Bortezomib and Dexamethasone Followed by ASCT Compared With ASCT Alone in Treating Patients With AL Amyloidosis

NCT ID: NCT01998503

Last Updated: 2013-11-29

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE3
• Total Enrollment: 56 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2007-12-31
• Study Completion Date: 2013-08-31

Brief Summary

This randomized phase III trial is studying the side effects and how well giving induction therapy with bortezomib and dexamethasone followed by autologous stem cell transplantation (ASCT) compared with ASCT alone in treating patients with newly diagnosed renal AL amyloidosis. In this prospective, randomized control study, patients with newly diagnosed AL amyloidosis who met the criteria for ASCT were randomized to receive 2 cycles of BD as induction therapy followed by ASCT (BD+ASCT) (arm 1) or to receive ASCT alone as an initial treatment (arm 2). Hematologic and organ responses were evaluated every 3 months after ASCT. All the patients should be followed up for 12 months.

Detailed Description

Arm 1: The BD regimen included bortezomib 1.3 mg/m2 i.v. and dexamethasone 40 mg p.o. on days 1, 4, 8 and 11 of the 21 day cycle. This process was repeated for 2 cycles. After two cycles of BD therapy, the collection of peripheral blood stem cells (PBSC) should be completed within 4 weeks. Recommended dose of drug is as follows: granulocyte colony-stimulating factor (G-CSF) 5-10ug/kg on days 1-5 will be given, then peripheral blood stem cells will be collected on days 5-6 for 2×10^6 CD34+ cells /kg. Patients will receive ASCT therapy in 8 weeks after collection of PBSC (Recorded as day 0), while melphalan (day -2) with a dose of 140 or 200 mg/m2 (choosing a dose according to the degree of risk for patients). Melphalan will be administered by central venous catheter.

Arm 2: the patients who assigned to arm 2 will receive ASCT alone as an initial treatment. The process of ASCT is as same as arm 1.

Conditions

Amyloidosis

Keywords

AL amyloidosis; bortezomib; autologous stem cell transplantation

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

BD induction followed by ASCT

The BD regimen included bortezomib 1.3 mg/m2 i.v. and dexamethasone 40 mg p.o. on days 1, 4, 8 and 11 of the 21 day cycle. This process was repeated for 2 cycles. After two cycles of BD therapy, the collection of peripheral blood stem cells (PBSC) should be completed within 4 weeks. Patients receive filgrastim (G-CSF) on days 1 to 5 and undergo autologous hematopoietic stem cell (HSC) collection. Patients will receive ASCT therapy in 8 weeks after collection of PBSC (Recorded as day 0), while melphalan (day -2) with a dose of 140 or 200 mg/m2 (choosing a dose according to the degree of risk for patients). Melphalan will be administered by central venous catheter.

Group Type: ACTIVE_COMPARATOR

Bortezomib

Intervention Type: DRUG

dexamethasone

Intervention Type: DRUG

Given orally

filgrastim

Intervention Type: BIOLOGICAL

Given subcutaneous

autologous hematopoietic stem cell transplantation (ASCT)

Intervention Type: PROCEDURE

Given on day 0

Melphalan

Intervention Type: DRUG

ASCT alone

the patients who assigned to this arm will receive ASCT alone as an initial treatment. At first, patients receive the collection of peripheral blood stem cells (PBSC), Patients receive filgrastim (G-CSF) on days 1 to 5 and undergo autologous hematopoietic stem cell (HSC) collection. After then patients will receive ASCT therapy in 8 weeks after collection of PBSC (Recorded as day 0), while melphalan (day -2) with a dose of 140 or 200 mg/m2 (choosing a dose according to the degree of risk for patients). Melphalan will be administered by central venous catheter.

Group Type: EXPERIMENTAL

filgrastim

Intervention Type: BIOLOGICAL

Given subcutaneous

autologous hematopoietic stem cell transplantation (ASCT)

Intervention Type: PROCEDURE

Given on day 0

Melphalan

Intervention Type: DRUG

Interventions

Bortezomib

Intervention Type: DRUG

dexamethasone

Given orally

Intervention Type: DRUG

filgrastim

Given subcutaneous

Intervention Type: BIOLOGICAL

autologous hematopoietic stem cell transplantation (ASCT)

Given on day 0

Intervention Type: PROCEDURE

Melphalan

Intervention Type: DRUG

Other Intervention Names

Velcade

Eligibility Criteria

Inclusion Criteria

• Patients with newly diagnosed AL amyloidosis
• Abnormal M protein or free light chain detected in serum and/or urine
• ECOG score 0-2 points
• No absolute neutrophil count of ANC less than or equal to 1000 within 14 days before enrollment
• No platelet count of less than or equal to 50K within 14 days before enrollment
• Serum bilirubin must lower than 2.0 mg/dl within 14 days before enrollment
• Serum creatinine must lower than 2.0 mg/dl within 14 days before enrollment
• Must have LVEF at least 45% by ECHO within 14 days of enrollment
• Pulmonary Function Tests must show DLCO at least 50%

Exclusion Criteria

• Subjects have received or are currently receiving systematic treatment with steroids (not including an emergent short-term use of steroids before randomization up to 4 days, maximum dose of 40mg/d)
• Pregnant and breastfeeding women, delivery term women or unwilling to take birth control measures during the study
• Subjects suffering from multiple myeloma
• Grade 2 or more than grade 2 peripheral neuropathy or neuropathic pain according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 3
• Known or suspected hypersensitivity to dexamethasone, bortezomib, mannitol, boron, or heparin (if use catheters)
• Subjects suffering from uncontrolled or severe cardiovascular disease, including myocardial infarction, class III-IV heart failure defined by New York Heart Association (NYHA), uncontrolled angina, clinical significant pericardial disease or cardiac amyloidosis (Other contraindications are not suitable for transplant patients) within 6 months before enrollment
• Subjects suffering from serious physical disease and mental illnesses which may interfere the study
• Subjects receiving other pilot study or treatment within 4 weeks before enrollment

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Nanjing University School of Medicine

OTHER

Sponsor Role: lead

Responsible Party

Zhi-Hong Liu, M.D.

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Zhihong Liu, MD

Role: PRINCIPAL_INVESTIGATOR

Jinling Hospital, China

Locations

Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine

Nanjing, Jiangsu, China

Countries

China

References

Huang X, Wang Q, Chen W, Zeng C, Chen Z, Gong D, Zhang H, Liu Z. Induction therapy with bortezomib and dexamethasone followed by autologous stem cell transplantation versus autologous stem cell transplantation alone in the treatment of renal AL amyloidosis: a randomized controlled trial. BMC Med. 2014 Jan 6;12:2. doi: 10.1186/1741-7015-12-2.

Reference Type: DERIVED

PMID: 24386911 (View on PubMed)

Other Identifiers

NJCT-0703

Identifier Type: -

Identifier Source: org_study_id