Meloxicam vs Placebo for Mobilization
Condition: Non-Hodgkin's Lymphoma; Hodgkin's Lymphoma; Multiple Myeloma; Hematopoietic Stem Cells
MeSH terms: Lymphoma; Multiple Myeloma; Lymphoma, Non-Hodgkin; Hodgkin Disease
Intervention: GCSF; meloxicam; Placebo
Intervention MeSH terms: Meloxicam
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Enrollment: 31.0
Sex: All
Minimum age: 18 Years
Maximum age: 75 Years
Healthy volunteers: No
Keywords: Non-Hodgkin's lymphoma; Hodgkin's lymphoma; Multiple myeloma; Hematopoietic stem cells

Summary:

      This research study is evaluating a drug called meloxicam to see if it provides a benefit to
      people receiving Autologous Hematopoietic Stem Cell Transplantation (AHSCT).

      The participant is currently scheduled to receive an AHSCT, which is a procedure that removes
      blood-forming stem cells (cells from which all blood cells develop) from the body. These stem
      cells are stored and later given back to the participant by a process called apheresis. This
      is a standard procedure to treat certain blood diseases such as lymphoma and multiple
      myeloma. However the use of meloxicam with this procedure is considered investigational.

      Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) which is given to decrease fever,
      swelling and pain that may come with inflammation. It has been approved by the FDA for the
      treatment of arthritis however it has not been approved for use in people receiving AHSCT.

      This study will compare the combination of meloxicam with a drug called G-CSF (also called
      neupogen), to the combination of G-CSF with an agent that has no medicine (placebo). G-CSF is
      a substance that causes blood stem cells to change or increase in number when given to people
      undergoing AHSCT. The researchers would like to learn if giving meloxicam in combination with
      G-CSF to people before they undergo AHSCT will increase the number of stem cells available in
      the blood to collect and make the collection process easier.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Participants must meet the following criteria on screening examination to be eligible
             to participate in the study:

          -  Patients with hematologic malignancies for whom autologous stem cell transplantation
             is deemed clinically appropriate. Patients participating in this study are patients
             who are going for their first attempt at stem cell mobilization.

          -  Non-Hodgkin's lymphoma, or Hodgkin's lymphoma: refractory/relapsed but chemosensitive
             disease. Patients with CR or PR will be eligible for this protocol.

        The designation of PR requires all of the following:

          -  At least a 50% decrease in sum of the product of the diameters (SPD) of up to six of
             the largest dominant nodes or nodal masses. These nodes or masses should be selected
             according to all of the following: they should be clearly measurable in at least 2
             perpendicular dimensions; if possible they should be from disparate regions of the
             body; and they should include mediastinal and retroperitoneal areas of disease
             whenever these sites are involved.

          -  No increase should be observed in the size of other nodes, liver, or spleen.

          -  Splenic and hepatic nodules must regress by ≥ 50% in their SPD or, for single nodules,
             in the greatest transverse diameter.

          -  With the exception of splenic and hepatic nodules, involvement of other organs is
             usually assessable and no measurable disease should be present.

          -  Bone marrow assessment is irrelevant for determination of a PR if the sample was
             positive before treatment. However, if positive, the cell type should be specified
             (eg, large-cell lymphoma or small neoplastic B cells). Patients who achieve a CR by
             the above criteria, but who have persistent morphologic bone marrow involvement will
             be considered partial responders. Multiple myeloma in first or second remission.
             Patients with CR or VGPR will be eligible for this protocol. [VGPR: Serum and urine
             M-protein detectable by immunofixation only but not on electrophoresis or 90% or
             greater reduction in serum M-protein plus urine M-protein level <100mg per 24 h]

          -  Ages 18-75 years

          -  ECOG performance status of 0, 1, or 2.

          -  Ability to understand and the willingness to sign a written informed consent

          -  Patients on NSAIDs will be eligible only when they are off NSAIDs for a month.

        Exclusion Criteria:

          -  Participants who exhibit any of the following conditions at screening will not be
             eligible for admission into the study.

          -  Cardiac disease: symptomatic congestive heart failure or RVG or echocardiogram
             determined left ventricular ejection fraction of < 45%, active angina pectoris, or
             uncontrolled hypertensionParticipants may not be receiving any other study agents.

          -  Pulmonary disease: severe chronic obstructive lung disease, or symptomatic restrictive
             lung disease, or corrected DLCO of < 50% of predicted.

          -  Renal disease: serum creatinine > 2.0 mg/dl.

          -  Hepatic disease: SGOT or SGPT > 3 x normal; serum bilirubin >2.0 mg/dl that is not due
             to Gilbert's syndrome or hemolysis

          -  Uncontrolled infection.

          -  Pregnancy or lactation

          -  Patients with NSAIDs allergies, including patients who have experienced a prior GI
             bleed due to NSAIDs will be excluded. Patients who have had a recent GI bleed less
             than 2 weeks ago will be excluded. Patients who are on therapeutic dose anticoagulants
             will be excluded from this protocol.