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NCT06022939 · SWOG Cancer Research Network

Comparing Dara-VCD Chemotherapy Plus Stem Cell Transplant to Dara-VCD Chemotherapy Alone for People Who Have Newly Diagnosed AL Amyloidosis

What this study is about

This phase III trial compares the effect of adding a stem cell transplant with melphalan after completing chemotherapy with daratumumab, cyclophosphamide, bortezomib and dexamethasone (Dara-VCD) versus chemotherapy with Dara-VCD alone for treating patients with newly diagnosed amyloid light chain (AL) amyloidosis. Melphalan is a chemotherapy given prior to a stem cell transplant.

View original scientific description

This phase III trial compares the effect of adding a stem cell transplant with melphalan after completing chemotherapy with daratumumab, cyclophosphamide, bortezomib and dexamethasone (Dara-VCD) versus chemotherapy with Dara-VCD alone for treating patients with newly diagnosed amyloid light chain (AL) amyloidosis. Melphalan is a chemotherapy given prior to a stem cell transplant.

Interventions

PROCEDURE

Autologous Hematopoietic Stem Cell Transplantation

Given IV

PROCEDURE

Biopsy

Undergo fat pad biopsy

PROCEDURE

Biospecimen Collection

Undergo blood and urine specimen collection

PROCEDURE

Bone Marrow Aspiration

Undergo bone marrow aspiration

PROCEDURE

Bone Marrow Biopsy

Undergo bone marrow biopsy

DRUG

Bortezomib

Given SC

PROCEDURE

Computed Tomography

Undergo CT scan

DRUG

Cyclophosphamide

Given PO or IV

DRUG

Daratumumab and Hyaluronidase-fihj

Given SC

DRUG

Dexamethasone

Given PO or IV

PROCEDURE

Echocardiography

Undergo echocardiography

PROCEDURE

Magnetic Resonance Imaging

Undergo MRI

DRUG

Melphalan

Given IV

PROCEDURE

Positron Emission Tomography

Undergo PET-CT

PROCEDURE

Stem Cell Isolation

Undergo stem cell collection

OTHER

Survey Administration

Ancillary study

Primary outcome measures

Major organ deterioration progression-free survival (PFS)

Time frame: From date of randomization (Step 2 registration) to date of first documentation of hematologic progression, cardiac organ progression, renal organ progression, or death due to any cause, assessed up to 4 years

Will be performed using a stratified log-rank test for comparison between study arms. The analyses will be stratified according to Mayo 2012 Prognostic Staging System for Light Chain Amyloidosis (Stage 1 versus \[vs.\] 2-3), hematological response following 2 cycles of daratumumab, cyclophosphamide, bortezomib and dexamethasone (Dara-VCD) induction (partial response \[PR\] or worse vs. very good partial response \[VGPR\] or better), and presence of t(11;14) by interphase fluorescence in situ hybridization \[iFISH\] (yes vs. no). All eligible participants will be considered in analyses of the primary endpoint, according to their assigned arm at randomization.

Who can participate

This study lists these criteria on ClinicalTrials.gov. A study coordinator reviews eligibility during screening — this page does not determine whether you qualify.

