Bortezomib, Cyclophosphamide, Dexamethasone, and Thalidomide in Treating Patients With Newly Diagnosed, Previously Untreated Multiple Myeloma

DISEASE CHARACTERISTICS:

* Diagnosis of multiple myeloma meeting 1 of the following criteria:

  * Monoclonal immunoglobulin spike on serum electrophoresis (IgG \> 3.5 g/dL or IgA \> 2.0 g/dL) and kappa or lambda light chain excretion \> 1 g/day by 24-hour urine protein electrophoresis AND meets any of the following criteria:

    * Bone marrow plasmacytosis (10-30% plasma cells)
    * Lytic bone lesions
  * Monoclonal immunoglobulin of lesser magnitude present and bone marrow plasmacytosis (10-30% plasma cells) AND meets any of the following criteria:

    * Lytic bone lesions
    * IgM \< 50 mg/dL, IgA \< 100 mg/dL, or IgG \< 600 mg/dL
  * Bone marrow plasmacytosis (\> 30% plasma cells) or plasmacytoma on tissue biopsy AND meets any of the following criteria:

    * Monoclonal immunoglobulin of lesser magnitude present
    * Lytic bone lesions
    * IgM \< 50 mg/dL, IgA \< 100 mg/dL, or IgG \< 600 mg/dL
  * FreeLite testing abnormal and kappa:lambda light chain ratio abnormal
* Symptomatic disease requiring treatment

  * Documented related organ or tissue involvement, if present
* Measurable disease, defined as 1 of the following:

  * Monoclonal immunoglobulin spike on serum electrophoresis ≥ 1 g/dL and/or urine monoclonal immunoglobulin spike ≥ 200 mg/day
  * Abnormal FreeLite testing (for nonsecretors)
  * Patients with nonsecretory disease must meet either of the following criteria for measurability:

    * Has measurable protein by FreeLite testing
    * Untreated soft tissue plasmacytoma and/or evaluable disease in bone marrow
* Newly diagnosed, previously untreated disease
* No POEMS syndrome (i.e., plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein \[M-protein\], and skin changes)
* No plasma cell leukemia

PATIENT CHARACTERISTICS:

* Karnofsky performance status 50-100%
* Platelet count ≥ 100,000/mm³ (≥ 50,000/mm³ if bone marrow is extensively infiltrated)

  * Extensive infiltration is defined as \> 50% myeloma cells or plasma cells
* Hemoglobin ≥ 8.5 g/dL
* Absolute neutrophil count ≥ 1,500/mm³
* AST and ALT ≤ 2 times upper limit of normal (ULN)
* Bilirubin ≤ 1.5 times ULN (unless clearly related to the disease)
* Creatinine clearance ≥ 20 mL/min
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use 2 methods of effective contraception ≥ 4 weeks prior to beginning treatment, during, and for ≥ 4 weeks after completion of study treatment
* No impaired kidney function requiring dialysis
* No uncontrolled infection
* No HIV positivity
* No known active hepatitis B or C
* No cardiovascular disease including, but not limited to, any of the following:

  * Myocardial infarction within the past 6 months
  * New York Heart Association class II-IV heart failure
  * Uncontrolled angina
  * Severe uncontrolled ventricular arrhythmias
  * Clinically significant pericardial disease
  * Acute ischemic or active conduction system abnormalities by EKG
* No history of allergic reactions to compounds containing mannitol, bortezomib, or cyclophosphamide
* No second malignancy requiring concurrent treatment
* No other serious medical or psychiatric illness that would preclude study compliance
* No peripheral neuropathy ≥ grade 1

PRIOR CONCURRENT THERAPY:

* No prior chemotherapy, immunotherapy, vaccine therapy, therapeutic doses of steroids, or other agents for the treatment of active myeloma

  * Drugs given to prevent onset of myeloma allowed
  * Bisphosphonates for hypercalcemia or short course corticosteroids for hypercalcemia or cord compromise allowed
* Prior local radiotherapy with or without a brief exposure to steroids allowed
* More than 4 weeks since prior and no concurrent radiotherapy

  * Spot radiotherapy to ≤ 3 vertebrae allowed
* No concurrent steroids at \> 10 mg of prednisone daily (or the equivalent) for other medical conditions (e.g., asthma, systemic lupus erythematosus, or rheumatoid arthritis)
* No other concurrent chemotherapy or investigational agents
* Concurrent daily acetylsalicylic acid required during course 4-6 of study treatment