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This is an open-label, multicenter, Phase 2 study in subjects with newly diagnosed or previous treated systemic light chain (AL) amyloidosis. Approximately 40 subjects will receive therapy with bortezomib, pomalidomide, and dexamethasone. The primary outcome is hematologic very good partial response and complete response rate at 6 months.
Proteasome inhibitor and immunmodulators have synergistic effect for plasma cell dyscrasia. Due to the fact that more than 70-80% of patients with amyloidosis have renal involvement, the application of lenalidomide is limited. Thus, the investigators designed this open-label, multicenter, phase 2 study for newly diagnosed or previously treated systemic AL amyloidosis with bortezomib, pomalidomide and dexamethasone regimen.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| BPd | Experimental | BPd regimen (Bortezomib, pomalidomide, and dexamethasone) will be applied every 28 days until progression of disease, unacceptable toxicity or subsequent therapy, for a maximum of six cycles. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Bortezomib | Drug | Bortezomib 1.3mg/m2 sc weekly |
|
|
| Measure | Description | Time Frame |
|---|---|---|
| Hematologic VGPR + CR rate at 6 months | Hematologic very good partial response plus complete response rate at 6 months | 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Overall Hematologic response rate at 6 months | Overall Hematologic partial response, very good partial response rate and complete response at 6 months | 6 months |
| At least one organ response at 6 months |
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Inclusion Criteria:
Diagnosis of AL amyloidosis, confirmed by histology and typed with immunohistochemistry, immunoelectron microscopy or mass spectrometry.
Newly diagnosed or previous treated AL amyloidosis
Patients must be ≥ 18 years of age.
ECOG performance status 0, 1 or 2.
Measurable disease defined by at least one of the following:
①serum free light chain (FLC) ≥2.0 mg/dL (20 mg/L) with an abnormal kappa:lambda ratio or the difference between involved and uninvolved free light chains (dFLC) ≥2mg/dL (20 mg/L).
②. presence of a monoclonal spike that is ≥5 g/l.
Symptomatic organ involvement (heart, kidney, liver/GI tract, peripheral nervous system).
Absolute neutrophil count (ANC) ≥1.0 X 10^9/L, Hemoglobin ≥70 g/L, Platelets ≥50 X 10^9/L
eGFR ≥20 mL/min/ 1.73 m^2
Written informed consent in accordance with local and institutional guidelines.
Contraceptive use should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Yang Liu, Dr | Contact | 86-13716926210 | pkuphliuyang@vip.sina.com |
| Name | Affiliation | Role |
|---|---|---|
| Jin Lu | Peking University People's Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Peking University People's Hospital | Recruiting | Beijing | Beijing Municipality | 100044 | China |
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| ID | Term |
|---|---|
| D000075363 | Immunoglobulin Light-chain Amyloidosis |
| ID | Term |
|---|---|
| D054219 | Neoplasms, Plasma Cell |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D000686 | Amyloidosis |
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| ID | Term |
|---|---|
| D000069286 | Bortezomib |
| C467566 | pomalidomide |
| D003907 | Dexamethasone |
| ID | Term |
|---|---|
| D001897 | Boronic Acids |
| D000148 | Acids, Noncarboxylic |
| D000143 | Acids |
| D007287 | Inorganic Chemicals |
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Bortezomib, pomalidomide, dexamethasone
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| Pomalidomide | Drug | 4mg per day taken orally on 1-21 of repeated 28-day cycles |
|
| Dexamethasone | Drug | Dexamethasone 20mg-40mg weekly |
|
At least one organ response (cardiac response, renal response, liver response) at 6 months
| 6 months |
| TTNT at 2 years | Time to next treatment at 2 years | 2 years |
| Estimated PFS at 2 years | Estimated Progression free survival at 2 years | 2 years |
| Estimated OS at 2 years | Estimated Overall Survival at 2 years | 2 years |
| TRAE | Treatment-related adverse events up to 6 months | 6 months |
| D057165 |
| Proteostasis Deficiencies |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D008232 | Lymphoproliferative Disorders |
| D007160 | Immunoproliferative Disorders |
| D007154 | Immune System Diseases |
| D010265 | Paraproteinemias |
| D001896 |
| Boron Compounds |
| D009930 | Organic Chemicals |
| D011719 | Pyrazines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D011246 | Pregnadienetriols |
| D011245 | Pregnadienes |
| D011278 | Pregnanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
| D013259 | Steroids, Fluorinated |