Trial Outcomes & Findings for A Multicenter, Single-Arm, Open-Label Expanded Access Program for Lenalidomide Plus Dexamethasone in Previously Treated Subjects With Multiple Myeloma (NCT NCT00478777)

NCT ID: NCT00478777

Last Updated: 2011-11-03

Results Overview

Time to disease progression (TTP) was based on the European Group for Blood and Marrow Transplantation (EBMT) myeloma response determination criteria developed by Bladé (Bladé, 1998). TTP is a Kaplan Meier estimate of the time from randomization to the first documentation of progressive disease. Progressive disease based on increasing monoclonal paraprotein levels require a confirmatory value one week apart. Disease progression can also be based on bone marrow findings, worsening lytic bone disease, progressively enlarging extramedullary plasmacytomas, or hypercalcemia.

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

150 participants

Primary outcome timeframe

up to 827 days

Results posted on

2011-11-03

Participant Flow

A total of 150 participants in 37 sites in Germany were enrolled when lenalidomide became commercially available in Germany. Study completion (end of study) was the time point when participants discontinued study drug and could switch to commercial lenalidomide.

Participant milestones

Participant milestones
Measure
Lenalidomide Plus Dexamethasone
Lenalidomide administered orally, 25 mg daily (QD) for the first 21 days of each 28-day cycle. Pulse dexamethasone administered orally, 40 mg daily on Days 1-4, 9-12, and 17-20 for each 28-day cycle during Cycles 1 to 4 (approximately months 1-4). Beginning with Cycle 5 (approximately month 5), dexamethasone was to be reduced to 40 mg QD for Days 1-4 of each 28 day-cycle.
Overall Study
STARTED
150
Overall Study
Safety and Full Analysis Set (FAS)
144
Overall Study
COMPLETED
73
Overall Study
NOT COMPLETED
77

Reasons for withdrawal

Reasons for withdrawal
Measure
Lenalidomide Plus Dexamethasone
Lenalidomide administered orally, 25 mg daily (QD) for the first 21 days of each 28-day cycle. Pulse dexamethasone administered orally, 40 mg daily on Days 1-4, 9-12, and 17-20 for each 28-day cycle during Cycles 1 to 4 (approximately months 1-4). Beginning with Cycle 5 (approximately month 5), dexamethasone was to be reduced to 40 mg QD for Days 1-4 of each 28 day-cycle.
Overall Study
Adverse Event
29
Overall Study
Lack of Efficacy
23
Overall Study
Withdrawal by Subject
4
Overall Study
Death
3
Overall Study
Protocol Violation
3
Overall Study
Lost to Follow-up
3
Overall Study
Physician Decision
1
Overall Study
Intolerance of therapy
1
Overall Study
Lack of compliance
1
Overall Study
Lymphocytes infusion
1
Overall Study
End of therapy
2
Overall Study
Not treated with lenalidomide
6

Baseline Characteristics

A Multicenter, Single-Arm, Open-Label Expanded Access Program for Lenalidomide Plus Dexamethasone in Previously Treated Subjects With Multiple Myeloma

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Lenalidomide Plus Dexamethasone
n=144 Participants
Lenalidomide administered orally, 25 mg daily (QD) for the first 21 days of each 28-day cycle. Pulse dexamethasone administered orally, 40 mg daily on Days 1-4, 9-12, and 17-20 for each 28-day cycle during Cycles 1 to 4 (approximately months 1-4). Beginning with Cycle 5 (approximately month 5), dexamethasone was to be reduced to 40 mg QD for Days 1-4 of each 28 day-cycle.
Age Continuous
64.7 years
STANDARD_DEVIATION 9.9 • n=5 Participants
Sex: Female, Male
Female
68 Participants
n=5 Participants
Sex: Female, Male
Male
76 Participants
n=5 Participants
Race/Ethnicity, Customized
White
142 participants
n=5 Participants
Race/Ethnicity, Customized
Other
2 participants
n=5 Participants
Region of Enrollment
Germany
144 participants
n=5 Participants

PRIMARY outcome

Timeframe: up to 827 days

Population: Full analysis dataset

Time to disease progression (TTP) was based on the European Group for Blood and Marrow Transplantation (EBMT) myeloma response determination criteria developed by Bladé (Bladé, 1998). TTP is a Kaplan Meier estimate of the time from randomization to the first documentation of progressive disease. Progressive disease based on increasing monoclonal paraprotein levels require a confirmatory value one week apart. Disease progression can also be based on bone marrow findings, worsening lytic bone disease, progressively enlarging extramedullary plasmacytomas, or hypercalcemia.

