Graft-versus-Host DiseasePhase 2NCT00675441
Lenalidomide (Revlimid®) as Second Line Therapy in Patients With Chronic Graft-Vs-Host Disease (GVHD)
A Phase 2 study testing Lenalidomide in people with Graft-versus-Host Disease, run by M.D. Anderson Cancer Center at 1 site in United States.
Trial summary
The goal of this clinical research study is to learn if Revlimid® (lenalidomide), along with standard-of-care steroid treatment you are already receiving, can help to control Chronic Graft-Versus-Host Disease (cGVHD). The safety of this study drug in combination with the steroids will also be studied. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Graft-versus-Host Disease
- What is being tested?
- Lenalidomide
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 5 participants
- Where
- 1 siteUnited States
- Study dates
- Apr 2008to Aug 2011
- Phase
- Phase 2
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients with chronic GVHD following allogeneic HSCT of any source (bone marrow, peripheral blood or cord blood stem cells), from any donor type (related, unrelated, mismatched) and with any type of malignancy.
- Patients must have failed a trial of steroids and calcineurin inhibitors. Steroids must have been given at an initial dose of 1 mg/kg/d of methylprednisolone (MP) or equivalent in combination with tacrolimus or cyclosporine. Steroid refractoriness or resistance will be defined as: 1- Lack of any response after 1 month of treatment with MP, including 15 days of at least 0.5 mg/kg/d, 2- Worsening of existing GVHD or new organ involvement at any time following one week of initiation of MP at 1 mg/kg/day, 3- Reflare or worsening of GVHD at any time during steroid taper.
- Patients may have received steroids and calcineurin inhibitors (i.e. cyclosporine or tacrolimus) for chronic GVHD. Patients who have previously been treated for chronic GVHD with any other drug or treatment may be enrolled, provided the other drug or treatment was completed >/= 30 days before registration for study entry.
- Eastern Cooperative Oncology Group (ECOG) performance status </= 2.
- White Blood Count (WBC) >/= 2,500/mm^3, Absolute neutrophil count (ANC)>/= 1,000/mm^3, platelet count >/= 50,000/mm^3
- Left ventricular ejection fraction >/= 40%. No uncontrolled arrythmias or symptomatic heart disease. forced expiratory volume at one second (FEV1), forced vital capacity (FVC) and diffusion capacity of lung for carbon monoxide (DLCO) >/= 40%.
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- Serum creatinine <2.0 mg/dL. Serum bilirubin <3 * upper limit of normal (ULN), aspartate aminotransferase (AST)/ serum glutamic-oxaloacetic transminase (SGOT) and Alanine transaminase (ALT)/ serum glutamic pyruvic transaminase (SGPT) < or = 5 * ULN. No evidence of chronic active hepatitis or cirrhosis.
- No uncontrolled infections.
- No evidence of malignancy (patients must be in complete remission from their malignancy)
- Patients must be able to provide written informed consent, and be 18 years or older at the time of signing consent.
- Patient must be able to return to clinic for follow up at least every 2 weeks for the first 2 months and at least monthly thereafter.
- Women of childbearing potential must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL 10 - 14 days prior to therapy and repeated within 24 hours of starting study drug and must either commit to continued abstinence from heterosexual intercourse or agree to use 2 contraceptive methods. These birth control methods must be used for at least 4 weeks before, during and after lenalidomide therapy. Men must agree not to father a child and agrees to use a condom if his partner is of child bearing potential.
- Able to take aspirin (81 or 325 mg) daily as prophylactic anticoagulation. (patients intolerant to ASA may use low molecular weight heparin).
Who cannot join
- Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
- Pregnant or lactating females.
- Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.
- Use of any other experimental drug or therapy within 28 days of baseline.
- Known hypersensitivity to thalidomide.
- The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs.
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- Any prior use of Lenalidomide.
- Use of prior immunosuppressants other than steroids and calcineurin inhibitors (i.e. cyclosporine or tacrolimus).
- Known positive for HIV or infectious hepatitis, type A, B or C
Trial locations and contacts
1 site in 1 country.
About this study
Official title: A Phase II Study of Lenalidomide (Revlimid®) as Second Line Therapy in Patients With Chronic Graft-Versus-Host Disease (GVHD)
The goal of this clinical research study is to learn if Revlimid® (lenalidomide), along with standard-of-care steroid treatment you are already receiving, can help to control Chronic Graft-Versus-Host Disease (cGVHD). The safety of this study drug in combination with the steroids will also be studied.
