Trial of High Dose Melphalan/Stem Cell Transplant With or Without Bortezomib

This study seeks to enroll patients with AL amyloidosis who have been recommended for
standard treatment with high-dose melphalan and stem cell transplant.

Standard treatment for this disease is high-dose melphalan and stem cell transplant.

The purpose of this study is to compare the safety and effectiveness of standard treatment
with high-dose melphalan and stem cell transplant, compared with investigational bortezomib
when used in combination with standard treatment with high-dose melphalan and stem cell
transplant for AL amyloidosis.

Patients enrolled in this study will receive either standard treatment with high-dose
melphalan and stem cell transplant, or investigational bortezomib used in combination with
standard treatment with high-dose melphalan and stem cell transplant.

Inclusion Criteria:

1. Histological diagnosis of primary systemic (AL) amyloidosis based on:

- Deposition of amyloid material by Congo red stain showing characteristic apple
green birefringence,AND…

- evidence of a clonal plasma cell dyscrasia with monoclonal protein in the serum
or urine by immunofixation electrophoresis studies AND/OR abnormal serum free
light chain assay AND/OR clonal plasma cells in the bone marrow exam demonstrated
by immunohistochemistry, flow cytometry or in situ hybridization AND…

- evidence of organ involvement other than carpal tunnel syndrome. Patients with
senile, secondary, localized, dialysis-related or familial amyloidosis are not
eligible. Confirmation of tissue diagnosis at all sites of organ dysfunction is
encouraged, but not required.

2. Patients must be > 18 years of age.

3. Patients must have a performance status of 0-2 by Eastern Cooperative Oncology Group
(ECOG) criteria

4. Patients must have left ventricular ejection fraction (LVEF) > 45% by echocardiogram
within 60 days of enrollment

5. Pulmonary Function Tests must show diffusing capacity of lung for carbon monoxide
(DLCO) > 50%.

6. All patients must be informed of the investigational nature of this study and must
sign and give written informed consent in accordance with institutional and federal
guidelines.

Exclusion Criteria:

1. Patients with recent (< 6 months) myocardial infarction, congestive heart failure, New
York Heart Association (NYHA) class III/IV or arrhythmia which are refractory to
medical therapy are ineligible.

2. Prior chemotherapy with alkylating agent allowed only if no evidence of
Myelodysplastic Dysplastic Syndrome (MDS) morphologically or cytogenetically. Total
cumulative dose of oral melphalan must be < 300 mg. Patients should not have received
any cytotoxic therapy < 4 weeks prior to registration and should have fully recovered
from the effects of such therapy.

3. Patients must not have overt multiple myeloma (>30% bone marrow plasmacytosis and,
extensive (>2) lytic lesions and hypercalcemia).

4. No other prior malignancy is allowed except for the following: adequately treated
basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated
Stage I or II cancer from which the patient is currently in complete remission, or any
other cancer from which the patient has been disease-free for 5 years.

5. Patients must not be HIV positive.

6. Pregnant or nursing women may not participate. Women and men of reproductive potential
may not participate unless they have agreed to use an effective contraceptive method.