Multiple Myeloma and Plasma Cell Neoplasm
Conditions
Keywords
refractory multiple myeloma, stage II multiple myeloma, stage III multiple myeloma
Brief summary
RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Vitamin C may increase the effectiveness of arsenic trioxide by making cancer cells more sensitive to the drug. PURPOSE: Phase I/II trial to determine the effectiveness of arsenic trioxide plus vitamin C in treating patients who have recurrent or refractory multiple myeloma.
Detailed description
OBJECTIVES: * Determine the maximum tolerated dose of arsenic trioxide when administered with ascorbic acid in patients with recurrent or refractory multiple myeloma. * Determine the therapeutic efficacy of this treatment combination in these patients. * Determine the expression of MDR and Bcl-xL genes and the intracellular levels of GSH in these patients before and after this treatment regimen and assess whether these measures have prognostic value. OUTLINE: This is a multicenter, dose-escalation study of arsenic trioxide. * Phase I: Patients receive arsenic trioxide IV over 1-4 hours and ascorbic acid IV over 5-10 minutes on days 1-5 weekly for 5 weeks. Treatment continues every 7 weeks for up to 6 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of arsenic trioxide until the maximum tolerated dose (MTD) is reached. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. * Phase II: Patients receive the MTD of arsenic trioxide with ascorbic acid as outlined above. Patients are followed monthly for up to 5 years. PROJECTED ACCRUAL: A total of 31-43 patients (6-18 for phase I and 16-25 for phase II) will be accrued for this study within 2.5 years.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically confirmed multiple myeloma * M-protein by serum protein electrophoresis or urine protein electrophoresis * Quantitative determination of immunoglobulin * Bone marrow biopsy and aspirate with a plasma cell count greater than 10% * Refractory or chemoresistant disease defined as failure to respond (less than 50% reduction in M protein level) or progression within 2 months after receiving at least 2 chemotherapy regimens including: * Alkylating based regimen (melphalan) in combination with steroids (prednisone) or other chemotherapy regimens (e.g., vincristine, bleomycin, melphalan, cyclophosphamide, and prednisone or vincristine, carmustine, doxorubicin, and prednisone) * Vincristine, doxorubicin, and dexamethasone (VAD) regimen * Pulse therapy with high dose steroids alone * High dose alkylating agent and autologous stem cell transplantation * Allogeneic bone marrow transplantation * Plateau phase defined as M protein in the serum or urine for more than 6 weeks despite response to prior therapy * Must have received at least 2 of the chemotherapy regimens listed above or equivalent regimens * Recurrent disease defined as progression more than 2 months after initial therapy and failure to respond (less than 50% reduction or progression in M protein levels) to 1 chemotherapy regimen listed above or other salvage regimens (e.g., high-dose cyclophosphamide or topotecan) * Must have received VAD or other equivalent chemotherapy regimen * Should be considered for autologous or allogenic transplantation * Prior local radiotherapy allowed PATIENT CHARACTERISTICS: Age: * Over 18 Performance status: * Karnofsky 60-100% Life expectancy: * Not specified Hematopoietic: * WBC at least 2,000/mm\^3\* * Platelet count at least 50,000/mm\^3\* NOTE: \*Unless attributable to bone marrow infiltration by multiple myeloma Hepatic: * Bilirubin less than 3 mg/dL * Transaminases less than 2.5 times upper limit of normal (ULN) Renal: * Creatinine less than 1.5 times ULN OR * Creatinine clearance at least 60 mL/min Cardiovascular: * No cardiac arrhythmias including recurrent supraventricular arrhythmia, any type of sustained ventricular arrhythmia, or conduction block (atrioventricular block grade II or III, left bundle branch block) * Ejection fraction at least 30% * No uncontrolled ischemic heart disease Other: * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective barrier contraception during and for 4 months after study * HIV negative * No grade 3 or higher neurological disorder, including seizure disorders * No underlying medical condition that would preclude study * No other active malignancy except adequately treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix PRIOR CONCURRENT THERAPY: Biologic therapy: * See Disease Characteristics Chemotherapy: * See Disease Characteristics * At least 2 weeks since prior chemotherapy Endocrine therapy: * See Disease Characteristics * Concurrent steroid treatment allowed except for primary treatment of myeloma Radiotherapy: * See Disease Characteristics * Concurrent local radiotherapy for pain or symptom control allowed provided the pain or symptom is not related to disease progression Surgery: * Not specified Other: * No other concurrent ascorbic acid supplements * No other concurrent investigational drug or therapy * Concurrent bisphosphonates allowed
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Disease response as measured by M protein quantitation and the percentage of plasma cell infiltration in bone marrow biopsies after every course | — |
Secondary
| Measure | Time frame |
|---|---|
| Toxicity as measured by CTCAE criteria | — |
Countries
United States