Outcome measures

Outcome measures
Measure
Lenalidomide Plus Dexamethasone
n=144 Participants
Lenalidomide administered orally, 25 mg daily (QD) for the first 21 days of each 28-day cycle. Pulse dexamethasone administered orally, 40 mg daily on Days 1-4, 9-12, and 17-20 for each 28-day cycle during Cycles 1 to 4 (approximately months 1-4). Beginning with Cycle 5 (approximately month 5), dexamethasone was to be reduced to 40 mg QD for Days 1-4 of each 28 day-cycle.
Kaplan Meier Estimate for Time to Disease Progression
214.0 days
Interval 146.0 to 281.0

SECONDARY outcome

Timeframe: Up to 827 days

Population: Full analysis set

Best overall response was calculated as the best assessment from all cycles (including treatment discontinuation visit) and follow-up. The response rate was summarized as complete response (CR), partial response (PR), stable disease (SD), progression (PD), response not evaluable, and derived categories (PR+CR) and (PR+CR+SD). CR is negative immunofixation on both serum and urine maintained for 6 weeks straight. PR is a 50% decrease in serum paraprotein maintained for 6 weeks straight. SD is serum paraprotein values within 25% of baseline.

Outcome measures

Outcome measures
Measure
Lenalidomide Plus Dexamethasone
n=144 Participants
Lenalidomide administered orally, 25 mg daily (QD) for the first 21 days of each 28-day cycle. Pulse dexamethasone administered orally, 40 mg daily on Days 1-4, 9-12, and 17-20 for each 28-day cycle during Cycles 1 to 4 (approximately months 1-4). Beginning with Cycle 5 (approximately month 5), dexamethasone was to be reduced to 40 mg QD for Days 1-4 of each 28 day-cycle.
Participant's Best Overall Response Based on the European Group for Blood and Marrow Transplantation (EBMT) Myeloma Response Criteria
Complete response (CR)
6 participants
Participant's Best Overall Response Based on the European Group for Blood and Marrow Transplantation (EBMT) Myeloma Response Criteria
Partial response (PR)
97 participants
Participant's Best Overall Response Based on the European Group for Blood and Marrow Transplantation (EBMT) Myeloma Response Criteria
Stable disease (SD)
30 participants
Participant's Best Overall Response Based on the European Group for Blood and Marrow Transplantation (EBMT) Myeloma Response Criteria
Progressive disease (PD)
3 participants
Participant's Best Overall Response Based on the European Group for Blood and Marrow Transplantation (EBMT) Myeloma Response Criteria
Not evaluable (NE)
8 participants
Participant's Best Overall Response Based on the European Group for Blood and Marrow Transplantation (EBMT) Myeloma Response Criteria
CR + PR
103 participants
Participant's Best Overall Response Based on the European Group for Blood and Marrow Transplantation (EBMT) Myeloma Response Criteria
CR + PR + SD
133 participants

SECONDARY outcome

Timeframe: up to 8 months

Population: Safety population

Counts of study participants who had treatment-emergent adverse events (TEAEs) defined as any reported AE that started on or after the first day of study drug dosing. A participant with multiple occurrences of an adverse event within a category is counted only once in that category. National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE version 3.0) was used by investigators to assess TEAEs. Severity scale ranges from 0 (none) to 5 (death). Grade 3=severe AE; Grade 4=life threatening or disabling AE; Grade 5=death.

