Combination Chemotherapy, Peripheral Stem Cell Transplantation, Biological Therapy, Pamidronate and Thalidomide in Treating Patients With Multiple Myeloma
| Status: | Completed |
|---|---|
| Conditions: | Blood Cancer, Hematology, Hematology |
| Therapuetic Areas: | Hematology, Oncology |
| Healthy: | No |
| Age Range: | Any - 65 |
| Updated: | 1/14/2018 |
| Start Date: | April 13, 1999 |
| End Date: | January 9, 2018 |
Sequential High-Dose Melphalan and Busulfan/Cyclophosphamide Followed by Peripheral Blood Progenitor Cell Rescue, Interferon/Thalidomide and Pamidronate for Patients With Multiple Myeloma
RATIONALE: Drugs used in chemotherapy work in different ways to stop cancer cells from
dividing so they stop growing or die. Peripheral stem cell transplantation may allow doctors
to give higher doses of chemotherapy drugs and kill more cancer cells. Biological therapies,
such as interferon alfa, use different ways to stimulate the immune system and stop cancer
cells from growing. Thalidomide may stop the growth of cancer cells by stopping blood flow to
the tumor. Pamidronate may help to reduce the side effects of treatment for multiple myeloma.
PURPOSE: This phase II trial is studying combination chemotherapy, peripheral stem cell
transplantation, biological therapy, pamidronate, and thalidomide to see how well they work
in treating patients with stage I, stage II, or stage III multiple myeloma.
dividing so they stop growing or die. Peripheral stem cell transplantation may allow doctors
to give higher doses of chemotherapy drugs and kill more cancer cells. Biological therapies,
such as interferon alfa, use different ways to stimulate the immune system and stop cancer
cells from growing. Thalidomide may stop the growth of cancer cells by stopping blood flow to
the tumor. Pamidronate may help to reduce the side effects of treatment for multiple myeloma.
PURPOSE: This phase II trial is studying combination chemotherapy, peripheral stem cell
transplantation, biological therapy, pamidronate, and thalidomide to see how well they work
in treating patients with stage I, stage II, or stage III multiple myeloma.
OBJECTIVES:
- Determine the feasibility and toxic effects of high-dose melphalan, busulfan, and
cyclophosphamide followed by autologous peripheral blood stem cell rescue, interferon
alfa, and pamidronate in patients with responsive or stable, low-bulk multiple myeloma.
- Determine the response rate and progression-free and overall survival of patients
treated with this regimen.
- Determine the feasibility of adding thalidomide to interferon alfa and pamidronate in
patients who are not in complete remission (CR) 6 months after the second course of
high-dose chemotherapy.
- Determine whether administration of thalidomide can increase the CR rate in patients who
are not in CR 6 months after the second course of high-dose chemotherapy and determine
its effect on progression-free and overall survival of these patients.
- Determine the pharmacokinetics of busulfan and cyclophosphamide and correlate the
pharmacokinetics with the toxic effects of these drugs and outcome in these patients.
- Determine the effect of thalidomide on microvascular density of bone marrow and
correlate these possible effects with outcome in these patients.
- Determine the cytogenetics, gene rearrangement, and fluorescence in situ hybridization
in baseline and post treatment bone marrow and blood specimens and correlate the
presence/persistence of these features with treatment outcome in these patients.
OUTLINE: Patients receive cyclophosphamide IV over 2 hours on day 1 and filgrastim (G-CSF)
subcutaneously (SC) or IV twice a day beginning on day 2 and continuing until peripheral
blood stem cells (PBSCs) are collected. PBSCs are collected beginning on day 10.
Patients receive high-dose melphalan IV on day -1. PBSCs are reinfused on day 0. G-CSF is
administered IV or SC daily beginning on day 1 and continuing until blood counts recover.
Between 8 and 14 weeks later, patients receive high-dose busulfan IV every 6 hours on days -7
to -4 and cyclophosphamide IV over 2 hours on days -3 and -2. PBSCs are reinfused on day 0
and G-CSF is administered IV or SC daily until blood counts recover.
Patients with responding or stable disease after chemotherapy receive maintenance therapy
with interferon alfa beginning 14-20 weeks after day 0 of the second course of chemotherapy.
Interferon alfa is administered SC 3 times a week for 3 years. Patients also receive
pamidronate IV every 4 weeks until disease progression. Patients who are not in complete
remission (CR) 6 months after completing the second course of chemotherapy receive oral
thalidomide daily for a maximum of 1 year or for 3 months after achieving CR.
Patients are followed monthly for 1 year, every 3 months for 1 year, and then periodically
thereafter.
PROJECTED ACCRUAL: A total of 70 patients will be accrued for this study within approximately
2.5 years.
