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A Randomized Phase III Trial of Melphalan and Dexamethasone (MDex) Versus Bortezomib, Melphalan and Dexamethasone (BMDex) for Untreated Patients With Systemic Light-Chain (AL) Amyloidosis Ineligible for Autologous Stem-Cell Transplantation


Phase 3
18 Years
N/A
Not Enrolling
Both
Light Chain Deposition Disease, Primary Systemic Amyloidosis

Thank you

Trial Information

A Randomized Phase III Trial of Melphalan and Dexamethasone (MDex) Versus Bortezomib, Melphalan and Dexamethasone (BMDex) for Untreated Patients With Systemic Light-Chain (AL) Amyloidosis Ineligible for Autologous Stem-Cell Transplantation


PRIMARY OBJECTIVES:

I. To compare hematologic overall response (partial response [PR], very good PR, amyloid
complete hematologic response [ACR], and stringent complete response [sCR]) after 3 courses
of therapy in patients with previously untreated systemic light-chain amyloidosis treated
with melphalan and dexamethasone with vs without bortezomib.

SECONDARY OBJECTIVES:

I. To evaluate the ACR rate after 3 courses of therapy and at completion of therapy.

II. To evaluate organ response rates after 3 courses of therapy and at 6, 9, and 12 months.

III. To evaluate treatment-related mortality. IV. To evaluate toxicity. V. To evaluate
progression-free and overall survival. VI. To evaluate PR or better at completion of
therapy. VII. To evaluate time to hematologic and organ response. VIII. To evaluate the
duration of hematologic and organ response. IX. To assess quality of life (QOL) at baseline,
at 3, 6, and 9 months during the therapy, at completion of therapy, and 3 and 6 months after
therapy.

TERTIARY OBJECTIVES:

I. To determine the prognostic impact of t(11;14) translocation and cyclin D1 overexpression
on response and overall survival.

II. (Correlative) To compare sCR rates and to determine the impact of sCR on the outcomes.

III. (Correlative) To perform a descriptive analysis of amyloid typing and proteomic
composition of amyloid tissues.

OUTLINE: This is a multicenter study. Patients are stratified according to cardiac stage (I
vs II) and are randomized to 1 of 2 treatment arms.

ARM I: Patients receive melphalan orally (PO) and dexamethasone PO on days 1-4. Treatment
repeats every 28 days for up to 9 courses in the absence of disease progression or
unacceptable toxicity.

ARM II: Patients receive melphalan PO and dexamethasone PO on days 1-4 and bortezomib
intravenously (IV) on days 1, 4, 8, and 11. Treatment repeats every 28 days for 2 courses.
Patients then receive melphalan PO and dexamethasone PO on days 1-4 and bortezomib IV on
days 1, 8, 15, and 22. Treatment repeats every 35 days for up to 6 courses in the absence of
disease progression or unacceptable toxicity.

Blood, urine, bone marrow, and fat samples may be collected periodically for laboratory
analysis. Health-related quality of life is assessed periodically before, during, and after
therapy. After completion of study treatment, patients are followed up periodically for 5
years.


Inclusion Criteria:



- Histologically confirmed diagnosis of systemic light-chain amyloidosis

- Histologic diagnosis of disease must be confirmed by pathology (positive Congo
red stain with green birefringence on polarized light microscopy)

- Genetic testing must be negative for transthyretin mutations associated with
hereditary amyloidosis (required in patients who are African-American or who present
with peripheral neuropathy as the dominant organ involvement)

- Measurable disease, defined by >= 1 of the following:

- Serum M-protein >= 1 g/dL by serum protein electrophoresis (SPEP)

- Serum kappa or lambda free light chain of >= 7.5 mg/dL allowed provided the
kappa to lambda free light chain ratio is abnormal

- Symptomatic organ involvement* (heart, kidney, liver/gastrointestinal tract,
peripheral nervous system, or soft tissue), defined as any of the following:

- NOTE: *Carpal tunnel syndrome skin purpura or the presence of vascular amyloid
on a bone marrow biopsy alone are not sufficient to meet criteria for
"symptomatic organ involvement"

- Renal involvement is defined as proteinuria (predominantly albumin) > 0.5 g/day
by 24-hour urine collection

- Cardiac involvement is defined as the presence of a mean left ventricular wall
thickness of > 12 mm by ECHO in the absence of a history of hypertension or
valvular heart disease or in the presence of unexplained low voltage (< 0.5 mV)
by ECG

