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