Inclusion criteria

  • STEP 1: Participants must have systemic AL amyloidosis which is biopsy proven and includes histologically-confirmed by positive Congo red stain with green birefringence on polarized light microscopy, OR characteristic appearance by electron microscopy AND confirmatory AL amyloid typing (mass spectrometry-based proteomic analysis or immunofluorescence). If there is question regarding diagnosis, consult study chairs prior to registration
  • STEP 1: Participants must have measurable disease within 28 days prior to treatment if initiated prior to registration or within 28 days of registration as defined by at least one of the following:
  • Positive monoclonal serum immunofixation electrophoresis
  • Positive monoclonal urine immunofixation electrophoresis
  • Monoclonal plasma cells in bone marrow In addition, participants must also have a difference between the involved and uninvolved free light chain (dFLC) \>= 2 mg/dL
  • STEP 1: Participants may receive up to one cycle (or 28 days) of therapy prior to enrollment. If a patient receives \>= 75% of 1 cycle of protocol identical Dara-VCD, this will be considered 1 cycle of protocol induction. Any patient who receives less than 75% of 1 cycle of Dara-VCD or non-protocol therapy will still be eligible but will be treated per protocol. If protocol identical therapy is initiated prior to enrollment, this treatment is not continued but rather treatment is dictated per protocol
  • STEP 1: Participants may be receiving chronic corticosteroids if they are being given for disorders other than AL amyloidosis or myeloma
  • STEP 1: Participant must be \>= 18 years old
  • STEP 1: Participant must have Eastern Cooperative Oncology Group (ECOG) performance score (PS) of 0, 1, or 2 (PS = 3 may be allowed if secondary to neuropathy)
  • STEP 1: Participant must have a complete medical history and physical exam within 28 DAYS prior to registration
  • STEP 1: Participants must be willing to undergo high dose chemotherapy and autologous stem cell transplantation if they are randomized to the arm receiving high dose chemotherapy and autologous stem cell transplantation
  • STEP 1: Participants must be eligible to receive high dose chemotherapy with melphalan at a dose of 200 mg/m\^2 or 140 mg/m\^2 (200 mg/m\^2 is highly encouraged but not mandated). Transplant eligibility criteria are included in the general eligibility criteria listed below:
  • Participant must have a supine systolic blood pressure (BP) \>= 90 mmHg (at registration step-1, this may by supported by midodrine
  • Participant must have non-severe cardiac AL (meeting all the below criteria) as defined by:
  • N-terminal proB-type natriuretic peptide (NT proBNP) \< 5000 (if no NTproBNP, brain natriuretic peptide \[BNP\] must be available and \< 400)
  • Troponin T (TnT) \< 0.06. If not available, one of the following two criteria must be met:
  • High sensitivity troponin (hsTnT) T \< 75 or troponin I \< 0.1ng/dL
  • New York Heart Association (NYHA) I or II
  • Cardiac ejection fraction (EF) \>= 40%
  • STEP 1: Hemoglobin \>= 8.0 g/dL (\> 5 mmol/L); red blood cell transfusion allowed up to 7 day prior to registration (within 28 days prior to registration) (NOTE: Growth factor support granulocyte colony-stimulating factor \[G-CSF\] is permitted per institutional guidelines)
  • STEP 1: Leukocytes \>= 2 x 10\^3/uL (within 28 days prior to registration) (NOTE: Growth factor support \[G-CSF\] is permitted per institutional guidelines)
  • STEP 1: Absolute neutrophil count \>= 1.0 x 10\^3/uL (within 28 days prior to registration) (NOTE: Growth factor support \[G-CSF\] is permitted per institutional guidelines)
  • STEP 1: Platelets \>= 50 x 10\^3/uL (within 28 days prior to registration) (NOTE: Growth factor support \[G-CSF\] is permitted per institutional guidelines)
  • STEP 1: Total bilirubin =\< 1.5 times the institutional upper limit of normal (ULN) unless history of Gilbert's disease. Participants with history of Gilbert's disease must have total bilirubin =\< 5 x institutional ULN (within 28 days prior to registration)
  • STEP 1: Direct bilirubin =\< 2.0 mg/dL (within 28 days prior to registration)
  • STEP 1: Aspartate aminotransferase (AST)/ alanine aminotransferase (ALT) =\< 3x upper limit of normal (ULN) (except if secondary to hepatic involvement) (within 28 days prior to registration)
  • STEP 1: Alkaline phosphatase =\< 750 U/L (except if secondary to hepatic involvement) (within 28 days prior to registration)
