This phase I/II trial studies the side effects and best dose of bortezomib when given together with melphalan, and total-body irradiation before stem cell transplant and to see how well it works in treating patients with multiple myeloma. Giving chemotherapy and total-body irradiation before a stem cell transplant stops the growth of cancer cells by stopping them from dividing or killing them. The stem cells that were collected from the patient's blood or bone marrow are returned to the patient to replace the blood-forming cells that were destroyed by the chemotherapy and total-body irradiation.
PRIMARY OBJECTIVES: I. To determine the maximum tolerated dose (MTD) of bortezomib that can be added to high dose melphalan and low dose total body irradiation as part of conditioning chemotherapy for myeloma. (Phase I) II. To determine the efficacy of the bortezomib added to high dose melphalan and low dose total-body irradiation (TBI) in patients with myeloma undergoing stem cell transplantation, as defined by achievement of complete response (CR). (Phase II) SECONDARY OBJECTIVES: I. To examine the toxicities associated with addition of bortezomib to high dose melphalan and TBI in patients with multiple myeloma (MM). II. To determine the progression free rate at 1 and 2 years. TERTIARY OBJECTIVES: I. To determine the proportion of patients achieving a minimal residual disease (MRD) negative status. II. To assess the HevyLite assay prior to and during treatment. OUTLINE: This is a phase I, dose-escalation study of bortezomib followed by a phase II study. CONDITIONING REGIMEN: Patients receive bortezomib intravenously (IV) on days -5 and -2, TBI twice daily (BID) on days -5 and -2, and melphalan IV over 1 hour on days -4 and -3. TRANSPLANT: Patients undergo autologous bone marrow or peripheral blood stem cell transplant on day 0. After completion of study treatment, patients are followed up at 100 days and then every 90 days for up to 3 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
11
Given IV
Undergo TBI
Given IV
Undergo autologous bone marrow transplant
Undergo autologous peripheral blood stem cell transplant
Undergo autologous peripheral blood stem cell transplant
Correlative studies
Mayo Clinic
Rochester, Minnesota, United States
MTD defined as the dose level below the lowest dose that induces dose-limiting toxicity in at least one-third of patients (phase I)
Time frame: Day 36
The number and severity of all adverse events (phase I)
Will be tabulated and summarized in this patient population. The grade 3+ adverse events will also be described and summarized in a similar fashion.
Time frame: Up to 3 years
Proportion of complete responses (CR) defined as a CR noted as the objective status on two consecutive evaluations (phase II)
Will be tabulated and summarized in this patient population. The grade 3+ adverse events will also be described and summarized in a similar fashion. 95% confidence intervals for the true success proportion will be calculated.
Time frame: Up to 3 years
CR rate at day 100 estimated by the total number of patients who achieve a complete CR by day 100 post-transplant divided by the total number of evaluable patients
Exact binomial 95% confidence intervals for the true CR rate at day 100 will be calculated.
Time frame: At day 100
Time to progression
Will be estimated using the method of Kaplan-Meier.
Time frame: Time from registration to the earliest date with documentation of disease progression, assessed at 1 year
Time to progression
Will be estimated using the method of Kaplan-Meier.
Time frame: Time from registration to the earliest date with documentation of disease progression, assessed at 2 years
Maximum grade for each type of adverse event
Will be recorded for each patient, and frequency tables will be reviewed to determine patterns. Additionally, the relationship of the adverse event(s) to the study treatment will be taken into consideration.
Time frame: Up to 3 years
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