• Marc-Andrea Baertsch, Jana Schlenzka, Elias K Mai, Maximilian Merz, Jens Hillengaß, Marc S Raab, Dirk Hose, Patrick Wuchter, Anthony D Ho, Anna Jauch, Thomas Hielscher, Christina Kunz, Steffen Luntz, Stefan Klein, Ingo G H Schmidt-Wolf, Martin Goerner, Martin Schmidt-Hieber, Peter Reimer, Ullrich Graeven, Roland Fenk, Hans Salwender, Christof Scheid, Axel Nogai, Mathias Haenel, Hans W Lindemann, Hans Martin, Richard Noppeney, Katja Weisel, and Hartmut Goldschmidt.
• Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany.
• Bmc Cancer. 2016 Apr 25; 16: 290.

BackgroundDespite novel therapeutic agents, most multiple myeloma (MM) patients eventually relapse. Two large phase III trials have shown significantly improved response rates (RR) of lenalidomide/dexamethasone compared with placebo/dexamethasone in relapsed MM (RMM) patients. These results have led to the approval of lenalidomide for RMM patients and lenalidomide/dexamethasone has since become a widely accepted second-line treatment. Furthermore, in RMM patients consolidation with high-dose chemotherapy plus autologous stem cell transplantation has been shown to significantly increase progression free survival (PFS) as compared to cyclophosphamide in a phase III trial. The randomized prospective ReLApsE trial is designed to evaluate PFS after lenalidomide/dexamethasone induction, high-dose chemotherapy consolidation plus autologous stem cell transplantation and lenalidomide maintenance compared with the well-established lenalidomide/dexamethasone regimen in RMM patients.Methods/DesignReLApsE is a randomized, open, multicenter phase III trial in a planned study population of 282 RMM patients. All patients receive three lenalidomide/dexamethasone cycles and--in absence of available stem cells from earlier harvesting--undergo peripheral blood stem cell mobilization and harvesting. Subsequently, patients in arm A continue on consecutive lenalidomide/dexamethasone cycles, patients in arm B undergo high dose chemotherapy plus autologous stem cell transplantation followed by lenalidomide maintenance until discontinuation criteria are met. Therapeutic response is evaluated after the 3(rd) (arm A + B) and the 5(th) lenalidomide/dexamethasone cycle (arm A) or 2 months after autologous stem cell transplantation (arm B) and every 3 months thereafter (arm A + B). After finishing the study treatment, patients are followed up for survival and subsequent myeloma therapies. The expected trial duration is 6.25 years from first patient in to last patient out. The primary endpoint is PFS, secondary endpoints include overall survival (OS), RR, time to best response and the influence of early versus late salvage high dose chemotherapy plus autologous stem cell transplantation on OS.DiscussionThis phase III trial is designed to evaluate whether high dose chemotherapy plus autologous stem cell transplantation and lenalidomide maintenance after lenalidomide/dexamethasone induction improves PFS compared with the well-established continued lenalidomide/dexamethasone regimen in RMM patients.Trial RegistrationISRCTN16345835 (date of registration 2010-08-24).

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