Intervention: Melphalan
Trial phase: Phase 2
ATC code: L01AA03
SMILES: N[C@@H](Cc1ccc(N(CCCl)CCCl)cc1)C(=O)O
Sex: All
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 36
Group description: Patients receive melphalan IV over 2-3 hours on day -2 and an infusion of IL-2-treated autologous or syngeneic peripheral blood stem cells on day 0. Beginning on day 0, patients also receive IL-2 IV continuously over 5 days followed by 2 days off. Treatment with IL-2 repeats weekly for 4 weeks. Beginning 1 month later, patients undergo maintenance therapy comprising interferon alfa SC 3 times a week in the absence of disease progression or unacceptable toxicity.

melphalan: Given IV

recombinant interferon alfa: Given SC

aldesleukin: Undergo IL2-treated autologous or syngeneic peripheral blood stem infusion

in vitro-treated peripheral blood stem cell transplantation: Undergo IL2-treated autologous or syngeneic peripheral blood stem infusion
Eligibility criteria:
Inclusion Criteria:

Patient must be less than 70 years old
Patients with advanced Multiple Myeloma that meet the eligibility requirements for mobilization/debulking with Cytoxan/VP-16/G-CSF, Cytoxan/Taxol/G-CSF, or Cytoxan/G-CSF (according to protocol 506.03); if clinically indicated a lower dose of cytoxan than 4g/m2 may be used for mobilization based on the attending's discretion; also, if the patients had previously collected PBSC of sufficient number in the past and meet the other eligibility requirements, they may be entered on this study after approval by the PI
Patients with advanced Multiple Myeloma that have an identical syngeneic twin for donation of PBSCs
Patients have advanced Multiple Myeloma if they were diagnosed initially with stage II or III disease or had stage I disease that progressed after initial therapy or failed to respond to therapy

Syngeneic Donor Inclusion:

Donor and patient have adequate documentation that donor and recipient are syngeneic; including ABO typing, HLA typing and VNTR studies
Donor > 20 kg
Donor meets eligibility to donate according to Standard Practice Guidelines

Exclusion Criteria:

Patient's age >= 70
Karnofsky score less than 80
A left ventricular ejection fraction less than 50%; Patients with congestive heart disease, history of myocardial infarction (MI), coronary artery disease or any arrhythmia history
Total bilirubin > 1.5 mg/ml (unless history of Gilbert's disease)
Serum glutamic oxaloacetic transaminase (SGOT) or serum glutamic pyruvic transaminase (SGPT) > 2 x upper limit of normal
Estimated creatinine clearance < 60 ml/min or creatinine serum > 2.0 mg/dl
Pregnancy
Seropositivity for human immunodeficiency virus
Patients who cannot give informed consent
Secondary malignancies other than basal cell carcinoma of the skin or carcinoma in situ within the last five years
History of seizures or requirement for medicines, such as haldol, for controlling mental disorders
Concurrent need for corticosteroid therapy
Active connective tissue disease
Pleural effusion, pericardial effusion or ascites
Patients allergic to gentamicin
Patients with positive PCR for hepatitis C or hepatitis B
Patients with hypersensitivity to E. coli - derived preparations
Patients with systemic infection at time of IL2 therapy
Patients who previously have had more than 50% of their pelvic area irradiated
Patients with pulmonary function tests that show diffusion capacity (corrected) < 60%, and/or forced expiratory volume in 1 second (FEV1) < 65% of predicted