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Phase I/II Study of Autologous Stem Cell Transplantation after Chemotherapy and Immunotherapy Followed by Thalidomide in Patients With High-Risk or Refractory Multiple Myeloma
Alternate Title Basic Trial Information Objectives Entry Criteria Expected Enrollment Outcomes Outline Trial Contact Information Registry Information
Alternate Title
Stem Cell Transplant, Chemotherapy, and Biological Therapy in Treating Patients With High-Risk or Refractory Multiple Myeloma
Basic Trial Information
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Phase
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Type
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Status
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Age
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Sponsor
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Protocol IDs
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Phase II, Phase I
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Biomarker/Laboratory analysis, Treatment
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Active
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18 to 80
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NCI
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MSGCC-0610-GCC 0610 GCC, UPCC-0610-GCC, NCT00499577
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Objectives Primary - To evaluate the safety of combination immunotherapy using activated T-cells and an
hTERT/survivin multipeptide vaccine in the post-autotransplant (autologous stem cell transplantation) setting and
whether it delays hematopoietic recovery or induces autoimmune events.
- To determine whether the strategy of infusing vaccine-primed T-cells early after
transplant in conjunction with post-transplant booster immunizations leads to the
induction of cellular immune responses to the putative tumor antigens hTERT ( the
catalytic subunit of telomerase) and survivin.
- To determine if combination immunotherapy as delivered to arm I patients
increases the frequency of delayed paraprotein responses between 60 days and
6 months post-transplant, sufficient to upgrade the maximal level of myeloma
response, when compared to non-vaccinated (arm II) patients.
Secondary - To determine if adoptive transfer of hTERT/survivin-primed T-cells in
conjunction with multi-peptide booster immunizations generates cytotoxic T-cell
responses to autologous myeloma cells in vivo.
- To evaluate myeloma clinical responses including the frequency of complete and
partial responses and the 1 & 2-year event-free and overall survivals.
- To measure antibody responses to 4 of the 7 serotypes contained in the pneumococcal polyvalent vaccine
as well as T-cell responses to the CRM-197 carrier protein and to a CMV peptide
antigen.
- To evaluate levels of hTERT and survivin expression in patient myeloma cells.
Entry Criteria Disease Characteristics:
- Diagnosis of myeloma meeting 1 of the following criteria:
- Myeloma has relapsed, progressed, or failed to respond after at least one
prior course of therapy (consisting of at least 2 treatment cycles or months of therapy)
- Failure to respond would correspond to a reduction
of less than or equal to 25% of the original, diagnostic serum or urine
paraprotein measurement
- Myeloma has responded partially to initial therapy but a complete
response (immunofixation negative) has NOT developed after a
minimum of 3 cycles or months of initial therapy
- Myeloma has high-risk features as defined by the presence of one or
more cytogenetic abnormalities known to confer a poor outcome even
after standard autotransplants (e.g., complex karyotype [≥ 3
abnormalities], t(4;14), t(14;16), del (17) (p13.1), and/or chromosome 13
abnormalities)
- May be enrolled even while in complete or
near-complete remission
- Extended disease-free survival after
autotransplantation would be unexpected for these patients and therefore
especially meaningful
- Must have measurable disease
- Measurable disease
may include quantifiable or detectable levels of serum or urine paraprotein
- For patients with minimally secretory disease or non-secretory myeloma on
study entry, serum free λ or κ light chain levels may be measured and used
for disease monitoring if abnormal
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Patients who are in complete remission at the time of proposed study entry
(serum and urine immunofixation consistently negative) are not eligible
unless their disease meets the criteria for high-risk disease
- No known history of myelodysplasia
Prior/Concurrent Therapy:
Inclusion criteria - Recovered from any toxicities related to prior therapy or at
least returned to their baseline level of organ function
- Patients should be off of glucocorticoids for at least 2 weeks and/or thalidomide
therapy for at least 1 week prior to enrollment
- At least 2 weeks since prior steroid therapy or chemotherapy