- Determine the feasibility and toxic effects of high-dose melphalan, busulfan, and
cyclophosphamide followed by autologous peripheral blood stem cell rescue, interferon
alfa, and pamidronate in patients with responsive or stable, low-bulk multiple myeloma.
- Determine the response rate and progression-free and overall survival of patients
treated with this regimen.
- Determine the feasibility of adding thalidomide to interferon alfa and pamidronate in
patients who are not in complete remission (CR) 6 months after the second course of
high-dose chemotherapy.
- Determine whether administration of thalidomide can increase the CR rate in patients who
are not in CR 6 months after the second course of high-dose chemotherapy and determine
its effect on progression-free and overall survival of these patients.
- Determine the pharmacokinetics of busulfan and cyclophosphamide and correlate the
pharmacokinetics with the toxic effects of these drugs and outcome in these patients.
- Determine the effect of thalidomide on microvascular density of bone marrow and
correlate these possible effects with outcome in these patients.
- Determine the cytogenetics, gene rearrangement, and fluorescence in situ hybridization
in baseline and post treatment bone marrow and blood specimens and correlate the
presence/persistence of these features with treatment outcome in these patients.
OUTLINE: Patients receive cyclophosphamide IV over 2 hours on day 1 and filgrastim (G-CSF)
subcutaneously (SC) or IV twice a day beginning on day 2 and continuing until peripheral
blood stem cells (PBSCs) are collected. PBSCs are collected beginning on day 10.
Patients receive high-dose melphalan IV on day -1. PBSCs are reinfused on day 0. G-CSF is
administered IV or SC daily beginning on day 1 and continuing until blood counts recover.
Between 8 and 14 weeks later, patients receive high-dose busulfan IV every 6 hours on days -7
to -4 and cyclophosphamide IV over 2 hours on days -3 and -2. PBSCs are reinfused on day 0
and G-CSF is administered IV or SC daily until blood counts recover.
Patients with responding or stable disease after chemotherapy receive maintenance therapy
with interferon alfa beginning 14-20 weeks after day 0 of the second course of chemotherapy.
Interferon alfa is administered SC 3 times a week for 3 years. Patients also receive
pamidronate IV every 4 weeks until disease progression. Patients who are not in complete
remission (CR) 6 months after completing the second course of chemotherapy receive oral
thalidomide daily for a maximum of 1 year or for 3 months after achieving CR.
Patients are followed monthly for 1 year, every 3 months for 1 year, and then periodically
thereafter.
PROJECTED ACCRUAL: A total of 70 patients will be accrued for this study within approximately
2.5 years.
DISEASE CHARACTERISTICS:
- Histologically proven stage I-III multiple myeloma
- Less than 18 months since diagnosis
- Smoldering myeloma allowed if there is evidence of progressive disease requiring
therapy
- At least 25% increase in M protein levels or Bence Jones excretion
- Hemoglobin no greater than 10.5 g/dL
- Hypercalcemia
- Frequent infections
- Rise in serum creatinine above normal on 2 separate occasions
- Nonquantifiable monoclonal proteins allowed if other criteria for multiple
myeloma or smoldering myeloma are met
- Response/status after induction therapy:
- Responding or stable disease AND no greater than 40% myelomatous involvement of
bone marrow
- No Waldenstrom's macroglobulinemia
PATIENT CHARACTERISTICS:
Age:
- 65 and under
Performance status:
- Karnofsky 80-100%
Life expectancy:
- Not specified
Hematopoietic:
- See Disease Characteristics
- Absolute neutrophil count greater than 1,500/mm^3
- Platelet count greater than 100,000/mm^3
Hepatic:
- Bilirubin no greater than 1.5 mg/dL
- SGOT and SGPT less than 2.5 times upper limit of normal
- Hepatitis B antigen or hepatitis C RNA negative
Renal:
- See Disease Characteristics
- Creatinine no greater than 1.4 mg/dL
- Creatinine clearance greater than 65 mL/min
Cardiovascular:
- Cardiac ejection fraction at least 50% by MUGA or echocardiogram
Pulmonary:
- FEV_1 greater than 60%
- DLCO greater than 50% of predicted lower limit
Other:
- Not pregnant
- Negative pregnancy test
- Fertile patients must use effective contraception
- HIV negative
- No other medical or psychosocial problems that would increase patient risk
- No other malignancy within past 5 years except nonmelanomatous skin cancer or
carcinoma in situ of the cervix
- No known hypersensitivity to filgrastim (G-CSF) or E. coli-derived proteins
PRIOR CONCURRENT THERAPY:
Biologic therapy:
- Not specified
Chemotherapy:
- See Disease Characteristics
- No more than 3 prior chemotherapy regimens
- At least 4 weeks since prior chemotherapy
Endocrine therapy:
- Not specified
Radiotherapy:
- At least 4 weeks since prior radiotherapy
Surgery:
- Not specified
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