S9628 Dexamethasone Plus Interferon Alfa in Treating Patients With Primary Systemic Amyloidosis

Study Overview
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Brief Summary
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RATIONALE: Chemotherapy plus interferon alfa may be effective for primary systemic amyloidosis. PURPOSE: Phase II trial to study the effectiveness of dexamethasone plus interferon alfa in treating patients who have primary systemic amyloidosis.

Detailed Description
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OBJECTIVES: Evaluate M protein and organ dysfunction responses and overall and progression-free survival in patients with primary systemic amyloidosis treated with dexamethasone/interferon alfa. Identify prognostic factors that may relate to response and overall survival in these patients. Evaluate the qualitative and quantitative toxic effects of this regimen. OUTLINE: Patients are stratified by prior amyloidosis treatment (yes vs no). All patients receive induction therapy with oral dexamethasone on days 1-4, 9-12, and 17-20 every 35 days for a total of 3 courses. Maintenance therapy begins within 5-8 weeks (within 10 weeks if patients undergo stem cell harvest) of initiation of the third course of induction, as follows: oral dexamethasone for 4 days every 4 weeks; and subcutaneous interferon alfa 3 times per week. Patients who achieved less than a 50% reduction in serum M protein or urinary Bence-Jones protein and who experienced less than grade 3 toxicity during induction receive 3 additional courses of pulse dexamethasone concurrently with entry to maintenance therapy and the initiation of interferon alfa. Combination therapy is continued until 2 years from entry; thereafter, interferon is administered alone for at least 3 years, toxicity permitting. Patients with stable disease after 5 years of therapy may discontinue interferon alfa at the discretion of the treating physician. Patients are followed every 6 months for 2 years and yearly thereafter. PROJECTED ACCRUAL: A total of 100 patients (50 with prior melphalan/prednisone or iododoxorubicin treatment and 50 without) will be entered over 3 years.

Official Title
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Phase II Study of Dexamethasone/Alpha-Interferon in AL Amyloidosis

Conditions
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Multiple Myeloma

Intervention / Treatment
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* Biological: recombinant interferon alfa
* Drug: dexamethasone


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically diagnosed primary systemic amyloidosis based on the following: Deposition of fibrillary protein with Congo red positive stain or characteristic electron microscopic appearance Monoclonal light chain protein (Bence-Jones protein) in serum or urine or immunohistochemical studies Evidence of tissue involvement other than carpal tunnel syndrome Diagnostic histologic material available for central pathology review Confirmation of tissue diagnosis at all sites of organ dysfunction encouraged No senile, secondary, localized, dialysis-related, or familial amyloidosis No known therapy-related myelodysplasia PATIENT CHARACTERISTICS: Age: Adult Performance status: SWOG 0-4 Hematopoietic: Not specified Hepatic: Not specified Renal: Not specified Cardiovascular: No NYHA class IV status Other: No uncontrolled diabetes No active peptic ulcer disease No medical condition that precludes high-dose steroids No second malignancy within 5 years except: Adequately treated nonmelanomatous skin cancer In situ cervical cancer Adequately treated stage I/II cancer in complete remission Not pregnant or nursing Effective contraception required of fertile patients Blood/body fluid analyses within 14 days prior to registration Imaging/exams for tumor measurement within 28 days prior to registration Other screening exams within 42 days prior to registration PRIOR CONCURRENT THERAPY: Biologic therapy No prior interferon alfa Chemotherapy Prior melphalan allowed, but recovered from effects At least 4 weeks since cytotoxic therapy and recovered Endocrine therapy Prior prednisone allowed, but recovered from effects At least 4 weeks since prior glucocorticoids No prior dexamethasone No planned or concurrent dexamethasone or other therapy for primary systemic amyloidosis Radiotherapy Not specified Surgery Not specified

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: induction and maintenance<br>dexamethasone induction followed by alpha interferon maintenance | Biological: recombinant interferon alfa<br>* first 2 years<br>* Other names: alpha interferon;Drug: dexamethasone<br>* 40 mg*/d PO 1 - 4, 9 - 12, 17-20 q 35 days for 3 cycles*<br>* Other names: decadron;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| response | 50% or more reduction in quantitative immunoglobulin, or if the patient has light-chain disease only, a 50% or more reduction in the urine M-component (Bence-Jones protein). | 10 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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primary systemic amyloidosis