Outcome measures

Outcome measures
Measure
Lenalidomide Plus Dexamethasone
n=144 Participants
Lenalidomide administered orally, 25 mg daily (QD) for the first 21 days of each 28-day cycle. Pulse dexamethasone administered orally, 40 mg daily on Days 1-4, 9-12, and 17-20 for each 28-day cycle during Cycles 1 to 4 (approximately months 1-4). Beginning with Cycle 5 (approximately month 5), dexamethasone was to be reduced to 40 mg QD for Days 1-4 of each 28 day-cycle.
Participants With Treatment-emergent Adverse Experiences (TEAEs)
>=1 TEAE
139 participants
Participants With Treatment-emergent Adverse Experiences (TEAEs)
>=1 TEAE related to study drug
119 participants
Participants With Treatment-emergent Adverse Experiences (TEAEs)
>=1 NCI CTCAE grade 3 or 4 TEAE
105 participants
Participants With Treatment-emergent Adverse Experiences (TEAEs)
>=1 NCI CTCAE grade 3 or 4 TEAE related to drug
83 participants
Participants With Treatment-emergent Adverse Experiences (TEAEs)
>=1 serious AE (SAE)
79 participants
Participants With Treatment-emergent Adverse Experiences (TEAEs)
>=1 study drug related SAE
48 participants
Participants With Treatment-emergent Adverse Experiences (TEAEs)
Discontinued due to TEAE
32 participants
Participants With Treatment-emergent Adverse Experiences (TEAEs)
Discontinued due to TEAE related to study drug
21 participants
Participants With Treatment-emergent Adverse Experiences (TEAEs)
TEAE leading to dose reduction
35 participants
Participants With Treatment-emergent Adverse Experiences (TEAEs)
TEAE leading to dose interruption
64 participants
Participants With Treatment-emergent Adverse Experiences (TEAEs)
Deaths
79 participants

SECONDARY outcome

Timeframe: up to 827 days

Population: Values for the free light chain concentrations were determined to be invalid.

Time to partial response is the time from randomization to a 50% decrease in serum paraprotein maintained for six weeks straight. This was determined by free light chain concentrations which were taken every two weeks during the treatment phase of the trial.