  • STEP 1: Participants must have a serum creatinine =\< the institutional (I)ULN OR measured OR calculated creatinine clearance \>= 30 mL/min using the following Cockcroft-Gault formula. This specimen must have been drawn and processed within 28 days prior to registration
  • STEP 1: If peripheral neuropathy is present at diagnosis, participants must be grade 2 (moderate symptoms; limiting instrumental activity of daily living \[ADL\]) or less
  • STEP 1: Participants must have adequate cardiac function. Participants with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, must have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, participants must be class 2 or better
  • STEP 1: Participants must not be seropositive for hepatitis B (defined by a positive test for hepatitis B surface antigen \[HBsAg\]). Subjects with resolved infection (i.e., subjects who are HBsAg negative but positive for antibodies to hepatitis B core antigen \[anti-HBc\] and/or antibodies to hepatitis B surface antigen \[anti-HBs\]) must be screened using real-time polymerase chain reaction (PCR) measurement of hepatitis B virus (HBV) deoxyribonucleic acid (DNA) levels. Those who are PCR positive will be excluded. EXCEPTION: Subjects with serologic findings suggestive of HBV vaccination (anti-HBs positivity as the only serologic marker) AND a known history of prior HBV vaccination, do not need to be tested for HBV DNA by PCR
  • STEP 1: Participants with a history of hepatitis C virus (HCV) infection must have been treated and cured. Participants currently being treated for HCV infection must have undetectable HCV viral load test on the most recent test results obtained within 6 months prior to registration, if indicated
  • STEP 1: Participants must not have concurrent multiple myeloma as defined by the presence of lytic bone disease, plasmacytomas, \>= 60% plasma cells in the bone marrow, or hypercalcemia. Participants will not be excluded solely based on the presence of plasma cells \> 10% in the bone marrow unless the plasma cell percentage exceeds \>60%
  • STEP 1: Participants must not have known allergies to any of the study drugs
  • STEP 1: Participants must not have had a major surgery within 14 days prior to registration and be fully recovered from surgery completed within 14 days prior to registration
  • STEP 1: Participants must not have a known chronic obstructive pulmonary disease with a forced expiratory volume in 1 second (FEV1) \< 50% of predicted normal
  • STEP 1: Participants with known human immunodeficiency virus (HIV)-infection must be on effective anti-retroviral therapy at registration and have undetectable viral load test on the most recent test results obtained within 6 months prior to registration
  • STEP 1: Participants must not have either moderate or severe persistent asthma within the past 2 years), or currently have uncontrolled asthma of any classification. (Note that subjects who currently have controlled intermittent asthma or controlled mild persistent asthma are allowed in the study)
  • STEP 1: Participants must not have uncontrolled diabetes within 28 days prior to registration
  • STEP 1: Participants must not have uncontrolled blood pressure and hypertension within 14 days prior to registration. Participants must have a supine systolic BP of \>= 90 mmHg
  • STEP 1: Participants must not have a prior or concurrent malignancy whose natural history or treatment (in the opinion of the treating physician) has the potential to interfere with the safety or efficacy assessment of the investigational regimen
  • STEP 1: Participants must not have received vaccination with live attenuated vaccines within 28 days prior to Registration to Step 1
  • STEP 1: Participants must not have uncontrolled infection at the discretion of the enrolling physician and to be discussed with the study chair if the participant is on active anti-infectious therapy. Any patient on active anti-microbial therapy for chronic infectious issues should be discussed with the study chair prior to enrollment
