The investigators propose this study utilizing Lenalidomide, Adriamycin, Dexamethasone (RAD) as comparator arm for Lenalidomide, Bortezomib, Dexamethasone (VRD) with the latter being considered a novel "standard" as an induction protocol, since response in general occurs early after starting treatment we decided to choose three cycles of either induction regimen. Together with the "novel compounds", tandem high-dose melphalan is still the standard of care; it seems desirable to re-address the question of the number of transplant (single vs. double high-dose melphalan) procedures required in the context of triplet-induction protocols utilizing at least one of the novel compounds. Thus, the question to be asked in the current protocol is whether immediate lenalidomide maintenance (i.e. following one cycle of high-dose therapy) as an investigational agent will result in identical progression free survival (PFS) when compared to tandem high-dose melphalan with deferred maintenance therapy. Despite induction with novel compounds, approximately 25 - 40% of patients will be in less than very good partial response. Very recently, achievement of less than VGPR was confirmed to negatively impact on both PFS as well as overall survival (OS). Therefore, allogeneic stem cell transplantation is considered the standard of care in patients with suboptimal response to a first autograft. In the current protocol, the standard for favourable responders (tandem-autologous transplant) is combined with 3 years of lenalidomide maintenance. This approach will be investigated for patients with less than VGPR following a first autotransplant and compared to the current standard of intensification in poor responders (allogeneic transplantation).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
406
Induction: two versus one novel drug maintenance: lenalidomide as a maintenance therapy
Universitätsklinikum Aachen, Med. Klinik IV, Hämatologie u. Onkologie
Aachen, Germany
Schön Klinik Starnberger See, Hämatologie und Onkologie
Berg, Germany
Charité Campus Virchow-Klinikum, Hämatologie, Onkologie u. Tumorimmunologie
Berlin, Germany
Klinikum Bremen-Mitte gGmbH, Klinik für Innere Medizin I
Bremen, Germany
Universitätsklinikum Carl Gustav Carus an der TU Dresden, Medizinische Klinik und Poliklinik I
Dresden, Germany
The primary efficacy endpoint for the induction phase is the rate of patients with CR at first restaging
Time frame: within 8 days after end of last induction cycle ((Day 92(RAD); Day 71(VRD))
In the consolidation phase the primary efficacy endpoint for comparison II (response <VGPR after first ASCT) is the PFS rate
Time frame: 3 years after the first ASCT, calculated from day 1 of ASCT.
ORR following 3 cycles of induction treatment (VRD vs RAD)
Time frame: within 8 days after end of last induction cycle
CR and ORR at the end of the whole treatment programme
Time frame: at the end of the whole treatment programme (approx. 8 years)
Overall survival (OS)
Time frame: 8 years from study entry
Incidence, severity and relationship of SAEs
Time frame: 30 days post last dosing of study drug
Numbers of hospital stays and hospitalization days
Time frame: within two years from second restaging
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Universitätsklinikum Erlangen, Medizinische Klinik 5
Erlangen, Germany
Malteser Krankenhaus St. Franziskus-Hospital, medizinische Klinik I
Flensburg, Germany
Klinikum Frankfurt (Oder) GmbH Medizinische Klinik I
Frankfurt (Oder), Germany
Klinikum der Johann Woflgang Goethe Universität, Frankfurt am Mai
Frankfurt am Main, Germany
Universitätsklinikum Freiburg, Abteilung für Innere Medizin I
Freiburg im Breisgau, Germany
...and 22 more locations