Outcome measures

Outcome data not reported

Adverse Events

Lenalidomide Plus Dexamethasone

Serious events: 79 serious events
Other events: 129 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Lenalidomide Plus Dexamethasone
n=144 participants at risk
Lenalidomide administered orally, 25 mg daily (QD) for the first 21 days of each 28-day cycle. Pulse dexamethasone administered orally, 40 mg daily on Days 1-4, 9-12, and 17-20 for each 28-day cycle during Cycles 1 to 4 (approximately months 1-4). Beginning with Cycle 5 (approximately month 5), dexamethasone was to be reduced to 40 mg QD for Days 1-4 of each 28 day-cycle.
General disorders
Pyrexia
9.7%
14/144 • Up to 8 months
General disorders
General physical health deterioration
4.2%
6/144 • Up to 8 months
General disorders
Asthenia
1.4%
2/144 • Up to 8 months
General disorders
Multi-organ failure
1.4%
2/144 • Up to 8 months
General disorders
Chills
0.69%
1/144 • Up to 8 months
General disorders
Fatigue
0.69%
1/144 • Up to 8 months
General disorders
Gait disturbance
0.69%
1/144 • Up to 8 months
General disorders
Orthostatic intolerance
0.69%
1/144 • Up to 8 months
General disorders
Pain
0.69%
1/144 • Up to 8 months
Infections and infestations
Pneumonia
5.6%
8/144 • Up to 8 months
Infections and infestations
Sepsis
4.2%
6/144 • Up to 8 months
Infections and infestations
Upper respiratory tract infection
1.4%
2/144 • Up to 8 months
Infections and infestations
Bronchitis
0.69%
1/144 • Up to 8 months
Infections and infestations
Febrile infection
0.69%
1/144 • Up to 8 months
Infections and infestations
Gastrointestinal infection
0.69%
1/144 • Up to 8 months
Infections and infestations
Herpes zoster
0.69%
1/144 • Up to 8 months
Infections and infestations
Infection
0.69%
1/144 • Up to 8 months
Infections and infestations
Lung infection
0.69%
1/144 • Up to 8 months
Infections and infestations
Respiratory tract infection
0.69%
1/144 • Up to 8 months
Infections and infestations
Tooth infection
0.69%
1/144 • Up to 8 months
Infections and infestations
Urinary tract infection
0.69%
1/144 • Up to 8 months
Infections and infestations
Urosepsis
0.69%
1/144 • Up to 8 months
Gastrointestinal disorders
Diarrhoea
3.5%
5/144 • Up to 8 months
Gastrointestinal disorders
Nausea
2.1%
3/144 • Up to 8 months
Gastrointestinal disorders
Haemorrhoidal haemorrhage
1.4%
2/144 • Up to 8 months
Gastrointestinal disorders
Vomiting
1.4%
2/144 • Up to 8 months
Gastrointestinal disorders
Abdominal pain upper
0.69%
1/144 • Up to 8 months
Gastrointestinal disorders
Anal haemorrhage
0.69%
1/144 • Up to 8 months
Gastrointestinal disorders
Diarrhoea haemorrhagic
0.69%
1/144 • Up to 8 months
Gastrointestinal disorders
Duodenitis
0.69%
1/144 • Up to 8 months
Gastrointestinal disorders
Gastrointestinal haemorrhage
0.69%
1/144 • Up to 8 months
Gastrointestinal disorders
Large intestinal perforation
0.69%
1/144 • Up to 8 months
Gastrointestinal disorders
Subileus
0.69%
1/144 • Up to 8 months
Gastrointestinal disorders
Tooth disorder
0.69%
1/144 • Up to 8 months
Musculoskeletal and connective tissue disorders
Back pain
2.1%
3/144 • Up to 8 months
Musculoskeletal and connective tissue disorders
Bone pain
1.4%
2/144 • Up to 8 months
Musculoskeletal and connective tissue disorders
Muscle spasms
1.4%
2/144 • Up to 8 months
Musculoskeletal and connective tissue disorders
Arthritis
0.69%
1/144 • Up to 8 months
Musculoskeletal and connective tissue disorders
Osteolysis
0.69%
1/144 • Up to 8 months
Musculoskeletal and connective tissue disorders
Pain in extremity
0.69%
1/144 • Up to 8 months
Musculoskeletal and connective tissue disorders
Pathological fracture
0.69%
1/144 • Up to 8 months
Nervous system disorders
Syncope
2.1%
3/144 • Up to 8 months
Nervous system disorders
Dizziness
1.4%
2/144 • Up to 8 months
Nervous system disorders
Grand mal convulsion
0.69%
1/144 • Up to 8 months
Nervous system disorders
Headache
0.69%
1/144 • Up to 8 months
Nervous system disorders
Neurological symptom
0.69%
1/144 • Up to 8 months
Nervous system disorders
Neuromyopathy
0.69%
1/144 • Up to 8 months
Nervous system disorders
Syncope vasovagal
0.69%
1/144 • Up to 8 months
Nervous system disorders
Tremor
0.69%
1/144 • Up to 8 months
Blood and lymphatic system disorders
Anaemia
3.5%
5/144 • Up to 8 months
Blood and lymphatic system disorders
Neutropenia
2.8%
4/144 • Up to 8 months
Blood and lymphatic system disorders
Thrombocytopenia
2.1%
3/144 • Up to 8 months
Blood and lymphatic system disorders
Febrile neutropenia
1.4%
2/144 • Up to 8 months