Primary Objectives:
Read more
- To assess the response rate of chronic GVHD to Lenalidomide after failing steroids
- To evaluate the safety and tolerability of Lenalidomide in patients with chronic GVHD
Secondary Objectives:
- To assess the steroid-sparing capacity of Lenalidomide (as proportion of patients able to discontinue steroids while receiving or following therapy with Lenalidomide)
- To assess changes in QOL after treatment with Lenalidomide
- To analyze survival at 6 and 12 months after initiation of Lenalidomide
- To evaluate relapse of underlying malignancy as well as second malignancies at 6 and 12 months after initiation of Lenalidomide
Read the detailed description
The Study Drug:
Lenalidomide is designed to change the body's immune system. It may also interfere with the development of tiny blood vessels that help support tumor growth. It may decrease or prevent the growth of cancer cells.
Researchers want to find out if lenalidomide can improve the cGVHD and if it can help decrease the amount of steroids you need, which may help prevent long-term side effects that occur when steroids are used over a long period of time.
Study Treatment:
If you are found to be eligible to take part in this study, you will take lenalidomide by mouth (1 larger-dose capsule or 2 smaller-dose capsules) once daily for 21 days followed by 7 days without treatment (a "rest period"). Each 28-day period is called a cycle of therapy. You will have up to 6 cycles of therapy on this study.
Study Drug Administration:
You will swallow lenalidomide capsules whole with water (about 16 ounces) at the same time each day. You should not break, chew, or open capsules. If you miss a dose of lenalidomide, you should take it as soon as you remember on the same day. If you miss taking your dose for the entire day, you will take your regular dose the next day ( DO NOT take double your regular dose to make up for the missed dose).
Study Visits:
During treatment, you will have additional testing to check for side effects and to learn your body's response to therapy. You will have these tests every 2 weeks (during Cycles 1 and 2), once a month (during Cycles 3-6), and every 3 months for up to 1 year from when you started treatment with the study drug.
- You will have a physical exam.
- You will have a full skin assessment. For this assessment, the study doctor will look at your skin to see if your skin shows a reaction to the cGVHD transplant.
- You will have a 2-minute walking test. For this test, you will be asked to walk for 2 minutes, and your walking distance will be measured.
- You will have a grip strength test. For this test, you will be asked to sit down and squeeze something that has a meter to measure your strength.
- You will complete some questionnaires about how you are feeling physically, emotionally, and socially. It should take about 20 minutes to complete.
- You will complete another questionnaire about how you assess your symptoms. It should take about 20 minutes to complete.
- You will have blood drawn (about 2 tablespoons) for routine tests and to check immune-suppressive drug (such as tacrolimus or cyclosporine) levels in your blood.
- You will be asked about how you are feeling and about any side effects you may have experienced since your last visit.
Females who are able to have children that have regular or no menstrual cycles must agree to have pregnancy tests weekly for the first 28 days of study participation and then every 28 days while on study, at the end of the study, and 28 days following the end of the study. If your menstrual cycles are irregular, the pregnancy testing must occur weekly for the first 28 days and then every 14 days while on study, at study discontinuation, and at days 14 and 28 following discontinuation from the study.
Your dose of the study drug will be temporarily stopped or decreased if the study doctor thinks it is necessary for your safety. Other drugs may also be given to you to help decrease side effects. The study doctor will tell you what these drugs will be if this is necessary.
Length of Study:
You will be taken off this study if the disease gets worse or you experience any intolerable side effects. If you are tolerating and responding to the study treatment, you will be on this study for up to 1 year from enrollment.
This is an investigational study. Lenalidomide is FDA approved and commercially available for the treatment of specific types of myelodysplastic syndrome (MDS). It is also approved in combination with dexamethasone for previously treated multiple myeloma. Its use in this study is investigational and authorized for use in research only. Up to 46 patients will take part in this study. All will be enrolled at M. D. Anderson.
- Conditions
- Graft-versus-Host Disease
- Being tested
- Lenalidomide
- Keywords
- Chronic Graft-versus-Host Disease, cGVHD, GVHD, Lenalidomide, Revlimid, CC-5013, Stem Cell Transplant, Allogeneic hematopoietic stem cell transplantation, Allogeneic HSCT, HSCT, Post-Transplant Prophylactic Immunosuppressive Therapy, Steroids, Standard-of-care steroid treatment, Corticosteroids, Prednisone, Medrol
- Medical subject headings
- Graft vs Host Disease, Bronchiolitis Obliterans Syndrome
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
LenalidomideDrug
Also called Revlimid, CC-5013
10 mg (capsule) by mouth on days 1-21 of a 28-day cycle, for a total of 6 cycles.
| Study group | Role | What they receive |
|---|---|---|
| Lenalidomide | Experimental | Lenalidomide 10 mg (capsule) by mouth on days 1-21 of a 28-day cycle, for a total of 6 cycles. Receives: Drug: Lenalidomide |
What is being measured
The primary outcome is the main question the study is designed to answer.
