Multiple Myeloma
Conditions
Keywords
Bortezomib, cyclophosphamide, dexamethason, multiple myeloma
Brief summary
Bortezomib and cyclophosphamide in combination with dexamethasone has already demonstrated high response rates in refractory multiple myeloma. Low dose continuous cyclophosphamide, also called metronomic scheduling, minimize toxic side effects and eliminate the obligatory rest periods. Combining cyclophosphamide with bortezomib might target distinct aspects of a myeloma functionality. The objectives of the present study are whether patients with refractory or relapsed multiple myeloma after reinduction with bortezomib, cyclophosphamide and dexamethasone will benefit from maintenance therapy with bortezomib and cyclophosphamide with acceptable side-effects. Recently two studies have shown with thalidomide that maintenance therapy might improve EFS and one study also the OS.
Interventions
DRUGBortezomib
Re-induction chemotherapy with bortezomib, cyclophosphamide and dexamethasone. All patients with first relapse or primary refractory multiple myeloma and bortezomib naive will be given 6 cycles of re-induction therapy. Patients will be evaluated for response after cycle 3 and 6. Maintenance therapy with bortezomib and cyclophosphamide Maintenance therapy with bortezomib and cyclophosphamide will start at 4 weeks after the last cycle of re-induction chemotherapy if ANC ≥ 2.0 x 109/l and platelets \> 75 x 109/l. Bortezomib is administered once every other week and cyclophosphamide (50 mg) every day for 1 year or until progression or death of any cause.
DRUGCyclophosphamide
Re-induction chemotherapy with bortezomib, cyclophosphamide and dexamethasone. All patients with first relapse or primary refractory multiple myeloma and bortezomib naive will be given 6 cycles of re-induction therapy. Patients will be evaluated for response after cycle 3 and 6. Maintenance therapy with bortezomib and cyclophosphamide Maintenance therapy with bortezomib and cyclophosphamide will start at 4 weeks after the last cycle of re-induction chemotherapy if ANC ≥ 2.0 x 109/l and platelets \> 75 x 109/l. Bortezomib is administered once every other week and cyclophosphamide (50 mg) every day for 1 year or until progression or death of any cause.
DRUGDexamethasone
Re-induction chemotherapy with bortezomib, cyclophosphamide and dexamethasone. All patients with first relapse or primary refractory multiple myeloma and bortezomib naive will be given 6 cycles of re-induction therapy. Patients will be evaluated for response after cycle 3 and 6. Maintenance therapy with bortezomib and cyclophosphamide Maintenance therapy with bortezomib and cyclophosphamide will start at 4 weeks after the last cycle of re-induction chemotherapy if ANC ≥ 2.0 x 109/l and platelets \> 75 x 109/l. Bortezomib is administered once every other week and cyclophosphamide (50 mg) every day for 1 year or until progression or death of any cause.
Sponsors
University Medical Center Groningen
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * Stage II-III Multiple Myeloma * Relapse or primary refractory disease after initial chemotherapy * WHO performance status 0 - 2 * Life expectancy of at least 6 weeks * ANC (absolute neutrophil count) ≥ 1.0x109/l(or ≥ 0.5x109/l, if due to bone marrow infiltration by malignancy) * Platelet count ≥ 75x109/l or ≥ 50x109/l, if due to bone marrow infiltration by malignancy) * Written informed consent (present in patient's file) * Patient is able and willing to use adequate contraception during therapy and for at least 1 month after study * Patient has the ability to understand the requirements of the study
Exclusion criteria
* Previous treatment with bortezomib * Urine production \< 1.5 l/24h * Pre-existent polyneuropathy (grade 2 or higher, according to CTCAE 3.0) * Pregnancy or positive pregnancy tests during study and for 1 month after final dose of thalidomide * History of active malignancy during the past 5 years with the exception of basal carcinoma of the skin) * Active uncontrolled infections * Additional uncontrolled serious medical or psychiatric illness
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Toxicity of induction chemotherapy according to CTCAE version 3.0 | 5 years |
Secondary
| Measure | Time frame |
|---|---|
| Progression Free Survival | 5 years |
| Overall Survival | 5 years |
Countries
Netherlands
Outcome results
None listed