Exclusion criteria - Prior autotransplant or allogeneic transplant
- More than 4 distinct, prior courses of therapy for myeloma
- Also see Disease Characteristics
Patient Characteristics:
Inclusion criteria: - ECOG performance status 0-2 (unless due solely to bone pain)
- Creatinine ≤ 3.0 mg/dL and not on dialysis
- WBC ≥ 3,000/mm³
- Platelet count ≥ 100,000/mm³
- AST ≤ 2 times upper limit of normal
- Bilirubin ≤ 2.0 mg/dL
(unless due to Gilbert’s syndrome)
- LVEF ≥ 45%
- A
lower LVEF is permissible if a formal cardiologic evaluation
reveals no evidence for clinically significant functional
impairment
- FEV1, FVC, TLC, and DLCO ≥ 40%
predicted
- Patients who are unable to
complete pulmonary function tests due to bone pain or fracture must have a high-resolution CT scan of the chest and must have acceptable arterial
blood gases (room air PO2 > 70 mmHg)
- Women of child-bearing potential and their spouses or partners
must be willing to use adequate contraception for the duration of the active
treatment phase of the study
- Contraceptive measures must be
continued as long as the patient remains on maintenance thalidomide in accordance
with the STEPS program
Exclusion criteria - Pregnant or nursing
- HIV, HTLV-1/2 seropositivity
- Known history of chronic active hepatitis or liver cirrhosis (if suspected
by laboratory studies, should be confirmed by liver biopsy)
- Active hepatitis B (as defined by positive hepatitis B surface antigen)
- Positive hepatitis C virus (HCV) antibody is NOT an exclusion
- History of severe autoimmune disease requiring steroids or other
immunosuppressive treatments
- Active immune-mediated diseases including:
- Connective tissue diseases
- Uveitis
- Sarcoidosis
- Inflammatory bowel disease
- Multiple sclerosis
- Evidence or history of other significant cardiac, hepatic, renal,
ophthalmologic, psychiatric, or gastrointestinal disease that might
increase the risks of participating in the study
- Active bacterial, viral or fungal infections.
Expected Enrollment 56Outcomes Primary Outcome(s)Toxicity at 21 and 28 days post-transplant T-cell responses against the hTERT vaccine as measured by tetramer assays at 100 days post-transplant Paraprotein levels in the blood or urine and serum free light chain analyses at 60 days and at 6 months post-transplant
Secondary Outcome(s)
Cytotoxic T-cell responses against autologous myeloma cell at day 100 post-transplant via chromium-51 release or flow-based
assays Maximum clinical response 1 and 2-year event-free survival Overall survival rates CD4 and CD8 T-cell
responses against cytomegalovirus (CMV) at days 60 and 100 post-transplantation by CFSE dye dilution
assays Composite binding antibody responses at days 60 and day 100 post-transplant by ELISA
Outline This is a multicenter study. Patients are stratified according to HLA-A2 status (positive vs negative). Patients are assigned to 1 of 2 treatment groups based on stratification. - Immunization 1:
- Group 1 (HLA-A2 positive): Patients receive the following peptides emulsified in incomplete Freund's adjuvant VG: I) hTERT I540 peptide; ii)
hTERT R572Y peptide; iii) hTERT D988Y peptide; iv) survivin Sur1M2 peptide ; and v) CMV control
peptide N495 subcutaneously (SC). Patients also receive sargramostim (GM-CSF) SC and pneumococcal
conjugate vaccine (PCV) intramuscularly (IM).
- Group 2: Patients receive PCV vaccine IM and GM-CSF
SC.
- Steady-state T-cell harvesting:About 10 days (range 7–14) after immunization #1, all patients undergo a
mononuclear cell apheresis procedure to collect steady-state T-cells that are cryopreserved for later expansion.
- Stem cell mobilization: After completion of the mononuclear cell apheresis procedure, all patients are offered
DT-PACE chemotherapy for cytoreduction and stem cell mobilization. This regimen is as follows:
dexamethasone once daily for 4 days; thalidomide once daily for 4 days; cisplatin IV continuously over 4 days (patients with serum creatinine levels ≥ 2.0 mg/dL do not receive cisplatin); doxorubicin hydrochloride IV continuously over 4 days; cyclophosphamide IV continuously over 4 days; etoposide IV continuously over 4 days. Patients also receive filgrastim (G-CSF) SC once daily starting on the day after completion of
chemotherapy. An acceptable alternative for stem cell mobilization is to use
cyclophosphamide IV over 12 hours or, for patients who require that outpatient stem cell mobilization
procedures be performed, cyclophosphamide IV over 2 hours. The cyclophosphamide mobilization regimen should
be used if the patient has already received DTPACE as part of the pre-transplant
therapy.
- High-dose therapy: High-dose therapy will consist of melphalan IV over 20 minutes on day -1. Autologous stem cell infusion takes place on
day 0, at least 18 hours after the administration of the high-dose melphalan. Stem cells
are infused IV over 20-60 minutes. G-CSF SC should be administered beginning on day +5.
