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
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.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
40
City of Hope
Duarte, California, United States
University of Colorado
Denver, Colorado, United States
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
Seattle, Washington, United States
University of Torino
Torino, Italy
PFS
The current study will be regarded as potentially efficacious if the observed 3-year PFS rate among all patients treated exceeds 30%. The Kaplan-Meier (KM) estimate of PFS will be used.
Time frame: From the date of transplant until the time of progression, relapse, death, or the date the patient was last known to be in remission, up to 3 years
Decrease in the short-term transplant-related mortality
Time frame: Day 100 after allograft
Establish stable allogeneic engraftment (mixed or full donor chimerism)
Time frame: At day 56 after allografting
Overall survival
Estimated by the method of Kaplan and Meier. Confidence intervals will be estimated.
Time frame: Up to 3 years
Relapse rate
Summarized using cumulative incidence estimates. Confidence intervals will be estimated.
Time frame: Up to 3 years
Response rate
Confidence intervals will be estimated.
Time frame: Up to 3 years
Ability to convert mixed to full donor chimerism with DLI
Confidence intervals will be estimated.
Time frame: Up to 3 years
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Undergo autologous bone marrow or PBSCT
Undergo TBI
Undergo donor PBSCT
Given IV and PO
Given PO
Undergo DLI