Bortezomib, Liposomal Doxorubicin Hydrochloride, Dexamethasone, and Cyclophosphamide in Treating Patients With Multiple Myeloma That Relapsed After Autologous Stem Cell Transplant

Inclusion Criteria:

Diagnosis of multiple myeloma that was symptomatic at the time of initial diagnosis

Must have met the following criteria at one point during the disease course:

Bone marrow plasmacytosis with ≥ 10% plasma cells or sheets of plasma cells or biopsy-proven plasmacytoma

Symptomatic disease at initial diagnosis that prompted the initiation of therapy as well as evidence of end-organ damage at the time of diagnosis, including at least 1 of the following:

Anemia
Hypercalcemia
Bone disease (lytic bone lesions or pathologic fracture)
Renal dysfunction
Disease relapsed < 12 months after autologous stem cell transplantation (SCT)

Measurable disease, as defined by the presence of ≥ 1 of the following:

Serum M-spike ≥ 1 g/dL
Urine M-spike ≥ 200 mg/24 hours
Involved free light chain (FLC) ≥ 10 mg/dL (provided the serum FLC is abnormal)
Plasma cells ≥ 30%
ECOG performance status 0-2
Negative pregnancy test
Fertile patients must use effective contraception
At least 14 days since prior palliative and/or localized radiotherapy
Left ventricular ejection fraction (LVEF) normal by Echocardiography (ECHO) or multiple-gated acquisition (MUGA) scan
Hemoglobin > 8 g/dL
Platelet count ≥ 75,000/mm^3 (without transfusion support)
Absolute neutrophil count (ANC) ≥ 1,000/mm^3 (without use of growth factors)
Creatinine < 2.5 mg/dL
Direct bilirubin ≤ 1.5 mg/dL
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 times upper limit of normal

All tests below must be performed within 14 days prior to registration:

Serum free light chain assay
Kappa free light chain
Lambda free light chain

Prior malignancy allowed provided it was treated curatively and has not relapsed in 5 years

Patients with basal cell skin cancer, in situ cervical cancer, or prostate cancer not requiring therapy are eligible

Exclusion Criteria:

Therapy for relapsed disease following SCT
Known allergy to bortezomib or anthracyclines
Prior allogeneic SCT
Peripheral neuropathy ≥ grade 2 according to the Cancer Therapy Evaluation Program (CTEP) active version of the NCI Common Terminology Criteria for Adverse Events (CTCAE)

Concurrent uncontrolled illness that would limit study compliance, including the following:

Uncontrolled hypertension
Symptomatic congestive heart failure
Unstable angina
Uncontrolled cardiac arrhythmia
Uncontrolled psychiatric illness or social situation
Active uncontrolled infection
Prior doxorubicin hydrochloride exposure > 240 mg/m^2
Active, uncontrolled seizure disorder
Seizures within the past 6 months
Pregnant or nursing