- Autologous T-cell expansion and infusion: Cryopreserved cells are expanded ex vivo for up to 12 days and prepared for infusion on day 2 post-transplant.
- Infusion of autologous T-cells: The costimulated (“activated”) T-cells are infused over 20-60
minutes on day +2 of transplant.
- Immunizations 2, 3, and 4:
- Group 1: On days 14, 42, and 90 post-transplant, patients receive peptides, PCV, and GM-CSF as in group I of immunization # 1.
- Group 2: On day 14, 42, 90 post-transplant, patients receive PCV and GM-CSF as in group II of immunization # 1.
- Maintenance therapy: At day 180 post-transplant, after completion of post-transplant
immunological assessments, patients receive low-dose
thalidomide in the absence of disease progression or unacceptable toxicity.
Blood is collected at T-cell harvest and days 14, 60, 100, and 180 post-transplant. Samples are analyzed by quantitative CD3/CD4/CD8 studies, cellular immunoassays, antibody immunoassays, and gene expression. After completion of study treatment, patients are followed periodically.
Trial Contact Information
Trial Lead Organizations Greenebaum Cancer Center at University of Maryland Medical Center ![](https://webarchive.library.unt.edu/eot2008/20081016025213im_/http://www.cancer.gov/images/spacer.gif) | ![](https://webarchive.library.unt.edu/eot2008/20081016025213im_/http://www.cancer.gov/images/spacer.gif) | ![](https://webarchive.library.unt.edu/eot2008/20081016025213im_/http://www.cancer.gov/images/spacer.gif) | Aaron Rapoport, MD, Principal investigator | ![](https://webarchive.library.unt.edu/eot2008/20081016025213im_/http://www.cancer.gov/images/spacer.gif) | | ![](https://webarchive.library.unt.edu/eot2008/20081016025213im_/http://www.cancer.gov/images/spacer.gif) | Trial Sites
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U.S.A. |
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Maryland |
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Baltimore |
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| | | | | | | | Greenebaum Cancer Center at University of Maryland Medical Center |
| | Clinical Trials Office - Greenebaum Cancer Center at University of Maryladn Medical Center | |
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Pennsylvania |
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Philadelphia |
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| | | Abramson Cancer Center of the University of Pennsylvania |
| | Clinical Trials Office - Abramson Cancer Center of the University of Pennsylvania | |
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Registry Information | ![](https://webarchive.library.unt.edu/eot2008/20081016025213im_/http://www.cancer.gov/images/spacer.gif) | Official Title | | Phase I/II Combination Immunotherapy After ASCT for Advanced Myeloma to Study HTERT Vaccination Followed by Adoptive Transfer of Vaccine-Primed Autologous T Cells | ![](https://webarchive.library.unt.edu/eot2008/20081016025213im_/http://www.cancer.gov/images/spacer.gif) | Trial Start Date | | 2006-12-26 | ![](https://webarchive.library.unt.edu/eot2008/20081016025213im_/http://www.cancer.gov/images/spacer.gif) | Trial Completion Date | | 2009-06-26 (estimated) | ![](https://webarchive.library.unt.edu/eot2008/20081016025213im_/http://www.cancer.gov/images/spacer.gif) | Registered in ClinicalTrials.gov | | NCT00499577 | ![](https://webarchive.library.unt.edu/eot2008/20081016025213im_/http://www.cancer.gov/images/spacer.gif) | Date Submitted to PDQ | | 2007-05-30 | ![](https://webarchive.library.unt.edu/eot2008/20081016025213im_/http://www.cancer.gov/images/spacer.gif) | Information Last Verified | | 2008-08-14 | ![](https://webarchive.library.unt.edu/eot2008/20081016025213im_/http://www.cancer.gov/images/spacer.gif) | NCI Grant/Contract Number | | CA130293 |
Note: The purpose of most clinical trials listed in this database is to test new cancer treatments, or new methods of diagnosing, screening, or preventing cancer. Because all potentially harmful side effects are not known before a trial is conducted, dose and schedule modifications may be required for participants if they develop side effects from the treatment or test. The therapy or test described in this clinical trial is intended for use by clinical oncologists in carefully structured settings, and may not prove to be more effective than standard treatment. A responsible investigator associated with this clinical trial should be consulted before using this protocol. Back to Top |
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