Chemotherapy, Vaccine Therapy, and Stem Cell Transplantation in Patients With Newly Diagnosed Multiple Myeloma

Johns Hopkins Medicine

Status and phase: Completed; Phase 2; Phase 1

Conditions: Multiple Myeloma

Treatments: Biological: GVAX; Procedure: Autologous transplant

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT00024466

01-01-17-06 (Other Identifier)

P30CA006973 (U.S. NIH Grant/Contract)

J0115

Details and patient eligibility

About

RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Vaccines made from a person's cancer cells may make the body build an immune response to kill cancer cells. Peripheral stem cell transplantation may be able to replace immune cells that were destroyed by chemotherapy. Combining chemotherapy with vaccine therapy and peripheral stem cell transplantation may be effective in treating multiple myeloma.

PURPOSE: Phase I/II trial to study the effectiveness of chemotherapy followed by vaccine therapy and peripheral stem cell transplantation in treating patients who have newly diagnosed multiple myeloma.

Full description

OBJECTIVES:

• Determine the efficacy of induction chemotherapy followed by autologous tumor cell vaccine and autologous peripheral blood stem cell transplantation in patients with multiple myeloma.
• Determine the safety of this regimen in these patients.

OUTLINE: Autologous tumor cells are harvested. The vaccine is prepared in vitro by mixing autologous tumor cells with a bystander cell expressing sargramostim (GM-CSF). Patients receive induction chemotherapy followed by autologous tumor cell vaccination (ATCV) once. Patients then undergo autologous peripheral blood stem cell transplantation. At 6 weeks after transplantation, patients receive additional ATCVs every 3 weeks for a total of 8 vaccinations.

PROJECTED ACCRUAL: A total of 25 patients will be accrued for this study.

Enrollment: 28 patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

INCLUSION CRITERIA

Initial Presentation

• Age between 18 and 70 years
• ECOG 0 - 2
• Patients with histologically confirmed multiple myeloma with ≥ 30% bone
• marrow involvement and a de novo presentation. One cycle of prior
• chemotherapy for myeloma is allowed. Local radiation therapy is permitted
• Ability to give informed consent
• No existing secondary malignancies and no history of secondary malignancies in the past 5 years (other than a history of carcinoma in situ of the cervix, superficial skin cancer, or superficial bladder cancer)
• No active autoimmune disease, nor a history of any autoimmune disease requiring medical treatment with systemic immunosuppressants
• No corticosteroids within 28 days of tumor harvest
• No major active medical or psychosocial problems that could be exacerbated or complicated by this treatment
• Not pregnant
• HIV negative
• AST/ALT, total bilirubin < threefold normal
• Absolute neutrophil count >500/mm3
• Platelet count >30,000/mm3

Prior to Transplantation

• ECOG performance status of 0 - 2.
• No active/uncontrolled infection.
• Absolute neutrophil count (ANC) >1000/mm3.
• Platelet count >50,000/mm3.
• Hemoglobin >8g/dL
• AST/ALT, total bilirubin <3-fold normal.
• 50% or greater reduction in tumor burden with prior chemotherapy
• Patient has received a minimum of 2 cycles of an accepted induction
• chemotherapy regimen
• Patient fulfills the requirements for standard peripheral stem cell transplantation Prior to Posttransplant Vaccination
• No active/uncontrolled infection
• Absolute neutrophil count (ANC) >1000/mm3
• Platelet count >50,000/mm3
• Hemoglobin >8g/dL
• AST/ALT, total bilirubin <3-fold normal
• No unresolved Grade 3 or 4 adverse events related to the transplant

EXCLUSION CRITERIA

• Failure of autologous tumor-cell processing for vaccine production

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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28 participants in 1 patient group

Vaccine

Experimental group

Description:

Participants are vaccinated with GVAX one month or more after finishing induction therapy (which is given as per standard of care). Two weeks later, participants go through leukapheresis on protocol, then receive autologous transplant as per standard of care. GVAX is administered eight subsequent times after the autologous transplant.

Treatment:

Procedure: Autologous transplant

Biological: GVAX