A Randomized Phase 2 Single-Center Study of Pomalidomide for Chronic GvHD
BACKGROUND:
- Chronic graft-versus-host disease (cGvHD) is the leading cause of non-relapse morbidity
and mortality in persons after allogeneic hematopoietic cell transplants.
- About 50% of persons with cGvHD have disease refractory to systemic corticosteroids and
there is no standard second-line therapy.
- Thalidomide, a drug with immune-modulating effects, was active in advanced cGvHD but
was difficult to use at appropriate doses.
- Pomalidomide is related to thalidomide but with higher potency and more favorable
toxicity profile. It is active in multiple myeloma and myeloproliferative neoplasm-
associated myelofibrosis. Preliminary data in humans with cGvHD are encouraging but
data are limited.
OBJECTIVES:
- Primary: Determine whether pomalidomide is effective in persons with moderate or severe
cGvHD not controlled by corticosteroids.
- Secondary:
- Determine whether pomalidomide is safe in persons with moderate or severe
cGvHD not controlled by corticosteroids.
- Determine the immune-modulatory effects of pomalidomide in persons with moderate or
severe cGvHD.
- Determine limited pharmacokinetics after oral administration of pomalidomide.
ELIGIBILITY:
Inclusion Criteria
- Moderate or severe cGvHD per NIH criteria
- Age 18 to 75 years old
- Karnofsky performance score greater than or equal to 60%
- Has cGvHD that did not respond to high-dose corticosteroids (average 0.5 mg/kg/d
prednisone for greater than or equal to 8 weeks) or second-line therapy
- Receiving stable or tapering doses of systemic therapy in the preceding 4 weeks
- Agree to adhere to methods of contraception and other fertility control measures as
prescribed by the protocol
Exclusion Criteria
- Acute GvHD (classic and late per NIH criteria)
- Absolute neutrophils < 1.0x10(9)/L, platelets < 75x10(9)/L, estimated creatinine
clearance < 50 mL/min/1.73m(2)
- NIH lung score 3
- Pregnant or lactating
- Uncontrolled infection
DESIGN:
Randomized phase 2 trial with the single stage selection design. Patients will receive
either a constant low dose of pomalidomide (0.5 mg/day) for six months or a strategy of
increasing dose of pomalidomide from 0.5 mg/d up through each individual patients' maximum
tolerated dose, with escalations by 0.5 mg/d every 2 weeks to a maximum of 2.0 mg/d. As an
early stopping rule for futility, if after 7 patients have enrolled on either arm, 0 have
responded, then no further patients will be accrued to that arm as soon as this can be
determined. To protect patient safety, an early stopping rule will be implemented. With two
arms, each of which has a maximal accrual of 16 patients, up to 32 evaluable patients will
be randomized. Response assessments will occur every 3 months with primary efficacy endpoint
evaluated at 6 months. Patients with responding disease will continue therapy for another 6
months.
Interventional
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Response rate
6 months
No
Steven Z Pavletic, M.D.
Principal Investigator
National Cancer Institute (NCI)
United States: Federal Government
120197
NCT01688466
August 2012
December 2014
Name | Location |
---|---|
National Institutes of Health Clinical Center, 9000 Rockville Pike | Bethesda, Maryland 20892 |