Desipramine Hydrochloride and Filgrastim For Stem Cell Mobilization in Patients With Multiple Myeloma Undergoing Stem Cell Transplant

Pilot Clinical Study of GCSF in Combination With Desipramine for Autologous Stem Cell Mobilization in Multiple Myeloma

This pilot clinical trial studied how well desipramine hydrochloride and filgrastim worked for stem cell mobilization in participants with multiple myeloma (MM) undergoing stem cell transplant. Giving colony-stimulating factors, such as filgrastim, and other drugs, such as desipramine hydrochloride, helps stem cells move from the participant's bone marrow to the blood so they can be collected and stored.

PRIMARY OBJECTIVES:

I. To study efficacy, safety, harvest kinetics and engraftment kinetics of participants undergoing autologous stem cell mobilization, mobilized with a combination of granulocyte colony-stimulating factor (GCSF) (filgrastim) with desipramine (desipramine hydrochloride) (G+D).

II. To analyze polymorphisms of adrenergic receptor beta 2 (ADRB2) and adrenergic receptor beta 3 (ADRB3) genes that correlate with mobilization efficiency.

OUTLINE:

Participants received desipramine hydrochloride orally (PO) daily on days -3 to +4 and filgrastim PO twice daily (BID) on days 1-4. Stem cell collection began on day 6.

After completion of study treatment, participants were followed up to 1 week after completion of stem cell collection.

Inclusion Criteria:

• Patients eligible for autologous stem cell transplant for multiple myeloma; planned use of filgrastim (GCSF) for stem cell mobilization

• Ability to give informed consent

• Glomerular filtration rate (GFR) > 30 ml/minute

• Liver function tests < 2.5 x upper limit of normal (ULN)

• Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 or less

• Based on prior therapy patients will be classified into two categories:

  • Initial mobilizers with no exposure to alkylators
  • Remobilizers or with prior exposure to alkylators or with greater than 5 cycles of lenalidomide therapy prior to mobilization

Exclusion Criteria:

• Use of a monoamine oxidase inhibitor (MAO-I) during or within 2 weeks of desipramine therapy
• Concomitant therapy with any drugs shown to have major interactions with desipramine
• Concurrent use of drugs that are contraindicated with desipramine
• Myocardial infarction in preceding 4 weeks; history of uncontrolled cardiac arrhythmias or family history of sudden cardiac death; baseline corrected QT (QTc) > 460 msec
• Active alcohol abuse
• Bipolar disorder
• Untreated active major depression
• History of seizures in the past 3 years
• Pregnancy and lactation; refusal to use adequate contraception
• Uncontrolled thyroid disease
• GCSF or pegfilgrastim use within 14 days prior to enrollment
• Bortezomib, Revlimid or thalidomide use within 7 days of enrollment
• Patients with sickle cell disease