- Hepatic involvement is defined as hepatomegaly or an alkaline phosphatase > 1.5
times upper limit of normal (ULN)

- Peripheral nerve involvement is defined by clinical history or abnormal sensory
and/or motor findings on neurologic exam

- Gastrointestinal (GI) involvement is defined as gross GI bleeding or diarrhea
(at least 4 stools per day over baseline); a positive GI biopsy is not
sufficient to document clinical involvement

- Autonomic nerve involvement is defined as orthostasis, symptoms of nausea or
dysgeusia, gastric atony by gastric emptying scan, diarrhea, or constipation

- Soft tissue and lymphatic involvement may be ascertained based on classic
physical exam findings (macroglossia, shoulder pad sign, raccoon eyes, carpal
tunnel syndrome, synovial enlargement, firm enlarged lymph nodes) or biopsy

- Amyloid cardiac biomarker stage I or II disease

- Staging defined by NT-proBNP and troponin T cut-offs of < 332 pg/mL and < 0.035
ng/mL, respectively, as thresholds: stage I, both under threshold; stage II,
either troponin or NT-proBNP (but not both) over threshold (if troponin T is not
available at local institution, troponin I may be used, but the threshold must
be < 0.1 ng/mL)

- No clinically overt myeloma (hypercalcemia or lytic bone lesions)

- Ineligible for autologous stem cell transplantation with melphalan 200 mg/m^2 or
refuses to undergo transplantation

- Eastern Cooperative Oncology Group (ECOG) performance status 0-2

- Absolute neutrophil count (ANC) > 1,500/mm^3

- Platelet count > 140,000/mm^3

- Hemoglobin > 11 g/dL

- Total bilirubin < 2.5 mg/dL

- Alkaline phosphatase < 5 times upper limit of normal (ULN)

- Aspartate aminotransferase (AST) < 3 times ULN

- Creatinine clearance > 30 mL/min

- Bone marrow plasma cells < 30%

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- No repetitive ventricular arrhythmias on 24-hour Holter electrocardiogram (ECG) (in
spite of antiarrhythmic treatment)

- The absence of supine systolic blood pressure < 100 mmHg and difficult to
managesymptomatic orthostatic hypotension

- No symptomatic orthostatic hypotension that is difficult to manage

- No cardiac syncope

- No uncompensated NYHA class III or IV congestive heart failure

- No uncontrolled infection

- No active malignancy within the past 5 years except for adequately treated basal cell
or squamous cell skin cancer, in situ cervical cancer, or adequately treated stage I
cancer currently in complete remission

- No serious medical or psychiatric illness likely to interfere with study
participation, including recent myocardial infarction (within the past 6 months) or
poorly controlled diabetes mellitus

- No peripheral neuropathy >= grade 2

- Human immunodeficiency virus (HIV)-positivity allowed provided the following criteria
are met:

- No history of acquired immunodeficiency syndrome (AIDS)-defining events
including history of CD4 cell count < 200/mm^3

- Current CD4 cell count >= 350/mm^3

- Not receiving zidovudine or stavudine

- No secondary amyloidosis

- No known hypersensitivity to bortezomib, boron, or mannitol

- No prior chemotherapy or radiotherapy for the treatment of myeloma or systemic
light-chain amyloidosis

- More than 3 weeks since radiotherapy

- Enrollment of subjects who require radiotherapy (which must be localized in
field size) should be deferred until the radiotherapy is completed and 3 weeks
have elapsed since the last date of therapy

- More than 14 days since prior and no concurrent participation in clinical trials with
other investigational agents not included in this trial

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Hematologic overall response (PR+VGPR+ACR+sCR)

Outcome Description:

Will be performed using Mantel-Haenszel test stratified on cardiac stage with an overall one-side type I error of 2.5%. The Mantel-Haenszel estimator is used to estimate the common odds ratio (BMDex/MDex), and a two-sided 95% confidence interval is also calculated.

