Total Marrow Irradiation With High Dose Melphalan Prior to Autologous Transplant for Multiple Myeloma

Inclusion Criteria:

- Patients meeting criteria for symptomatic myeloma

- Patients must be high or intermediate risk of disease progression as defined by
having one of the following criteria:

- Durie Salmon stage 2 or 3 disease

- Abnormal metaphase cytogenetics

- Presence of FISH abnormalities aside from hyperdiploidy

- Patients who have received at least 2 cycles of systemic treatment of any kind in the
preceding 12 months

- 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 the following will be ineligible for registration:

- Patients with diagnosis of plasma cell leukemia

- Patients with myeloma who have had any disease progression prior to enrollment

- 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 allograft or autologous transplant

- Prior solid organ transplant

- Patients receiving prior radiation to more than 20% of bone marrow containing areas