In this phase I trial, patients with relapsed or refractory multiple myeloma will receive standard high dose melphalan with autologous stem cell rescue. In addition the pre-transplant conditioning will include targeted total marrow irradiation (TMI). This conventional 3+3 phase I trial will increase the dose of TMI until the maximum tolerated dose (MTD) is reached. Initial patients enrolled will receive the lowest possible dose of 3Gy. Maximum dose will be 9Gy.
Patients meeting criteria for symptomatic myeloma Patients who have progressive myeloma following initial induction (patients may have received any number of treatment regimens including prior autologous transplant) Patient age 18-75 years at time of enrollment Karnofsky performance status of ≥70 Cardiac function: LVEF >40% Hepatic: Bilirubin <2x upper limit of normal and ALT and AST < 2.5x the upper limit of normal Renal: Creatinine clearance of >30mL/min, estimated or calculated Pulmonary: DLCO, FEV1, FVC >50% of predicted (after correction for hemoglobin)
Exclusion Criteria:
Patients with diagnosis of plasma cell leukemia Patients with truly non secretory myeloma (patients with light chain disease are eligible) Pregnant or breast-feeding Uncontrolled viral, fungal or bacterial infection Note: Infection is permitted if there is evidence of response to medication. Eligibility of HIV infected patients will be determined on a case-by-case basis. Patients who have undergone prior allogeneic stem cell transplant Prior solid organ transplant Patients receiving prior radiation to more than 20% of bone marrow containing areas
