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Myelomatosis therapy trial for patients of all age groups
Source of recordUK Trials
ISRCTNISRCTN68454111
Date ISRCTN assigned21/09/2000
Local reference number(s)G0100132
Public titleMyelomatosis therapy trial for patients of all age groups
Scientific title
AcronymMRC Myeloma IX
Disease/condition/study domainMultiple Myeloma
Study hypothesisTherapeutic questions within the intensive pathway:
1. To compare an oral induction regimen containing thalidomide with a standard infusional induction chemotherapy, CTD versus CVAD, with respect to overall/progression-free survival and response.
2. To investigate the effects of giving additional consolidation therapy in the form of a low intensity conditioning allogeneic stem cell transplantation on survival.

Therapeutic questions within the non-intensive pathway:
1. To compare attenuated C-Thal-Dex (CTDa) with standard MP with respect to overall/progression-free survival and response.

Therapeutic questions across both pathways:
1. To assess the value of low dose thalidomide in maintenance in improving overall and progression-free survival.
2. To compare an aminobisphosphonate, zoledronic acid, with standard clodronate on the severity of bone disease and in improving survival.
3. To investigate quality of life in the short-term (during induction chemotherapy/bisphosphonate treatment) and in the long-term (during maintenance therapy).
4. To investigate prognostic factors for outcome.

Biological objectives:
1. To determine the clinical relevance of genetic/cytogenetic changes present at presentation in the definition of prognostic groups.
2. To determine the relevance of cellular phenotypes at presentation and to subsequently use these data to monitor residual disease.
3. To evaluate serum free light chain (flc) measurement as a prognostic factor and in monitoring disease.
Design/methodologyRandomised controlled trial
Research ethics reviewEthics information not required at time of registration.
Countries of trialUnited Kingdom, New Zealand, South Africa
Participants - inclusion criteria1. Aged 18 years or greater
2. Newly diagnosed as having symptomatic multiple myeloma or non secretory multiple myeloma based on:
a. Paraprotein (M-protein) in serum and/or urine
b. Bone marrow clonal plasma cells or plasmacytoma
c. Related organ or tissue impairment
3. Written informed consent
4. Prepared to use contraception
5. Negative pregnancy test
Participants - exclusion criteria1. Asymptomatic myeloma
2. Solitary plasmacytoma of bone
3. Extramedullary plasmacytoma (without evidence of myeloma)
4. Previous or concurrent active malignancies, except surgically removed basal cell carcinoma of the skin or other in situ carcinomas
5. Previous treatment for myeloma, except the following:
a. local radiotherapy to relieve bone pain or spinal cord compression
b. prior bisphosphonate treatment
c. low-dose corticosteroids (up to 12 mg/day dexamethasone or 80 mg/day prednisolone, for 14 days)
d. up to four single doses of corticosteroids (total dose 1 g methylperdnisolone, 200 mg dexamethasone, or 1.25 g prenisolone)
Caution is advised in patients with a past history of ischaemic heart disease or psychiatric disorders, but exclusion is essentially to be at the discretion of the treating clinician.
6. Acute renal failure (unresponsive to up to 72 h of rehydration characterised by creatine >500 µmol/l or urine output <400 ml/day or requirement for dialysis). These patients are not eligible for this study but may be eligible for inclusion in MERIT (Myeloma Renal Impairment Trial). NB Patients with serum creatinine >2 x upper limit or normal (or creatinine clearance <20 ml/min) are eligible for Myeloma IX, but bisphosphonates should not be administered until serum creatinine has decreased to <2 x upper limit of normal (or creatinine clearance >30 ml/min)
Patient information material
Anticipated start date14/05/2003
Anticipated end date31/07/2014
Status of trialOngoing
Target number of participants1930
InterventionsThere are two main pathways:
A. Intensive for 'younger/fitter' patients
B. Non-intensive for 'older/less fit' patients
There are three randomised comparisons within each pathway.

A. Intensive pathway
At diagnosis:
i. Cyclophosphamide, vincristine, adriamycin, dexamethasone (CVAD) versus cyclophosphamide, thalidomide, dexamethasone (CTD)
ii. Clodronate versus Zoledronic acid
After high dose consolidation therapy (HDT):
iii. Thalidomide versus no maintenance therapy
In addition, following standard high dose melphalan with autograft, patients with an available tissue-compatible sibling donor may be offered a reduced intensity conditioning allograft, if appropriate.

B. Non-intensive pathway
At diagnosis:
i. Melphalan, prednisolone (MP) versus cyclophosphamide, thalidomide, dexamethasone (attenuated) (CTDa)
ii. Clodronate versus Zoledronic acid
After achievement of plateau state:
iii. Thalidomide versus no maintenance therapy
Primary outcome measure(s)1. Overall survival
2. Progression-free survival
3. Response
Secondary outcome measure(s)1. Quality of Life
2. Skeletal related events
3. Toxicity
4. Thromboembolic events
5. Renal toxicity
6. Haematologic toxicity
7. Graft versus Host Disease (GvHD)
PublicationsInterim report on http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16166766
Sources of fundingMedical Research Council (UK)
Sponsor nameUniversity of Leeds (UK)
Sponsor detailsc/o Clinical Trials Research Unit (CTRU)
University of Leeds
17 Springfield Mount
Leeds
United Kingdom
LS2 9NG
Contact nameMiss Alexa Gillman
Contact detailsClinical Trials Research Unit
University of Leeds
17 Springfield Mount
Leeds
United Kingdom
LS2 9NG
Contact telephone+44 (0)113 343 4931
Contact emaila.gillman@leeds.ac.uk
More informationFor more up-to-date information please go to the ISRCTN link below.
Link to record in ISRCTN RegisterISRCTN68454111
Date last extracted from ISRCTN register17/04/2008
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