Lenalidomide in Treating Patients With Multiple Myeloma Undergoing Autologous Stem Cell Transplant
Lenalidomide in Treating Patients With Multiple Myeloma Undergoing Autologous Stem Cell Transplant
This randomized phase III trial studies lenalidomide to see how well it works compared to a
 placebo in treating patients with multiple myeloma who are undergoing autologous stem cell
 transplant. Giving chemotherapy before a peripheral blood stem cell transplant helps kill any
 cancer cells that are in the body and helps make room in the patient's bone marrow for new
 blood-forming cells (stem cells) to grow. After treatment, stem cells are collected from the
 patient's blood and stored. More chemotherapy is then given to prepare the bone marrow for
 the stem cell transplant. The stem cells are then returned to the patient to replace the
 blood-forming cells that were destroyed by the chemotherapy. Biological therapies, such as
 lenalidomide, may stimulate or suppress the immune system in different ways and stop cancer
 cells from growing. Giving lenalidomide after autologous stem cell transplant may be an
 effective treatment for multiple myeloma.
PRIMARY OBJECTIVE:

 I. To determine the efficacy of CC-5013 (lenalidomide) in prolonging time to disease
 progression in patients with multiple myeloma after autologous stem cell transplant (ASCT).

 SECONDARY OBJECTIVES:

 I. To determine if CC-5013 will increase the complete response (CR) rate in patients with
 multiple myeloma following ASCT.

 II. To compare the progression-free survival (PFS) and overall survival (OS) in patients with
 multiple myeloma who have undergone ASCT and who then are randomized to either CC-5013 or
 placebo.

 III. To determine the feasibility of long-term administration of CC-5013 to multiple myeloma
 patients who have undergone ASCT.

 OUTLINE:

 PERIPHERAL BLOOD STEM CELL (PBSC) MOBILIZATION: Mobilization of autologous PBSC will be
 performed according to institutional guidelines.

 AUTOLOGOUS PBSC TRANSPLANTATION (PBSCT): Patients receive melphalan intravenously (IV) over
 30-60 minutes on day -2 or -1 or over 2 days on days -3 and -2 or -2 and -1. Patients undergo
 autologous PBSCT on day 0.

 Patients are then randomized to 1 of 2 maintenance treatment arms. (Note: As of 12/17/09, no
 more patients will be randomized between lenalidomide and placebo. Patients who have not been
 randomized as of 12/17/09 will be assigned to lenalidomide.)

 ARM I: Beginning between day 100-110, patients receive lenalidomide orally (PO) once daily.

 ARM II: Beginning between day 100-110, patients receive placebo (PO) once daily.

 In both arms, treatment continues in the absence of disease progression or unacceptable
 toxicity.

 After completion of study treatment, patients are followed up every 3 months for 1 year and
 then every 6 months thereafter.
Inclusion Criteria:

 -  Patients must have active multiple myeloma requiring treatment (Durie-Salmon stage >=
 1) and have stable disease or be responsive to at least 2 months of any induction
 therapy; patients with smoldering myeloma are not eligible unless the disease has
 progressed to >= stage 1

 -  No more than 12 months of any prior therapy, including CC-5013 and thalidomide

 -  Within 12 months of initiation of induction therapy

 -  No prior progression after initial therapy; in addition, no more than two regimens
 will be allowed excluding dexamethasone alone

 -  No prior peripheral blood, bone marrow, or solid organ transplant

 -  Patients must have peripheral blood stem cell collection of >= 2 x 10^6 cluster of
 differentiation (CD)34+ cells/kg (patient body weight) and preferably 5 x 10^6
 cells/kg (patient body weight); stem cells may be collected at any time prior to
 transplant; peripheral blood stem cell collection may occur before or after
 registration

 -  Patients must have Eastern Cooperative Oncology Group (ECOG) performance status of 0-1

 -  Patients must have diffusing capacity of the lung for carbon monoxide (DLCO) > 50%
 predicted with no symptomatic pulmonary disease

 -  Patients must have left ventricular ejection fraction (LVEF) >= 40% by multi gated
 acquisition scan (MUGA) or echocardiogram

 -  Patients must not have uncontrolled diabetes mellitus

 -  Patients must not have an active serious infection

 -  Patients must not be human immunodeficiency virus (HIV), hepatitis B surface antigen
 (HBSag), or hepatitis (Hep) C positive

 -  Patients must be non-pregnant and non-nursing; women of childbearing potential must
 have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL
 10-14 days prior to registration and repeated within 24 hours prior to the first dose
 of lenalidomide; in addition, women of childbearing potential taking lenalidomide must
 have a pregnancy test performed by the doctor weekly during the first 4 weeks of
 treatment, and then every 4 weeks if menses are regular and every 2 weeks if menses
 are irregular, and then 30 days following the last dose of lenalidomide; women of
 childbearing potential must either commit to continued abstinence from heterosexual
 intercourse or begin two acceptable methods of birth control - one highly effective
 method (intrauterine device [IUD], hormonal, tubal ligation, or partner's vasectomy),
 and one additional effective method (latex condom, diaphragm, or cervical cap) - at
 the same time, at least 4 weeks before she begins lenalidomide therapy; "women of
 childbearing" potential is defined as a sexually mature woman who has not undergone a
 hysterectomy or who has had menses at any time in the preceding 24 consecutive months;
 men must agree not to father a child and must use a latex condom during any sexual
 contact with women of childbearing potential while taking lenalidomide and for 4 weeks
 after therapy is stopped, even if they have undergone a successful vasectomy

 -  Absolute neutrophil count (ANC) >= 1000/uL

 -  Platelets >= 100,000/uL

 -  Creatinine clearance* >= 40 cc/min

 -  To be calculated by method of Cockcroft-Gault or after 24-hour urine collection

 -  Creatinine =< 2 mg/dL

 -  Total bilirubin =< 2 mg/dL

 -  Aspartate aminotransferase (AST) =< 3 x upper limits of normal

 -  Alkaline phosphatase =< 3 x upper limits of normal

 -  Urine (U)-human chorionic gonadotropin (HCG) or serum HCG negative (if patient of
 childbearing potential)