmacytoma which must be obtained within 6 weeks prior to registration.
  • Measurable levels of monoclonal protein (M protein): > 1 g/dL of IgG or IgM M-protein or > 0.5 g/dL IgA or IgD M protein on serum protein electrophoresis OR > 200 mg of free light chain on a 24 hour urine protein electrophoresis which must be obtained within 4 weeks prior to registration OR > 20 mg/dL involved free light chain on serum free light chain testing with an abnormal kappa:lambda light chain ratio. Note that if both serum and urine m-components are present, both must be followed in order to evaluate response. Both SPEP and UPEP must be performed within 28 days prior to registration.
  • Patients with lytic bone disease, defined as at least one lytic lesion that can be accurately measured in at least one dimension.
  • Patients must have received prior chemotherapy for their myeloma, but not in the last 4 weeks. Patients may have previously received autologous peripheral blood stem cell transplantation. Prior treatment with lenalidomide is allowed.
  • Patients should not have received any radiation for the preceding 4 weeks before entry onto the study. Exception: local radiation therapy for symptomatic bone lesions (eg,uncontrolled pain or high risk of pathologic fracture)
  • Age >= 18 years
  • Life expectancy of greater than 6 months.
  • ECOG performance status >=2 (Karnofsky >=60%). Patients with PS of 3 are eligible if their PS is due to pain, which would likely improve with treatment.
  • Patients must have normal organ and marrow function as defined below, obtained within 4 weeks prior to registration:

    • Hgb > 9 g/dL (which may be supported by transfusion or growth factors)
    • leukocytes >=2,000/ml
    • absolute neutrophil count ≥1000/ ml
    • platelets >=75,000/mcL
    • total bilirubin >=2.5 mg/dl
    • AST(SGOT)/ALT(SGPT) >=5 X institutional upper limit of normal
    • creatinine <2.5 mg/dl
  • Patients must not be pregnant or breast feeding. Due to the potential teratogenic properties of lenalidomide, the use of this drug in patients that are pregnant is absolutely contraindicated. Further, all women of childbearing potential and sexually active males must agree to avoid conception while participating in this study. Specifically, women of childbearing potential must either agree to refrain from sexual intercourse or employ a dual method of contraception, one of which is highly effective (IUD, birth control pills, tubal ligation or partners vasectomy), and another additional method (condom, diaphragm, or cervical cap) for 4 weeks prior to receiving lenalidomide, and for four weeks after discontinuing this therapy. Sexually active males cannot participate unless they agree to use a condom (even if they have undergone a prior vasectomy) while having intercourse with a woman of child bearing potential while taking lenalidomide and for four weeks after stopping treatment. Women of child bearing potential (those who have not had a hysterectomy or the absence of menstrual periods for at least 24 consecutive months) must have a negative pregnancy test 10-14 days prior to the initiation of therapy and a repeat negative pregnancy test 24 hours prior to the initiation of lenalidomide.
  • Ability to understand and the willingness to sign a written informed consent document. Patient must be informed of the investigational nature of this study.

Exclusion Criteria:

  • Patients who have had chemotherapy or radiotherapy within 4 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier. Exception: local radiation therapy for symptomatic bone lesions (eg, uncontrolled pain or high risk of pathologic fracture)
  • Patients receiving any other investigational agents.
  • Patients with known brain metastases will 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.
  • Patients with a history of allergic reactions attributed to compounds of similar chemical or biologic composition to lenalidomide and/or Bendamustine or other agents used in the study.
  • Patients with a second malignancy other than squamous/basal cell carcinoma of the skin or in situ carcinoma of the cervix unless the tumor was curatively treated at least two years previously.
  • Inability to comply with study and/or follow-up procedures.
  • If a patient is on full-dose anticoagulants, the following criteria should be met for enrollment:

    • Must not have active bleeding or pathological conditions that carry high risk of bleeding (e.g. tumor involving major vessels, known varices).
    • Must have a platelet count >75,000.
    • Must have stable INR between 2-3.
  • Patients who have not collected hematopoietic progenitors and are potential candidates for autologous transplantation .
  • Patients that have a serious cardiac condition, such as myocardial infarction within 6 months or heart disease as defined by the New York Heart Association Class III or IV,
  • Patients with prior allogeneic stem cell transplant.
  • Non-secretory patients (i.e., patients who do not meet the minimum M-protein or light chain criteria)

Information from the National Library of Medicine

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): NCT01042704

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Sponsors and Collaborators
Robert Redner, MD
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Principal Investigator: Robert L Redner, M.D. University of Pittsburgh Physicians, Hematology/Oncology
Zangari M, Tricot G, Zeldis J, Eddlemon P, Saghafifar F, Barlogie B. Results of phase I study of CC-5013 for the treatment of multiple myeloma (MM) patients who relapse after high dose chemotherapy (HDCT). Blood. 2001 :775a (A3226).
Richardson P, Jagannath 5, Schlossman R, eta!. A multi-center, randomized, phase 2 study to evaluate the efficacy and safety of 2 CC-5013 dose regimens when used alone or in combination with dexamethasone (Dex) for the treatment of relapsed or refractory multiple myeloma (MM). Blood. 2003;1 02:235a.
Dimopoulos MA, Spencer A, Attal M, a!. e. Study of lenalidomide plus dexamethasone versus dexamethasone alone in relapsed or refractory multiple myeloma (MM); results of a phase 3 study (MM-01 0). Blood. 2005:106:1 06a (abstract).
Weber DM, Chen D, Niesvizky R, et al. Lenalidomide plus high-dose dexamethasone provides improved overall survival compared to high-dose dexamethasone alone for relapsed or refractory multiple myeloma (MM): results of a North American phase Ill study (MM-009). Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings. 2006;24(1 8S):Abstract #7521.
Hrusovsky I, Heidtmann H, (ASH Annual Meeting Abstracts) Blood 2005 106:abstract 5122

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Robert Redner, MD, Professor, Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh Identifier: NCT01042704    
Other Study ID Numbers: 07-089
First Posted: January 5, 2010    Key Record Dates
Last Update Posted: July 31, 2017
Last Verified: July 2017
Keywords provided by Robert Redner, MD, University of Pittsburgh:
Relapsed Myeloma
Refractory Myeloma
Additional relevant MeSH terms:
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Multiple Myeloma
Neoplasms, Plasma Cell
Neoplasms by Histologic Type
Hemostatic Disorders
Vascular Diseases
Cardiovascular Diseases
Blood Protein Disorders
Hematologic Diseases
Hemorrhagic Disorders
Lymphoproliferative Disorders
Immunoproliferative Disorders
Immune System Diseases
Anti-Bacterial Agents
Bendamustine Hydrochloride
Anti-Inflammatory Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Gastrointestinal Agents
Hormones, Hormone Substitutes, and Hormone Antagonists
Antineoplastic Agents, Hormonal
Antineoplastic Agents