Blood and lymphatic system disorders
Leukopenia
1.4%
2/144 • Up to 8 months
Blood and lymphatic system disorders
Pancytopenia
0.69%
1/144 • Up to 8 months
Cardiac disorders
Cardiac failure
2.1%
3/144 • Up to 8 months
Cardiac disorders
Atrial fibrillation
1.4%
2/144 • Up to 8 months
Cardiac disorders
Tachyarrhythmia
1.4%
2/144 • Up to 8 months
Cardiac disorders
Angina pectoris
0.69%
1/144 • Up to 8 months
Cardiac disorders
Arrhythmia
0.69%
1/144 • Up to 8 months
Cardiac disorders
Atrial flutter
0.69%
1/144 • Up to 8 months
Cardiac disorders
Bundle branch block right
0.69%
1/144 • Up to 8 months
Cardiac disorders
Extrasystoles
0.69%
1/144 • Up to 8 months
Cardiac disorders
Myocardial infarction
0.69%
1/144 • Up to 8 months
Cardiac disorders
Pericardial effusion
0.69%
1/144 • Up to 8 months
Cardiac disorders
Ventricular fibrillation
0.69%
1/144 • Up to 8 months
Cardiac disorders
Ventricular tachycardia
0.69%
1/144 • Up to 8 months
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Multiple myeloma
4.2%
6/144 • Up to 8 months
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Colon cancer
0.69%
1/144 • Up to 8 months
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Colon adenoma
0.69%
1/144 • Up to 8 months
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Leukaemia plasmacytic
0.69%
1/144 • Up to 8 months
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Squamous cell carcinoma of skin
0.69%
1/144 • Up to 8 months
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Tumour pain
0.69%
1/144 • Up to 8 months
Renal and urinary disorders
Renal failure
2.8%
4/144 • Up to 8 months
Renal and urinary disorders
Renal failure acute
2.1%
3/144 • Up to 8 months
Renal and urinary disorders
Renal impairment
0.69%
1/144 • Up to 8 months
Respiratory, thoracic and mediastinal disorders
Pulmonary embolism
2.8%
4/144 • Up to 8 months
Respiratory, thoracic and mediastinal disorders
Dyspnoea
2.1%
3/144 • Up to 8 months
Respiratory, thoracic and mediastinal disorders
Respiratory failure
1.4%
2/144 • Up to 8 months
Respiratory, thoracic and mediastinal disorders
Pleural effusion
0.69%
1/144 • Up to 8 months
Respiratory, thoracic and mediastinal disorders
Pulmonary oedema
0.69%
1/144 • Up to 8 months
Vascular disorders
Thrombosis
2.1%
3/144 • Up to 8 months
Vascular disorders
Hypotension
1.4%
2/144 • Up to 8 months
Vascular disorders
Circulatory collapse
0.69%
1/144 • Up to 8 months
Vascular disorders
Deep vein thrombosis
0.69%
1/144 • Up to 8 months
Vascular disorders
Subclavian vein thrombosis
0.69%
1/144 • Up to 8 months
Metabolism and nutrition disorders
Hypercalcaemia
1.4%
2/144 • Up to 8 months
Metabolism and nutrition disorders
Hyperglycaemia
1.4%
2/144 • Up to 8 months
Metabolism and nutrition disorders
Dehydration
0.69%
1/144 • Up to 8 months
Metabolism and nutrition disorders
Diabetes mellitus
0.69%
1/144 • Up to 8 months
Metabolism and nutrition disorders
Electrolyte imbalance
0.69%
1/144 • Up to 8 months
Metabolism and nutrition disorders
Hyperkalaemia
0.69%
1/144 • Up to 8 months
Metabolism and nutrition disorders
Hypocalcaemia
0.69%
1/144 • Up to 8 months
Injury, poisoning and procedural complications
Humerus fracture
2.1%
3/144 • Up to 8 months
Injury, poisoning and procedural complications
Femoral neck fracture
0.69%
1/144 • Up to 8 months
Psychiatric disorders
Confusional state
1.4%
2/144 • Up to 8 months
Psychiatric disorders
Depression
0.69%
1/144 • Up to 8 months
Psychiatric disorders
Disorientation
0.69%
1/144 • Up to 8 months
Psychiatric disorders
Mental disorder due to a general medical condition
0.69%
1/144 • Up to 8 months
Psychiatric disorders
Psychotic disorder
0.69%
1/144 • Up to 8 months
Ear and labyrinth disorders
Vertigo
2.1%
3/144 • Up to 8 months
Investigations
Haemoglobin decreased
0.69%
1/144 • Up to 8 months
Investigations
Platelet count decreased
0.69%
1/144 • Up to 8 months
Investigations
Protein total increased
0.69%
1/144 • Up to 8 months
Investigations
White blood cell count increased
0.69%
1/144 • Up to 8 months
Congenital, familial and genetic disorders
Epidermolysis bullosa
0.69%
1/144 • Up to 8 months
Congenital, familial and genetic disorders
Factor VIII deficiency
0.69%
1/144 • Up to 8 months
Eye disorders
Vision blurred
0.69%
1/144 • Up to 8 months
Immune system disorders
Acute graft versus host disease in intestine
0.69%
1/144 • Up to 8 months
Immune system disorders
Graft versus host disease
0.69%
1/144 • Up to 8 months
Skin and subcutaneous tissue disorders
Hyperhidrosis
0.69%
1/144 • Up to 8 months

