Intervention: Bortezomib
Trial phase: Phase 2
ATC code: L01XG01 | L01XX32
SMILES: CC(C)C[C@H](NC(=O)[C@H](Cc1ccccc1)NC(=O)c1cnccn1)B(O)O
Sex: All
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 50
Group description: Bortezomib is administered at a dose of 1.6mg/m2 IV push over 3 to 5 seconds. Treatment is administered once a week for four weeks followed by one week off. This 5 week period is considered a treatment cycle. Dexamethasone is also administered at a dose of 40mg daily on day of and day after each dose of Bortezomib, with a dose reduction to 20mg on the same schedule if the patient cannot tolerate the higher dose of dexamethasone. The study duration for a given subject will be approximately 30 weeks.

Bortezomib: Bortezomib will be administered at a dose of 1.6 mg/m2 IV push. Treatment will be administered once a week for four weeks followed by one week off. This 5 week period is considered a treatment cycle.

Dexamethasone will also be administered at a dose of 40mg on the day of and day after each dose of bortezomib, with a dose reduction to 20mg on the same schedule if the patient cannot tolerate the higher dose of dexamethasone.
Eligibility criteria:
Inclusion Criteria:

Diagnosis of multiple myeloma based on standard criteria.
Measurable disease, defined as a monoclonal immunoglobulin spike on serum electrophoresis of > 1Gm/dL and/or urine monoclonal immunoglobulin spike of > 200mg/24 hours.
Non-secretors must have measurable protein by Freelite or measurable disease such as plasmacytoma to be eligible.
Patient must not have been previously treated with chemotherapy. Prior treatment of hypercalcemia with corticosteroids, or bisphosphonates does not disqualify the patient.

Patient must be ineligible for autologous stem cell transplant due to one or more of the following reasons:

Age>65
Impaired renal function (creatinine≥2.0 mg/dL)
Impaired pulmonary function (DLCO≤50%)
Poor performance status (KPS≤80)

Other prohibitive comorbid disorder

5b. Patients≥60 who decline autologous stem cell transplant are eligible for this study.
5c. Patients who are eligible but wish to postpone autologous stem cell transplant are eligible for this study.
Karnofsky performance status>50
Patients treated with local radiotherapy with or without a brief exposure to steroids are eligible. Patients who require concurrent radiotherapy should have entry to the protocol deferred until the radiotherapy is completed, followed by a four week wash out period Spot RT to ≤3 vertebrae acceptable prior to entry.

Meets the following pretreatment laboratory criteria at Baseline (Within 14 days prior to study drug administration):

Platelet count>50x10^9/L or, if the bone marrow is extensively infiltrated,>30x10^9/L
Hemoglobin>8.0G/dL
Absolute neutrophil count >1.0x10^9/L or, if the bone marrow is extensively infiltrated, >0.5x10^9/L

Meets the following pretreatment laboratory criteria for liver function tests at the screening visit conducted within 14 days of registration

AST (SGOT): <3 times the upper limit of institutional laboratory normal
ALT (SGPT): <3 times the upper limit of institutional laboratory normal
Total bilirubin: <2 times the upper limit of institutional laboratory normal, unless clearly related to the disease
Women with child-bearing potential should be practicing an adequate form of contraception, as judged by the investigator (i.e. birth control pills, double barrier method, abstinence, etc.) or be surgically sterile or 12 months post-menopausal. Male subject agrees to use an acceptable method for contraception for the duration of the study.
Age 18 years or older
Has given voluntary written informed consent.

Exclusion Criteria:

POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein (M-protein) and skin changes)
Plasma cell leukemia
Impaired kidney function requiring dialysis, patients on hemodialysis are excluded
Receiving steroids >the equivalent of 10mg prednisone daily for other medical conditions, e.g., asthma, systemic lupus erythematosis, rheumatoid arthritis
Infection not controlled by antibiotics
HIV infection. Patients should provide consent for HIV testing according to the institution's standard practice
Known active hepatitis B or C
Myocardial infarction within 6 months prior to enrollment or has New York Heart Association (NYHA) Class III or IV heart failure (Appendix D), uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities
Second malignancy requiring concurrent treatment
Other serious medical or psychiatric illness that could potentially interfere with the completion of treatment according to this protocol
Positive pregnancy test in women of childbearing potential
Patient has hypersensitivity to boron or mannitol.
Patient has ≥Grade 2 peripheral neuropathy within 14 days before enrollment.
Patient has received other investigational drugs with 14 days before enrollment