Multiple Myeloma Clinical Trial
Melphalan and Stem Cell Transplant Before Total-Body Irradiation and Donor Stem Cell Transplant in Treating Patients With Stage I-III Multiple Myeloma
Summary
In this study donor bone marrow transplantation is divided into a two step process to try to significantly reduce the side effects of the procedure yet still provide patients with multiple myeloma the benefits of this procedure
Full Description
PRIMARY OBJECTIVES:
I. To evaluate engraftment of human leukocyte antigen (HLA) identical peripheral blood stem cell (PBSC) allografts given after conditioning with total-body irradiation (TBI) (200 cGy) and post-grafting immunosuppression with cyclosporine (CSP)/mycophenolate mofetil (MMF) in myeloma patients initially cytoreduced with high-dose melphalan.
II. To evaluate non-relapse mortality at day 100 post allografting. III. To evaluate the efficacy of this allografting strategy in terms of long-term progression free survival (PFS).
OUTLINE:
CONDITIONING REGIMEN: Patients receive high-dose melphalan intravenously (IV) over 15-20 minutes on day -2.
TRANSPLANTATION: Patients undergo autologous bone marrow or PBSC transplantation (PBSCT) on day 0.
NON-MYELOABLATIVE CONDITIONING REGIMEN: Beginning 40-120 days after autologous transplant, patients undergo TBI on day 0.
TRANSPLANTATION: Patients undergo donor PBSCT on day 0.
IMMUNOSUPPRESSION: Patients receive cyclosporine IV twice daily (BID) on days -1 and 0 and orally (PO) BID on days 1-80 with taper based on evaluation of disease response and graft-versus-host disease (GVHD). Patients also receive mycophenolate mofetil PO BID on days 0-27.
POST-TRANSPLANTATION DONOR LYMPHOCYTE INFUSION (DLI): Beginning 4 weeks after immunosuppression, patients achieving persistent or progressive disease may undergo DLI over 30 minutes every 4 weeks for up to 3 treatments.
After completion of study treatment, patients are followed up for 3 years.
Eligibility Criteria
Inclusion Criteria:
Meet Salmon and Durie criteria for initial diagnosis of multiple myeloma; transplant will be offered to patients with stage II or III multiple myeloma (MM) at diagnosis or have received chemotherapy and/or radiation therapy for progressive MM after initial diagnosis of stage I disease
The patient must have the capacity to give informed consent
Have received at least 4 cycles of conventional dose chemotherapy for MM
DONOR: HLA genotypically identical sibling
DONOR: Donor must consent to filgrastim (G-CSF) administration and leukapheresis for both peripheral blood stem cell (PBSC) allograft and subsequent DLI
DONOR: Donor must have adequate veins for leukapheresis or agree to placement of central venous catheter (femoral, subclavian)
DONOR: Age < 75, older donors may be considered after consultation by Psychological Consultation Center (PCC)
Exclusion Criteria:
Karnofsky score less than 60, unless due solely to myeloma
Left ventricular ejection fraction less than 40%
Bilirubin greater than 2 X the upper limit of normal
Serum glutamic pyruvic transaminase (SGPT) and serum glutamic oxaloacetic transaminase (SGOT) > 2 X the upper limit of normal
Diffusion lung capacity of carbon monoxide (DLCO) < 50% (corrected) or receiving continuous supplemental oxygen
Patients with poorly controlled hypertension
Pregnancy
Seropositive for the human immunodeficiency virus
Fertile men or women unwilling to use contraceptive techniques during and for 12 months following treatment
Creatinine clearance < 40 cc/min at the time of initial autografting evaluation
Prior autograft (can be treated on alternative protocol)
DONOR: Identical twin
DONOR: Age less than 12 years
DONOR: Pregnancy
DONOR: Infection with human immunodeficiency virus (HIV)
DONOR: Inability to achieve adequate venous access
DONOR: Known allergy to G-CSF
DONOR: Current serious systemic illness
DONOR: Failure to meet Fred Hutchinson Cancer Research Center (FHCRC) criteria for stem cell donation as described in the standard practice guidelines of the institution
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There are 4 Locations for this study
Duarte California, 91010, United States
Denver Colorado, 80217, United States
Seattle Washington, 98109, United States
Torino , 10126, Italy
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