Other adverse events

Other adverse events
Measure
Lenalidomide Plus Dexamethasone
n=144 participants at risk
Lenalidomide administered orally, 25 mg daily (QD) for the first 21 days of each 28-day cycle. Pulse dexamethasone administered orally, 40 mg daily on Days 1-4, 9-12, and 17-20 for each 28-day cycle during Cycles 1 to 4 (approximately months 1-4). Beginning with Cycle 5 (approximately month 5), dexamethasone was to be reduced to 40 mg QD for Days 1-4 of each 28 day-cycle.
Musculoskeletal and connective tissue disorders
Muscle spasms
24.3%
35/144 • Up to 8 months
Musculoskeletal and connective tissue disorders
Back pain
9.0%
13/144 • Up to 8 months
Musculoskeletal and connective tissue disorders
Arthralgia
8.3%
12/144 • Up to 8 months
Musculoskeletal and connective tissue disorders
Pain in extremity
7.6%
11/144 • Up to 8 months
Musculoskeletal and connective tissue disorders
Muscular weakness
6.2%
9/144 • Up to 8 months
Musculoskeletal and connective tissue disorders
Bone pain
5.6%
8/144 • Up to 8 months
General disorders
Fatigue
22.9%
33/144 • Up to 8 months
General disorders
Oedema peripheral
13.2%
19/144 • Up to 8 months
General disorders
Pyrexia
12.5%
18/144 • Up to 8 months
Nervous system disorders
Dizziness
11.8%
17/144 • Up to 8 months
Nervous system disorders
Tremor
10.4%
15/144 • Up to 8 months
Nervous system disorders
Polyneuropathy
9.7%
14/144 • Up to 8 months
Nervous system disorders
Paraesthesia
5.6%
8/144 • Up to 8 months
Gastrointestinal disorders
Diarrhoea
15.3%
22/144 • Up to 8 months
Gastrointestinal disorders
Constipation
13.9%
20/144 • Up to 8 months
Gastrointestinal disorders
Nausea
6.2%
9/144 • Up to 8 months
Blood and lymphatic system disorders
Leukopenia
19.4%
28/144 • Up to 8 months
Blood and lymphatic system disorders
Thromboyctopenia
17.4%
25/144 • Up to 8 months
Blood and lymphatic system disorders
Anaemia
10.4%
15/144 • Up to 8 months
Blood and lymphatic system disorders
Lymphopenia
9.7%
14/144 • Up to 8 months
Blood and lymphatic system disorders
Neutropenia
8.3%
12/144 • Up to 8 months
Infections and infestations
Nasopharyngitis
8.3%
12/144 • Up to 8 months
Infections and infestations
Urinary tract infection
6.2%
9/144 • Up to 8 months
Investigations
Haemoglobin decreased
9.0%
13/144 • Up to 8 months
Investigations
C-reactive protein increased
8.3%
12/144 • Up to 8 months
Psychiatric disorders
Insomnia
10.4%
15/144 • Up to 8 months
Respiratory, thoracic and mediastinal disorders
Dyspnoea
6.2%
9/144 • Up to 8 months
Respiratory, thoracic and mediastinal disorders
Cough
5.6%
8/144 • Up to 8 months
Metabolism and nutrition disorders
Hyperglycaemia
6.2%
9/144 • Up to 8 months

Additional Information

Associate Director, Clinical Trials Disclosure

Celgene Corporation

Phone: 1-888-260-1599

Results disclosure agreements

  • Principal investigator is a sponsor employee * Multicenter publication must include input from investigators and Celgene, agreement to be established before publication. It has priority over subset (single center) publication, for duration of 1 year after study completion. * Individual investigators have publication right after multicenter publication is complete (or 1 year after study completion), whichever is first. In this case, Celgene has the right to comment and right to ask delay of publication for 90 days.
  • Publication restrictions are in place

Restriction type: OTHER