  • STEP 1: Participants must not be pregnant or nursing (nursing includes breast milk fed to an infant by any means, including from the breast, milk expressed by hand, or pumped). Individuals who are of reproductive potential must have agreed to use an effective contraceptive method with details provided as a part of the consent process. A person who has had menses at any time in the preceding 12 consecutive months or who has semen likely to contain sperm is considered to be of "reproductive potential." In addition to routine contraceptive methods, "effective contraception" also includes refraining from sexual activity that might result in pregnancy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy, bilateral tubal ligation/occlusion, and vasectomy with testing showing no sperm in the semen
  • STEP 1: Participants must be offered the opportunity to participate in specimen banking. With participant consent, specimens must be collected and submitted via the Southwestern Oncology group (SWOG) Specimen Tracking System
  • STEP 1: Participants must agree to have blood, bone marrow core biopsy and aspirate, and fat pad biopsy specimens submitted for minimal residual disease assessment and future exploratory studies
  • STEP 1: Participants who can complete PRO, QOL, PRO-CTCAE questionnaires, etc. forms in English, Spanish and French must participate in the patient-reported outcomes and quality of life
  • STEP 2: Participants must have met all eligibility criteria for Step-1 registration
  • STEP 2: Participants must have achieved at least a partial response
  • STEP 2: Participants must continue receiving at least one of study drugs (bortezomib, cyclophosphamide, or daratumumab and hyaluronidase-fihj) if another study drug (daratumumab and hyaluronidase-fihj, cyclophosphamide, or bortezomib) has been discontinued due to adverse events. Note: daratumumab and hyaluronidase-fihj cannot be permanently discontinued
  • STEP 2: Participants must have completed induction therapy
  • STEP 2: Participants must be registered to Step 2 within 42 days of cycle 3, day 28 of induction therapy
  • STEP 2: Participants must plan to initiate their assigned consolidation therapy within 8 weeks after randomization
  • STEP 2: Participants must not have experienced a MOD-PFS event
  • STEP 2: Participants must have ECOG performance score (PS) of 0, 1, or 2 (PS = 3 may be allowed if secondary to neuropathy)
  • STEP 2: Participant must have a complete medical history and physical exam within 28 days prior to registration
  • STEP 2: Participants must be willing to undergo high dose chemotherapy and autologous stem cell transplantation if they are randomized to the arm receiving high dose chemotherapy and autologous stem cell transplantation
  • STEP 2: Participants randomized to Arm 2 must be willing and able to return to a participating treatment center for their assigned treatment after transplant. Note that participants need not to have a direct relationship with the transplant center in order to register
  • STEP 2: Participants must be eligible to receive high dose chemotherapy with melphalan at a dose of 200 mg/m\^2 or 140 mg/m\^2 (200 mg/m\^2 is highly encouraged but not mandated). Transplant eligibility criteria are included in the general eligibility criteria listed below:
  • Patient must have a supine systolic BP \>= 90 mmHg (at registration step-1, this may not by supported by midodrine)
  • Patient must have non-severe cardiac AL as defined by:
  • NT proBNP \<5000 (if no NTproBNP, BNP must be available and \< 400 pg/mL) (within 14 days prior to registration step-2)
  • TnT \< 0.06. If not available, one of the following two criteria must be met (within 14 days prior to registration step-2)
  • hsTnT \<75 or troponin I \< 0.1ng/dL
  • NYHA I or II (within 14 days prior to registration step-2)
  • Cardiac EF \>= 40% (within 14 days prior to registration step-2)
  • STEP 2: Hemoglobin \> 8.0 g/dL (\> 5 mmol/L); red blood cell transfusion allowed up to 7 days prior to registration (within 28 days prior to registration) (NOTE: Growth factor support \[G-CSF\] is permitted per institutional guidelines)
  • STEP 2: Leukocytes \>= 2 x 10\^3/uL (within 28 days prior to registration) (NOTE: Growth factor support \[G-CSF\] is permitted per institutional guidelines)
  • STEP 2: Absolute neutrophil count \>= 1.0 x 10\^3/uL (within 28 days prior to registration) (NOTE: Growth factor support \[G-CSF\] is permitted per institutional guidelines)
  • STEP 2: Platelets \>= 50 x 10\^3/uL (within 28 days prior to registration) (NOTE: Growth factor support \[G-CSF\] is permitted per institutional guidelines)
  • STEP 2: Total bilirubin =\< 1.5 times the institutional ULN unless history of Gilbert's disease. Participants with history of Gilbert's disease must have total bilirubin =\< 5 x institutional ULN (within 28 days prior to registration)