Number of Participants' With Treatment Response of Complete or Partial Response
Treatment responses defined as complete (CR) or partial organ response (PR) of chronic Graft-Versus-Host Disease (GVHD) to lenalidomide. Complete organ response (CR) indicates resolution of all reversible manifestations related to chronic GVHD in a specific organ. Partial organ response (PR) requires at least 50% improvement in scale used to measure disease manifestations related to chronic GVHD. Tools for response evaluation were skin assessment and functional assessment including minute walk and grip strength.
Measured: Response assessed after completing 28 day cycle, repeated with each cycle for 6 cycles, approximately 180 days.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 May 2008 (estimated)
- Study startApr 2008
- Primary completionAug 2011
- Study completionAug 2011
Why it stopped: Terminated due to slow accrual.
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Other trials for Graft-versus-Host DiseaseStudies of the same condition, open and under way.
- More trials run by M.D. Anderson Cancer CenterThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 5 participants (actual)
Sponsor and investigators
- Lead sponsor
- M.D. Anderson Cancer Center
- Sponsor type
- University, hospital or other
- Collaborators
- Celgene Corporation
- Responsible party
- Sponsor
- Investigators
- Amin Alousi, MD, Principal investigator, M.D. Anderson Cancer Center
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00675441
- Sponsor's protocol ID
- 2006-0321
- Status last verified
- Oct 2013
- First submitted
- 7 May 2008
- Last updated
- 11 Dec 2013
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 11 Dec 2013. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Phase II Study of Lenalidomide (Revlimid®) as Second Line Therapy in Patients With Chronic Graft-Versus-Host Disease (GVHD)
- ClinicalTrials.gov ID
- NCT00675441
- Acronym / sponsor ID
- 2006-0321
- Conditions
- Graft-versus-Host Disease
- Keywords
- Chronic Graft-versus-Host Disease, cGVHD, GVHD, Lenalidomide, Revlimid, CC-5013, Stem Cell Transplant, Allogeneic hematopoietic stem cell transplantation
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- TerminatedReason stopped: Terminated due to slow accrual.
- Enrolment
- 5 participants (actual)
- Lead sponsor
- M.D. Anderson Cancer CenterUniversity, hospital or other
- Collaborators
- Celgene Corporation
- Study start
- Apr 2008
- Primary completion
- Aug 2011 (actual)
- Study completion
- Aug 2011 (actual)
- First posted
- 9 May 2008 (estimated)
- Results
- Posted 11 Dec 2013
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this clinical research study is to learn if Revlimid® (lenalidomide), along with standard-of-care steroid treatment you are already receiving, can help to control Chronic Graft-Versus-Host Disease (cGVHD). The safety of this study drug in combination with the steroids will also be studied.
Primary Objectives:
- To assess the response rate of chronic GVHD to Lenalidomide after failing steroids
- To evaluate the safety and tolerability of Lenalidomide in patients with chronic GVHD
Secondary Objectives:
- To assess the steroid-sparing capacity of Lenalidomide (as proportion of patients able to discontinue steroids while receiving or following therapy with Lenalidomide)
- To assess changes in QOL after treatment with Lenalidomide
- To analyze survival at 6 and 12 months after initiation of Lenalidomide
- To evaluate relapse of underlying malignancy as well as second malignancies at 6 and 12 months after initiation of Lenalidomide
Detailed description
The Study Drug:
Lenalidomide is designed to change the body's immune system. It may also interfere with the development of tiny blood vessels that help support tumor growth. It may decrease or prevent the growth of cancer cells.
Researchers want to find out if lenalidomide can improve the cGVHD and if it can help decrease the amount of steroids you need, which may help prevent long-term side effects that occur when steroids are used over a long period of time.
Study Treatment:
If you are found to be eligible to take part in this study, you will take lenalidomide by mouth (1 larger-dose capsule or 2 smaller-dose capsules) once daily for 21 days followed by 7 days without treatment (a "rest period"). Each 28-day period is called a cycle of therapy. You will have up to 6 cycles of therapy on this study.
Study Drug Administration:
You will swallow lenalidomide capsules whole with water (about 16 ounces) at the same time each day. You should not break, chew, or open capsules. If you miss a dose of lenalidomide, you should take it as soon as you remember on the same day. If you miss taking your dose for the entire day, you will take your regular dose the next day ( DO NOT take double your regular dose to make up for the missed dose).
Study Visits:
During treatment, you will have additional testing to check for side effects and to learn your body's response to therapy. You will have these tests every 2 weeks (during Cycles 1 and 2), once a month (during Cycles 3-6), and every 3 months for up to 1 year from when you started treatment with the study drug.
- You will have a physical exam.
- You will have a full skin assessment. For this assessment, the study doctor will look at your skin to see if your skin shows a reaction to the cGVHD transplant.
- You will have a 2-minute walking test. For this test, you will be asked to walk for 2 minutes, and your walking distance will be measured.
