Melphalan and Autologous Stem Cell Transplant Followed By Bortezomib and Dexamethasone in Treating Patients With Previously Untreated Systemic Amyloidosis

DISEASE CHARACTERISTICS:

• Histologically confirmed amyloidosis

• Diagnosed within the past 12 months
• Clonal plasma cell disorder, as demonstrated by any of the following:

• Presence of M-protein in serum and/or urine by immunofixation and/or serum free light chain assay
• Clonal population of plasma cells in the bone marrow based on kappa/lambda staining of a marrow biopsy
• Negative genetic testing for hereditary forms of amyloidosis
• No amyloid-specific syndrome (e.g., carpal tunnel syndrome or skin purpura) as the only evidence of disease

• Vascular amyloidosis only in a bone marrow biopsy specimen or in plasmacytoma is not indicative of systemic amyloidosis
• No advanced cardiac amyloidosis
• Must have symptomatic involvement of no more than 2 of the following visceral organ systems:

• Kidneys
• Liver/gastrointestinal
• Peripheral/autonomic nervous system
• Heart
• No persistent pleural effusions
• No clinically overt multiple myeloma with > 30% plasma cells in the bone marrow or lytic bone lesions
• Able to undergo autologous stem cell transplantation

PATIENT CHARACTERISTICS:

• SWOG performance status 0-3
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• Bilirubin < 2.0 mg/dL
• Creatinine clearance < 51 mL/min allowed
• LVEF > 45% by echocardiogram
• No New York Heart Association class III-IV congestive heart failure
• No history of cardiac syncope
• No recurrent symptomatic arrhythmias
• No oxygen-dependent restrictive cardiomyopathy
• No myocardial infarction within the past 6 months
• Pulmonary diffusion capacity > 50% predicted by pulmonary function testing
• No uncontrolled infection
• No other active malignancy, except for any of the following:

• Adequately treated basal cell or squamous cell skin cancer
• In situ cervical cancer
• Adequately treated stage I cancer from which the patient is currently in complete remission
• Any other cancer from which the patient has been disease-free for 5 years
• No hypersensitivity to bortezomib, boron, or mannitol
• No HIV positivity
• No serious medical or psychiatric illness that would preclude study compliance

PRIOR CONCURRENT THERAPY:

• At least 14 days since prior investigational drugs
• No prior therapy for monoclonal plasma disease