  • STEP 2: Direct bilirubin =\< 2.0 mg/dL (except if secondary to hepatic involvement) (within 28 days prior to registration)
  • STEP 2: AST/ALT =\< 3x upper limit of normal (ULN) (except if secondary to hepatic involvement) (within 28 days prior to registration)
  • STEP 2: Alkaline phosphatase =\< 750 U/L (except if secondary to hepatic involvement) (within 28 days prior to registration)
  • STEP 2: Participants must have a serum creatinine =\< the IULN OR calculated creatinine clearance ≥ 30 mL/min using the following Cockcroft-Gault Formula. This specimen must have been drawn and processed within 28 days prior to registration
  • STEP 2: Participants must not have uncontrolled infection at the discretion of the enrolling physician and to be discussed with the study chair if the participant is on active anti-infectious therapy. Any patient on active anti-microbial therapy for chronic infectious issues should be discussed with the study chair prior to enrollment
  • STEP 2: Participants randomized to the ASCT arm must be able to have at least 2.0 x 10\^6 CD34 cells/kg collected
  • STEP 2: Participants who can complete PRO, QOL, PRO-CTCAE questionnaires, etc. forms in English, Spanish and French must participate in the patient-reported outcomes and quality of life
  • STEP 3: Participants must have met all eligibility criteria for Step-1 and Step-2 registration
  • STEP 3: Participants must not have had daratumumab and hyaluronidase-fihj permanently discontinued during induction or consolidation
  • STEP 3: Participants must have completed induction and consolidation therapy
  • STEP 3: Participants must be registered to Step 3 within the following time frames:
  • If randomized to Arm 1 Dara-VCD consolidation: within 28 days of completion of 3 cycles of consolidation therapy
  • If randomized to Arm 2 high dose chemotherapy and autologous stem cell transplantation: within 180 days following initiation of stem cell transplantation
  • STEP 3: Participants must not have experienced a MOD-PFS event
  • STEP 3: Participants must have ECOG performance score (PS) of 0, 1, or 2 (PS = 3 is allowed if secondary to neuropathy)
  • STEP 3: Participants must have a complete medical history and physical exam within 28 DAYS prior to registration
  • STEP 3: Hemoglobin \> 8.0 g/dL (\> 5 mmol/L); red blood cell transfusion allowed up to 7 days prior to registration (within 28 days prior to registration) (NOTE: Growth factor support \[G-CSF\] is permitted per institutional guidelines)
  • STEP 3: Leukocytes \>= 2 x 10\^3/uL (within 28 days prior to registration) (NOTE: Growth factor support \[G-CSF\] is permitted per institutional guidelines)
  • STEP 3: Absolute neutrophil count \>= 1.0 x 10\^3/uL (within 28 days prior to registration) (NOTE: Growth factor support \[G-CSF\] is permitted per institutional guidelines)
  • STEP 3: Platelets \>= 50 x 10\^3/uL (within 28 days prior to registration) (NOTE: Growth factor support \[G-CSF\] is permitted per institutional guidelines)
  • STEP 3: Total bilirubin =\< 1.5 times the institutional upper limit of normal (ULN) unless history of Gilbert's disease. Participants with history of Gilbert's disease must have total bilirubin =\< 5 x institutional ULN (within 28 days prior to registration)
  • STEP 3: Direct bilirubin =\< 2.0 mg/dL (within 28 days prior to registration)
  • STEP 3: AST/ALT =\< 3x upper limit of normal (ULN) (except if secondary to hepatic involvement) (within 28 days prior to registration)
  • STEP 3: Alkaline phosphatase =\< 750 U/L (except if secondary to hepatic involvement) (within 28 days prior to registration)
  • STEP 3: Participants must not have uncontrolled infection at the discretion of the enrolling physician and to be discussed with the study chair if the participant is on active anti-infectious therapy. Any patient on active anti-microbial therapy for chronic infectious issues should be discussed with the study chair prior to enrollment
  • Participants must be informed of the investigational nature of this study and must sign and give informed consent in accordance with institutional and federal guidelines. For participants with impaired decision-making capabilities, legally authorized representatives may sign and give informed consent on behalf of study participants in accordance with applicable federal, local, and Central Institutional Review Board (CIRB) regulations