- You will have a grip strength test. For this test, you will be asked to sit down and squeeze something that has a meter to measure your strength.
- You will complete some questionnaires about how you are feeling physically, emotionally, and socially. It should take about 20 minutes to complete.
- You will complete another questionnaire about how you assess your symptoms. It should take about 20 minutes to complete.
- You will have blood drawn (about 2 tablespoons) for routine tests and to check immune-suppressive drug (such as tacrolimus or cyclosporine) levels in your blood.
- You will be asked about how you are feeling and about any side effects you may have experienced since your last visit.
Females who are able to have children that have regular or no menstrual cycles must agree to have pregnancy tests weekly for the first 28 days of study participation and then every 28 days while on study, at the end of the study, and 28 days following the end of the study. If your menstrual cycles are irregular, the pregnancy testing must occur weekly for the first 28 days and then every 14 days while on study, at study discontinuation, and at days 14 and 28 following discontinuation from the study.
Your dose of the study drug will be temporarily stopped or decreased if the study doctor thinks it is necessary for your safety. Other drugs may also be given to you to help decrease side effects. The study doctor will tell you what these drugs will be if this is necessary.
Length of Study:
You will be taken off this study if the disease gets worse or you experience any intolerable side effects. If you are tolerating and responding to the study treatment, you will be on this study for up to 1 year from enrollment.
This is an investigational study. Lenalidomide is FDA approved and commercially available for the treatment of specific types of myelodysplastic syndrome (MDS). It is also approved in combination with dexamethasone for previously treated multiple myeloma. Its use in this study is investigational and authorized for use in research only. Up to 46 patients will take part in this study. All will be enrolled at M. D. Anderson.
Study design
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Lenalidomide | Experimental | Drug: LenalidomideLenalidomide 10 mg (capsule) by mouth on days 1-21 of a 28-day cycle, for a total of 6 cycles. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (13 listed)
- Patients with chronic GVHD following allogeneic HSCT of any source (bone marrow, peripheral blood or cord blood stem cells), from any donor type (related, unrelated, mismatched) and with any type of malignancy.
- Patients must have failed a trial of steroids and calcineurin inhibitors. Steroids must have been given at an initial dose of 1 mg/kg/d of methylprednisolone (MP) or equivalent in combination with tacrolimus or cyclosporine. Steroid refractoriness or resistance will be defined as: 1- Lack of any response after 1 month of treatment with MP, including 15 days of at least 0.5 mg/kg/d, 2- Worsening of existing GVHD or new organ involvement at any time following one week of initiation of MP at 1 mg/kg/day, 3- Reflare or worsening of GVHD at any time during steroid taper.
- Patients may have received steroids and calcineurin inhibitors (i.e. cyclosporine or tacrolimus) for chronic GVHD. Patients who have previously been treated for chronic GVHD with any other drug or treatment may be enrolled, provided the other drug or treatment was completed >/= 30 days before registration for study entry.
- Eastern Cooperative Oncology Group (ECOG) performance status </= 2.
- White Blood Count (WBC) >/= 2,500/mm^3, Absolute neutrophil count (ANC)>/= 1,000/mm^3, platelet count >/= 50,000/mm^3
Key exclusion criteria (9 listed)
- Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
- Pregnant or lactating females.
- Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.
- Use of any other experimental drug or therapy within 28 days of baseline.
- Known hypersensitivity to thalidomide.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| LenalidomideAlso: Revlimid, CC-501310 mg (capsule) by mouth on days 1-21 of a 28-day cycle, for a total of 6 cycles. | Drug | Lenalidomide |
Primary outcome
Number of Participants' With Treatment Response of Complete or Partial Response
Time frame: Response assessed after completing 28 day cycle, repeated with each cycle for 6 cycles, approximately 180 days.
Treatment responses defined as complete (CR) or partial organ response (PR) of chronic Graft-Versus-Host Disease (GVHD) to lenalidomide. Complete organ response (CR) indicates resolution of all reversible manifestations related to chronic GVHD in a specific organ. Partial organ response (PR) requires at least 50% improvement in scale used to measure disease manifestations related to chronic GVHD. Tools for response evaluation were skin assessment and functional assessment including minute walk and grip strength.
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Dec 2013.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- The University of Texas MD Anderson Cancer Center official websiteLink provided by the sponsor.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Amin Alousi, MD principal investigator
M.D. Anderson Cancer Center
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Lenalidomide in people with Graft-versus-Host Disease, run by M.D. Anderson Cancer Center at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 13 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: stopped early, as of the sponsor's last update on 11 Dec 2013. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 11 Dec 2013). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Number of Participants' With Treatment Response of Complete or Partial Response (time frame: Response assessed after completing 28 day cycle, repeated with each cycle for 6 cycles, approximately 180 days.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Dec 2013.