Outcome Time Frame:

84 days (3 courses)

Safety Issue:

No

Principal Investigator

Angela Dispenzieri

Investigator Role:

Principal Investigator

Investigator Affiliation:

Eastern Cooperative Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2011-02010

NCT ID:

NCT01078454

Start Date:

November 2010

Completion Date:

Related Keywords:

  • Light Chain Deposition Disease
  • Primary Systemic Amyloidosis
  • Amyloidosis
  • Multiple Myeloma

Name

Location

Mayo Clinic Rochester, Minnesota  55905
University of Iowa Hospitals and Clinics Iowa City, Iowa  52242
University of Mississippi Medical Center Jackson, Mississippi  39216-4505
Washington University School of Medicine Saint Louis, Missouri  63110
Fox Chase Cancer Center Philadelphia, Pennsylvania  19111
University of Washington Medical Center Seattle, Washington  98195-6043
Boulder Community Hospital Boulder, Colorado  80301-9019
Porter Adventist Hospital Denver, Colorado  80210
Rose Medical Center Denver, Colorado  80220
Swedish Medical Center Englewood, Colorado  80110
Sky Ridge Medical Center Lone Tree, Colorado  80124
North Suburban Medical Center Thornton, Colorado  80229
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Fairview Ridges Hospital Burnsville, Minnesota  55337
Hutchinson Area Health Care Hutchinson, Minnesota  55350
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
Geisinger Medical Center Danville, Pennsylvania  17822-0001
Marshfield Clinic Marshfield, Wisconsin  54449
Methodist Medical Center of Illinois Peoria, Illinois  61636
University of Arkansas for Medical Sciences Little Rock, Arkansas  72205
Boston Medical Center Boston, Massachusetts  02118
Group Health Cooperative Seattle, Washington  98112
Great Falls Clinic Great Falls, Montana  59405
MetroHealth Medical Center Cleveland, Ohio  44109
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium Seattle, Washington  98109
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Bozeman Deaconess Hospital Bozeman, Montana  59715
Kalispell Medical Oncology Kalispell, Montana  59901
Kalispell Regional Medical Center Kalispell, Montana  59901
Harborview Medical Center Seattle, Washington  98104
Cancer Care Northwest - Spokane South Spokane, Washington  99202
Welch Cancer Center Sheridan, Wyoming  82801
Beebe Medical Center Lewes, Delaware  19958
Memorial Hospital Carthage, Illinois  62321
Galesburg Clinic Galesburg, Illinois  61401
Mason District Hospital Havana, Illinois  62644
McDonough District Hospital Macomb, Illinois  61455
BroMenn Regional Medical Center Normal, Illinois  61761
Proctor Hospital Peoria, Illinois  61614
Perry Memorial Hospital Princeton, Illinois  61356
Grandview Hospital Dayton, Ohio  45405
Providence Milwaukie Hospital Milwaukie, Oregon  97222
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
Eureka Hospital Eureka, Illinois  61530
Mercy Hospital Coon Rapids, Minnesota  55433
Graham Hospital Association Canton, Illinois  61520
Holy Family Medical Center Des Plaines, Illinois  60016
Saint Joseph Medical Center Joliet, Illinois  60435
Fairview-Southdale Hospital Edina, Minnesota  55435
Abbott-Northwestern Hospital Minneapolis, Minnesota  55407
Regions Hospital Saint Paul, Minnesota  55101
Saint Francis Regional Medical Center Shakopee, Minnesota  55379
Rice Memorial Hospital Willmar, Minnesota  56201
Geisinger Medical Group State College, Pennsylvania  16801
Miami Valley Hospital Dayton, Ohio  45409
Eastern Connecticut Hematology and Oncology Associates Norwich, Connecticut  06360
Bozeman Deaconess Cancer Center Bozeman, Montana  59715
Northern Montana Hospital Havre, Montana  59501
Wayne Hospital Greenville, Ohio  45331
Clinton Memorial Hospital Wilmington, Ohio  45177
Wenatchee Valley Medical Center Wenatchee, Washington  98801-2028
Marshfield Clinic Cancer Care at Regional Cancer Center Eau Claire, Wisconsin  54701
Marshfield Clinic - Weston Center Weston, Wisconsin  54476
Diagnostic and Treatment Center Weston, Wisconsin  54476