Where

  • Goodyear, Arizona
  • Tucson, Arizona
  • Duarte, California
  • Irvine, California
  • Orange, California
  • Derby, Connecticut
  • Greenwich, Connecticut
  • Guilford, Connecticut
  • Hartford, Connecticut
  • New Haven, Connecticut
  • North Haven, Connecticut
  • Stamford, Connecticut

And 84 more locations — see the full list below.

Collaborators

National Cancer Institute (NCI)

Related conditions & keywords

AL Amyloidosis

Frequently asked questions

What is a clinical trial?

A clinical trial is a research study that tests new medical treatments, drugs, devices, or procedures to determine their safety and effectiveness. Trials are carefully designed and monitored to protect participants while advancing medical knowledge.

Is it safe to participate?

Clinical trials follow strict safety guidelines and ethical standards. Trials must be reviewed and approved, and participants are closely monitored by medical professionals throughout the study. You can withdraw at any time if you choose.

Will I be compensated?

Many clinical trials offer compensation for your time, travel expenses, and inconvenience. The specific compensation varies by study and will be discussed during the screening process. All study-related medical care is typically provided at no cost to participants.

Will I receive a placebo instead of treatment?

When effective treatment exists, participants typically receive either the standard treatment plus the study intervention, or the standard treatment plus placebo. You would not be denied effective care. Placebos are primarily used when no proven treatment is available, or in addition to standard care. Your trial consent form will clearly explain what treatments you may receive.

Can I leave a trial if I change my mind?

Absolutely. Participation in clinical trials is completely voluntary. You have the right to withdraw from the study at any time, for any reason, without penalty or loss of benefits to which you are otherwise entitled.

How long does a clinical trial last?

Trial duration varies widely depending on the study design and purpose. Some trials last just a few weeks, while others may continue for months or years. The study coordinator will provide specific timeline information during your screening call.

Data: ClinicalTrials.gov · synced May 6, 2026 · Source of record for eligibility and locations

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See if this study fits

A short prescreen based on this study's listed criteria. A coordinator confirms eligibility — this is not a medical assessment.

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Study locations

Choose your preferred location, or select flexible during enrollment.

RECRUITING

Goodyear

Arizona

Location available
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Tucson

Arizona

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Tucson

Arizona

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Duarte

California

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Irvine

California

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Irvine

California

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Orange

California

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Derby

Connecticut

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View Derby location page
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Greenwich

Connecticut

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And 108 more locations available.

Express your interest

Share your contact details and a study coordinator can follow up about screening.

Secure & Confidential

Your information is protected and will only be shared with the research team.

What participation can include

  • Study-related care provided by the research team
  • Close monitoring by medical professionals
  • Possible compensation for time and travel*
  • The option to withdraw at any time
  • Contributing to medical research that may help future patients

*Compensation varies by study. Confirm details with coordinator.

Typical next steps

  1. 1.Submit this form
  2. 2.Phone screening
  3. 3.In-person assessment if eligible
  4. 4.Begin participation

Find More Amyloidosis Trials by City

Browse all amyloidosis clinical trials in these cities — not just this study.

Looking for AL Amyloidosis Treatment in Goodyear?

Join others in Arizona exploring innovative treatment options through clinical research

AL Amyloidosis Treatment Options in Goodyear, Arizona

If you're searching for AL Amyloidosis treatment in Goodyear, participating in a clinical research study may provide access to innovative approaches under expert medical supervision. This study is actively recruiting participants in Goodyear, Tucson, Duarte and surrounding areas.

Clinical trials offer participants the opportunity to receive cutting-edge treatments while contributing to medical research that may help future patients with AL Amyloidosis. All study-related care is provided at no cost to participants.

Local Sites
3 locations in Arizona
Now Enrolling
Up to 338 participants
Quick Start
Screening available now

Why Consider a Clinical Trial for AL Amyloidosis?

Potential Benefits

  • ✓Access to new treatment approaches before public availability
  • ✓Close monitoring by experienced medical professionals
  • ✓Study-related care provided at no cost
  • ✓Contribute to medical research for AL Amyloidosis

What to Expect

  • →Initial screening to determine eligibility
  • →Regular check-ups and monitoring visits
  • →Possible compensation for time and travel
  • →You can withdraw at any time

Frequently Asked Questions About This AL Amyloidosis Study

Important Clinical Trial Information

This information is provided for educational purposes and does not constitute medical advice. Clinical trial participation involves potential risks and benefits. Eligibility requirements apply and will be assessed during the screening process.

Study identifier: NCT06022939. For complete study details, visit ClinicalTrials.gov. Always consult with your healthcare provider before making decisions about your medical care or participating in clinical research.