Chemotherapy, Holmium Ho 166 DOTMP, and Peripheral Stem Cell Transplantation in Treating Patients With Multiple Myeloma

DISEASE CHARACTERISTICS:

• Diagnosis of multiple myeloma (MM)
• Patients with a prior diagnosis of monoclonal gammopathy of undetermined significance (MGUS) or smoldering myeloma are eligible if they progressed and met the criteria for diagnosis of MM
• No non-secretory MM
• No symptomatic MGUS, smoldering MM, or indolent MM
• No solitary bone or extramedullary plasmacytoma
• No immunoglobulin M myeloma
• Prior induction therapy for myeloma required
• Responding, stable, or progressive disease after induction therapy, or relapsed disease
• Candidate for autologous hematopoietic stem cell transplantation
• Prior stem cell mobilization with chemotherapy and growth factors according to institutional procedures
• Availability of at least 2,000,000 CD34+ cells/kg

PATIENT CHARACTERISTICS:

Age

• 18 to 70

Performance status

• ECOG 0-2

Life expectancy

• Not specified

Hematopoietic

• Not specified

Hepatic

• Bilirubin no greater than 2 mg/dL
• SGPT no greater than 2 times upper limit of normal
• No clinical evidence of amyloidosis of the liver

Renal

• Creatinine no greater than 2.0 mg/dL
• Creatinine clearance at least 45 mL/min
• Renal ultrasound normal
• No clinical evidence of amyloidosis of the kidney
• No urinary obstruction in the renal pelvis, ureter, or bladder outlet by ultrasound

Cardiovascular

• Ejection fraction at least 50% with no evidence of amyloidosis by echocardiogram
• No clinical evidence of amyloidosis of the heart
• No uncontrolled arrhythmia
• No symptomatic cardiac disease

Pulmonary

• FEV1, FVC, and DLCO at least 60%
• No symptomatic pulmonary disease
• No clinical evidence of amyloidosis of the lungs

Other

• No known allergy to vitamin C or bisphosphonates
• No known hypersensitivity to technetium Tc 99m phosphorus radiopharmaceuticals (e.g., technetium Tc 99m-methylene diphosphonate)
• No concurrent illness that would severely limit life expectancy
• No symptoms, physical findings, or radiographic evidence of cord compression
• No clinical evidence of amyloidosis of the autonomic nervous system or gastrointestinal tract
• No prior noncompliance in other studies
• No other malignancy within the past 5 years except treated indolent skin cancers or carcinoma in situ of the cervix
• HIV negative
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy

• See Disease Characteristics
• No prior stem cell or bone marrow transplantation
• No concurrent maintenance therapy comprising interferon or thalidomide

Chemotherapy

• See Disease Characteristics

Endocrine therapy

• See Disease Characteristics
• No concurrent maintenance therapy comprising dexamethasone

Radiotherapy

• No prior cumulative external-beam radiotherapy (EBRT) to more than 20% of bone marrow
• No prior cumulative EBRT dose of 30 Gy or more to the spinal cord
• No prior radiotherapy to the bladder

Surgery

• See Disease Characteristics

Other

• At least 4 weeks since prior investigational agents for MM
• At least 4 weeks since other prior experimental therapies for any other condition
• No bisphosphonates for at least 4 weeks before study, during study, and for at least 30 days posttransplantation