Samarium 153 and Bortezomib in Treating Patients With Relapsed or Refractory Multiple Myeloma

DISEASE CHARACTERISTICS:

Diagnosed with multiple myeloma by 1 of the following criteria:

Meets any 2 of the following major criteria:

Plasmacytomas on tissue biopsy
Bone marrow plasmacytosis (i.e., > 30% plasma cells)
Monoclonal immunoglobulin spike IgG > 3.5 g/dL or IgA > 2.0 g/dL by serum electrophoresis; kappa or lambda light chain excretion > 1 g by 24-hour urine protein electrophoresis

Plasmacytomas on tissue biopsy AND meets any 1 of the following minor criteria:

Presence of monoclonal immunoglobulin at a lesser magnitude than given under above major criteria
Lytic bone lesions
Normal IgM < 50 mg/dL, IgA < 100 mg/dL, or IgG < 600 mg/dL

Monoclonal immunoglobulin spike IgG > 3.5 g/dL or IgA > 2.0 g/dL by serum electrophoresis; kappa or lambda light chain excretion > 1 g by 24-hour urine protein electrophoresis AND meets 1 of the following minor criteria:

Bone marrow plasmacytosis (i.e., 10-30% plasma cells)
Lytic bone lesions

Presence of monoclonal immunoglobulin at a lesser magnitude than given under major criteria with bone marrow plasmacytosis (i.e., 10-30% plasma cells) AND meets 1 of the following minor criteria:

Lytic bone lesions
Normal IgM < 50 mg/dL, IgA < 100 mg/dL, or IgG < 600 mg/dL
Measurable disease, defined as a monoclonal immunoglobulin spike of ≥ 1 gm/dL by serum electrophoresis and/or a immunoglobulin spike of ≥ 200 mg by 24-hour urine protein electrophoresis or evidence of lytic bone disease OR
Nonmeasurable disease (i.e., patients with nonsecretory or oligosecretory multiple myeloma)

Relapsed or refractory disease

Relapsed disease following a response or stable disease after prior chemotherapy (e.g., single-agent steroids, vincristine, doxorubicin, and dexamethasone [VAD], or melphalan and prednisone [MP]) or high-dose chemotherapy
Refractory (i.e., failure to achieve at least complete or partial response or stable disease) to the most recent chemotherapy with or without systemic corticosteroids
No plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein (M-protein), and skin changes (POEMS syndrome)
No extramedullary myeloma

PATIENT CHARACTERISTICS:

Karnofsky performance status 60-100%
Life expectancy > 3 months
Absolute neutrophil count ≥ 1,500/mm³
Platelet count ≥ 75,000/mm³
AST and ALT ≤ 3 times upper limit of normal (ULN)
Bilirubin ≤ 2 times ULN (unless clearly related to disease)

Creatinine clearance ≥ 30 mL/min

Creatinine clearance > 15 mL/min and < 30 mL/min due to significant myelomatous involvement of kidneys allowed at discretion of investigator
Sodium > 130 mmol/L
No ECG evidence of acute ischemia or new conduction system abnormalities
No myocardial infarction within the past 6 months
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
No active infection
No severe hypercalcemia (i.e., serum calcium ≥ 14 mg/dL)
No New York Hospital Association class III or IV heart failure
No poorly controlled hypertension, diabetes mellitus, or other serious medical or psychiatric illness that would preclude study treatment
No known HIV history
No known active hepatitis B or C viral infection
No history of allergic reaction attributable to compounds of similar chemical or biological composition to bortezomib, boron, mannitol, ethylenediaminetetramethylenephosphonic acid (EDTMP), or phosphonates
No peripheral neuropathy > grade 1

PRIOR CONCURRENT THERAPY:

At least 12 weeks since prior samarium Sm 153 lexidronam pentasodium

No more than 1 prior treatment

At least 24 weeks since prior strontium chloride Sr 89

No more than 1 prior treatment
No major surgery within the past 4 weeks
No chemotherapy within the past 3 weeks (6 weeks for nitrosoureas)
No corticosteroids (> 10 mg/day prednisone or equivalent) within the past 3 weeks
No immunotherapy, antibody therapy, or radiotherapy (except localized radiotherapy) within the past 4 weeks
No other concurrent investigational agents
No concurrent corticosteroids (≥ 10 mg prednisone or equivalent)