A Study of Lenalidomide and CC-486 With Radiation Therapy in Patients With Plasmacytoma

  • End date
    Nov 19, 2023
  • participants needed
  • sponsor
    Memorial Sloan Kettering Cancer Center
Updated on 26 May 2022
bone marrow procedure
bone lesion
bone marrow plasma cells


The purpose of this study is to investigate if the combination of CC-486 with lenalidomide and radiation therapy is a safe and effective treatment for plasmacytoma.

Condition Plasmacytoma, Plasmacytoma of Bone, Multiple Myeloma
Treatment radiation therapy, Lenalidomide, CC-486
Clinical Study IdentifierNCT04174196
SponsorMemorial Sloan Kettering Cancer Center
Last Modified on26 May 2022


Yes No Not Sure

Inclusion Criteria

Cohort 1: Must meet all the following 3 criteria
Histologically confirmed newly diagnosed or recurrent solitary plasmacytoma/lytic lesion (recurrent solitary plasmacytomas will be considered based on treating physician discretion for cases where they clinically plan to treat with RT alone) - Minimal marrow involvement (Detectable clonal bone marrow plasma cells by multicolor flow cytometry and </= 10% clonal plasma cells in a bone marrow biopsy by immunohistochemistry, morphology, or flow cytometry)
Secretory M protein < 3 g/dL
Cohort 2: Must meet all the following criteria
Relapsed multiple myeloma with plasmacytomas/lytic lesion appropriate for RT on imaging
Relapsed (reappearance of M-spike/serum FLC) or progressive myeloma defined by a 25% increase from nadir in M-spike or involved serum FLB on 2 separate measurements; or with bone marrow involvement by clonal plasma cells detectable by IHC or flow cytometry
Any prior number of therapies is permitted, including prior radiation therapy
Allogeneic transplant patients are permitted
All Cohorts
Age >/= 18 years
Surgical resection of plasmacytoma or stabilization surgery is permitted if necessary based on physician judgement
ECOG performance status of 0-1
Anticipated lifespan greater than 3 months
Able and willing to give valid written informed consent
Creatinine clearance >/=30ml/min by Cockroft-Gault method. See section below, "Dosing Regimen", regarding lenalidomide dose adjustment for calculated creatinine clearance >/= 30ml/min and <60ml/min
Serum bilirubin levels </= 1.5 times the upper limit of the normal range for the laboratory (ULN). Higher levels are acceptable if these can be attributed to active hemolysis or ineffective erythropoiesis of Gilbert's syndrome
Recommendation is for 2 effective contraceptive methods during the study and for at least 6
Women of childbearing potential should be advised to avoid becoming pregnant and must adhere to the scheduled pregnancy testing a required in the Revlimid REMS program. They must be agreeable to use acceptable methods of birth control throughout the study and for at least 6 months after the last dose
AST (SGOT) and ALT (SGPT) </= 2.5 x ULN
months after the last dose. Adequate forms of contraception are double-barrier methods
(condoms with spermicidal jelly or foam and diaphragm with spermicidal jelly or foam)
oral, depo provera, or injectable contraceptive, intrauterine devices, and tubal ligation
Agree to abstain from breastfeeding during study participation and for at least 90
days after the last dose of investigational product (IP). Men should be advised to not
father a child while receiving treatment with azacitidine. Male patients with female
partners who are of childbearing potential: Recommendation is for the patient and
partner use at least 2 effective contraceptive methods, as described above, during the
study and for 3 months following the last dose of study drug
Refrain from semen or sperm donation while taking IP and for at least 90 days after the
last dose of IP
Willing to be registered into the mandatory Revlimid REMS program, and be willing and
able to comply with the requirements of the REMS program
Able to swallow oral medication
Able to take aspirin (81 or 325 mg) daily as prophylactic anticoagulation (patients
Hematologic criteria: Hemoglobin >/= 9 g/dL, platelets >/= 50,000 and ANC >/= 1
intolerant to ASA may use physician's choice of anticoagulation)

Exclusion Criteria

Subjects should not enter the study if any of the following exclusion criteria are
Pregnant or breast feeding females. (Lactating females must agree not to breast feed
while taking azacitidine)
Significant active cardiac disease within the previous 6 months including
Uncontrolled systemic fungal, bacterial or viral infection (defined as ongoing
NYHA class 4 CHF Unstable angina Myocardial infarction
signs/symptoms related the infection without improvement despite appropriate
known or suspected hypersensitivity to azacitidine or mannitol
antibiotics, antiviral therapy and/or other treatment)
History of inflammatory bowel disease (eg, Crohn's disease, ulcerative colitis)
Known hypersensitivity to thalidomide or lenalidomide
celiac disease (ie, sprue), prior gastrectomy or upper bowel removal, or any other
Patients on tacrolimus therapy
gastrointestinal disorder or defect that would interfere with the absorption
Concurrent systemic chemotherapy with drugs other than CC-486 and lenalidomide
distribution, metabolism or excretion of the study drug and/or predispose the subject
to an increased risk of gastrointestinal toxicity
Abnormal coagulation parameters without any known etiology (PTT > 45 seconds, and/or
INR > 1.5). Patients currently on therapeutic anti-coagulation treatment are exempt
from these parameters
The development of erythema nodosum if characterized by a desquamating rash while
taking thalidomide or similar drugs
Active viral infection with human immunodeficiency virus (HIV), hepatitis B virus
(HBV), or hepatitis C virus (HCV) as determined by a positive Polymerase Chain
Reaction (PCR) will be excluded. Patients who are seropositive because of HBV vaccine
are eligible. Seropositive status-antibody positive patients with negative PCR on two
occasions will be eligible
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