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)