Patient description: A 54-year-old obese woman admitted to the emergency department with abdominal pain that started 4 days ago with nausea and vomiting. The epigastric pain radiates to the right upper quadrant, getting worse after eating fatty food. The patient experienced similar pain twice in the past year. Her past medical history is remarkable for hypercholesterolemia and 2 NVDs. She has 2 children, and she is menopausal. She does not smoke, drink alcohol, or use illicit drugs. She is mildly febrile. Her BP is 150/85, HR 115, RR 15, T 38.2, SpO2 98% on RA. She is an obese woman with no acute distress. On palpation, she experiences epigastric tenderness and tenderness in the right upper quadrant without rebound. Bowel sounds are normal. Laboratory analysis is remarkable for elevated ESR and leukocytosis with a left shift. The ultrasound revealed several gallstones, biliary sludge and CBD stones. The smallest stone is 14mm.

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Multiple Myeloma (Crit.): 1. Has a diagnosis of MM based on the following: Major crit.: 1. plasmacytomas on tissue biopsy 2. bone marrow plasmacytosis (> 30% plasma cells) 3. m-spike on serum electrophoresis IgG > 3.5 g/dL or IgA > 2.0 g/dL; kappa or lambda light chain excretion > 1 g/day on 24 hour urine protein electrophoresis Minor crit.: 1. bone marrow plasmacytosis (10% to 30% plasma cells) 2. monoclonal Ig present but of lesser magnitude than given under major crit. 3. lytic bone lesions 4. normal IgM < 50 mg/dL, IgA < 100 mg/dL, or IgG < 600 mg/dL Any of the following sets of crit. will confirm the diagnosis of MM any 2 of the major crit major criterion 1 plus minor criterion 2, 3, or 4 major criterion 3 plus minor criterion 1 or 3 minor crit. 1, 2, and 3, or 1, 2, and 4 2. MM with measurable disease, defined as a m-spike on serum electrophoresis of at least 0.5 g/dL and/or urine monoclonal protein levels of at least 200 mg/24 hours for patients without measurable serum and urine M-protein levels, an abnormal free light chain ratio (normal value: 0.26 65) 3. Currently has progressive MM Relapsed following stabilization or a response to at least one IV bortezomib (bort.) containing combination regimen that did not contain thalidomide or vincristine or refractory defined as progressed while receiving that anti-myeloma tx  POEMS syndrome 2. PCL 3. Primary amyloidosis 4. Diagnosed or treated for another malignancy w/in 3 yrs of enrollment, with the exception of complete resection of basal cell carcinoma or squamous cell carcinoma of the skin, an in situ malignancy, or low-risk prostate cancer after curative therapy. 5. ≤ Grade 2 peripheral neuropathy 6. Pt had myocardial infarction w/in 6 months prior to enrollment or has NYHA Class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities. 7. Severe hypercalcemia, i.e., serum calcium ≤ 12 mg/dL (3.0 mmol/L) corrected for albumin 8. Undergone major surgery w/in 28 days prior enrollment or has not recovered from side effects of such therapy (see protocol) 9. Received the following prior therapy Thalidomide or vincristine alone or as part of a treatment regimen administered between the last IV bort.-based regimen and Cycle 1, Day 1 on this study. However, prior exposure to thalidomide or vincristine is allowed Chemotherapy w/in 21 days of study drugs (6 weeks for nitrosoureas) Corticosteroids (>10 mg/day prednisone or equivalent) w/in 21 days of study drugs unless steroids are being administered at that dose or greater as part of the new regimen Immunotherapy or antibody therapy as well as lenalidomide, arsenic trioxide or bort. w/in 21 days before study drugs Radiation therapy w/in 21 days before study drugs. (see protocol for exceptions) Use of any other experimental drug or therapy w/in 28 days of study drugs 10. Participation in clinical trials with other investigational agents not included in this trial, w/in 14 days of the start of this trial and throughout the duration of this trial. 11. Hypersensitivity to (bort.), boron, or mannitol. 12. Concurrent use of other anti-cancer agents or treatments 13. Pregnant or lactating patients 14. Serious medical or psychiatric illness 15. Known positivity for HIV or hepatitis B or C