Marshfield Clinic - Wisconsin Rapids Center Wisconsin Rapids, Wisconsin  54494
Rocky Mountain Oncology Casper, Wyoming  82609
Longmont United Hospital Longmont, Colorado  80501
Greene Memorial Hospital Xenia, Ohio  45385
Union Hospital of Cecil County Elkton MD, Maryland  21921
Mayo Clinic in Arizona Scottsdale, Arizona  85259-5404
Mayo Clinic in Florida Jacksonville, Florida  32224
Memorial Medical Center Springfield, Illinois  62781
Queen's Medical Center Honolulu, Hawaii  96813
Northwest Cancer Specialists Vancouver, Washington  98664
Kapiolani Medical Center at Pali Momi Aiea, Hawaii  96701
Kapiolani Medical Center for Women and Children Honolulu, Hawaii  96826
Hennepin County Medical Center Minneapolis, Minnesota  
Cleveland Clinic Florida - Weston Weston, Florida  33331
Case Western Reserve University Cleveland, Ohio  44106
Emory University Atlanta, Georgia  30322
Wayne State University Detroit, Michigan  48202
Straub Clinic and Hospital Honolulu, Hawaii  96813
Providence Portland Medical Center Portland, Oregon  97213-3635
Indiana University Medical Center Indianapolis, Indiana  46202
Presbyterian - Saint Lukes Medical Center - Health One Denver, Colorado  80218
Montana Cancer Consortium CCOP Billings, Montana  59101
Metro-Minnesota CCOP St. Louis Park, Minnesota  
Providence Hospital Southfield, Michigan  48075
Tufts Medical Center Boston, Massachusetts  02111
Lakeview Hospital Stillwater, Minnesota  55082
Decatur Memorial Hospital Decatur, Illinois  62526
Montana Cancer Specialists Missoula, Montana  59807-7877
Castle Medical Center Kailua, Hawaii  96734
Clackamas Radiation Oncology Center Clackamas, Oregon  97015
Providence Newberg Medical Center Newberg, Oregon  97132
Littleton Adventist Hospital Littleton, Colorado  80122
Parker Adventist Hospital Parker, Colorado  80138
New Ulm Medical Center New Ulm, Minnesota  56073
OSF Saint Francis Medical Center Peoria, Illinois  61637
The Medical Center of Aurora Aurora, Colorado  80012
Penrose-Saint Francis Healthcare Colorado Springs, Colorado  80907
Saint Anthony Central Hospital Denver, Colorado  80204
Exempla Saint Joseph Hospital Denver, Colorado  80218
Colorado Cancer Research Program CCOP Denver, Colorado  80224-2522
Saint Mary's Hospital and Regional Medical Center Grand Junction, Colorado  81502
Saint Mary Corwin Medical Center Pueblo, Colorado  81004
Oncare Hawaii Inc-POB II Honolulu, Hawaii  96813
Oncare Hawaii Inc-Kuakini Honolulu, Hawaii  96817
University of Hawaii Honolulu, Hawaii  96813
Community Cancer Center Foundation Normal, Illinois  61761
Illinois CancerCare-Ottawa Clinic Ottawa, Illinois  61350
Ottawa Regional Hospital and Healthcare Center Ottawa, Illinois  61350
Pekin Cancer Treatment Center Pekin, Illinois  61554
Illinois Oncology Research Association CCOP Peoria, Illinois  61615
Illinois CancerCare-Peoria Peoria, Illinois  61615
Illinois Valley Hospital Peru, Illinois  61354
Saint Francis Hospital and Health Centers Beech Grove, Indiana  46107
Reid Hospital and Health Care Services Richmond, Indiana  47374
McFarland Clinic Ames, Iowa  50010
Mercy Medical Center-Sioux City Sioux City, Iowa  51104
Saint Luke's Regional Medical Center Sioux City, Iowa  51104
Green Bay Oncology - Escanaba Escanaba, Michigan  49431
Green Bay Oncology - Iron Mountain Iron Mountain, Michigan  49801
Unity Hospital Fridley, Minnesota  55432
Saint John's Hospital - Healtheast Maplewood, Minnesota  55109
Minnesota Oncology Hematology PA-Maplewood Maplewood, Minnesota  55109
North Memorial Medical Health Center Robbinsdale, Minnesota  55422
Park Nicollet Clinic - Saint Louis Park Saint Louis Park, Minnesota  55416
Minnesota Oncology and Hematology PA-Woodbury Woodbury, Minnesota  55125
Hematology-Oncology Centers of the Northern Rockies PC Billings, Montana  59101
Saint Vincent Healthcare Billings, Montana  59101
Billings Clinic Billings, Montana  59107-7000
Saint James Community Hospital and Cancer Treatment Center Butte, Montana  59701
Benefis Healthcare- Sletten Cancer Institute Great Falls, Montana  59405
Saint Peter's Community Hospital Helena, Montana  59601
Glacier Oncology PLLC Kalispell, Montana  59901
Saint Patrick Hospital - Community Hospital Missoula, Montana  59802
Cooper Hospital University Medical Center Camden, New Jersey  08103
Good Samaritan Hospital - Dayton Dayton, Ohio  45406
Dayton CCOP Dayton, Ohio  45429
Samaritan North Health Center Dayton, Ohio  45415
Blanchard Valley Hospital Findlay, Ohio  45840
Atrium Medical Center-Middletown Regional Hospital Franklin, Ohio  45005-1066
Kettering Medical Center Kettering, Ohio  45429
Upper Valley Medical Center Troy, Ohio  45373
Providence Saint Vincent Medical Center Portland, Oregon  97225
Columbia River Oncology Program Portland, Oregon  97225
Geisinger Wyoming Valley Wilkes-Barre, Pennsylvania  18711
Harrison Bremerton Hematology and Oncology Bremerton, Washington  98310
Columbia Basin Hematology and Oncology PLLC Kennewick, Washington  99336
Minor and James Medical PLLC Seattle, Washington  98104
The Polyclinic Seattle, Washington  98122
Swedish Medical Center-First Hill Seattle, Washington  98122-4307
Saint Vincent Hospital Green Bay, Wisconsin  54301
Green Bay Oncology Limited at Saint Mary's Hospital Green Bay, Wisconsin  54303
Saint Mary's Hospital Green Bay, Wisconsin  54303
Green Bay Oncology at Saint Vincent Hospital Green Bay, Wisconsin  54301-3526
Bay Area Medical Center Marinette, Wisconsin  54143
Marshfield Clinic-Minocqua Center Minocqua, Wisconsin  54548
Green Bay Oncology - Oconto Falls Oconto Falls, Wisconsin  54154
Marshfield Clinic at James Beck Cancer Center Rhinelander, Wisconsin  54501
Marshfield Clinic-Rice Lake Center Rice Lake, Wisconsin  54868
Green Bay Oncology - Sturgeon Bay Sturgeon Bay, Wisconsin  54235
Illinois CancerCare-Bloomington Bloomington%, Illinois  61701
Illinois CancerCare-Canton Canton, Illinois  61520
Illinois CancerCare-Carthage Carthage, Illinois  62321
Illinois CancerCare-Eureka Eureka, Illinois  61530
Illinois CancerCare-Havana Havana, Illinois  62644
Illinois CancerCare-Kewanee Clinic Kewanee, Illinois  61443
Illinois CancerCare-Macomb Macomb, Illinois  61455
Illinois CancerCare-Monmouth Monmouth, Illinois  61462
Illinois CancerCare-Community Cancer Center Normal, Illinois  61761
Illinois CancerCare-Pekin Pekin, Illinois  61603
Illinois CancerCare-Peru Peru, Illinois  61354
Illinois CancerCare-Princeton Princeton, Illinois  61356
Illinois CancerCare-Spring Valley Spring Valley, Illinois  61362
University of Michigan University Hospital Ann Arbor, Michigan  48109
Skagit Valley Hospital Mt. Vernon, Washington  98273
Evergreen Hematology and Oncology PS Spokane, Washington  99218
Marshfield Clinic-Chippewa Center Chippewa Falls, Wisconsin  54729
Holy Family Memorial Hospital Manitowoc, Wisconsin  54221
Marshfield Clinic Cancer Care at Saint Michael's Hospital Stevens Point, Wisconsin  54481
Kuakini Medical Center Honolulu, Hawaii  96817
Wilcox Memorial Hospital and Kauai Medical Clinic Lihue, Hawaii  96766-1099
Cancer Care Center at Island Hospital Anacortes, Washington  98221
Highline Medical Center-Main Campus Burien, Washington  98166
United General Hospital Sedro-Woolley, Washington  98284
Gundersen Lutheran La Crosse, Wisconsin  54601
Saint Nicholas Hospital Madison, Wisconsin  53715
The Jewish Hospital Cincinnati, Ohio  45236
Siouxland Hematology Oncology Associates Sioux City, Iowa  51101
Swedish Cancer Institute-Issaquah Issaquah, Washington  98029
Geisinger Medical Center-Cancer Center Hazelton Hazleton, Pennsylvania  18201
PeaceHealth Saint Joseph Medical Center Bellingham, Washington  98225
Christiana Care Health System-Christiana Hospital Newark, Delaware  19718
Harrison Poulsbo Hematology and Oncology Poulsbo, Washington  98370
PeaceHealth Southwest Medical Center Vancouver, Washington  98664
OnCare Hawaii-Liliha Honolulu, Hawaii  96817-3169
Providence Willamette Falls Medical Center Oregon City, Oregon  97045
Oncare Hawaii Inc - Kapiolani Medical Center at Pali Momi Aiea, Hawaii  96701