Study of Captisol Enabled Melphalan and Pharmacokinetics for Patients With Multiple Myeloma or Light Chain Amyloidosis That Are Receiving an Autologous Transplant.
Study of Captisol Enabled Melphalan and Pharmacokinetics for Patients With Multiple Myeloma or Light Chain Amyloidosis That Are Receiving an Autologous Transplant.
Captisol Enabled Melphalan, is a new formulation of the standard of care melphalan
 chemotherapy that in packaged in an inactive substance that is believed to help the
 chemotherapy be more stable (meaning that it doesn't lose its effect or need to be
 administered quickly after being mixed). It may also have fewer side effects such as problems
 with important levels of body electrolytes such as potassium, phosphorous and magnesium; and
 cause less kidney and heart damage] than standard formulation melphalan.

 The purpose of this study is to determine if the investigators can achieve a certain level of
 Captisol Enabled Melphalan that would be best to use in treating Multiple Myeloma and AL
 Amyloidosis.
Inclusion Criteria:

 -  Age ≥18 and ≤ 75

 -  Patients must have either:

 -  Symptomatic multiple myeloma who have responded to prior induction or salvage
 chemotherapy (i.e. chemosensitive disease): Patients who are receiving high-dose
 melphalan and AHCT as part of their initial therapy require at least a partial
 response (PR) as defined by the International Myeloma Working Group uniform
 response criteria for MM.

 Patients who are receiving high-dose melphalan and AHCT as part of salvage therapy require
 at least a minor response to their last line of therapy to document chemosensitive disease.
 There is no limit on the number of prior regimens received by the patient.

 OR

 -  Light chain (AL) amyloidosis who may be newly diagnosed or previously treated

 -  Histologic and serologic findings, reviewed at MSKCC, confirming the diagnosis of
 multiple myeloma or AL amyloidosis. Standard diagnostic criteria for multiple
 myeloma will be used, as per the International Myeloma Foundation consensus
 guidelines

 -  Patients must have at least 3 x 10^6 CD34+ cells/kg frozen.

 -  Adequate organ function is required, defined as follows:

 -  Serum bilirubin ≤ 2.0 mg/dl

 -  AST, ALT and alkaline phosphatase < 3 times the upper limit of laboratory normal

 -  Creatinine clearance ≥ 40 ml/min (24 hour urine collection)

 -  LVEF ≥ 45% by MUGA or rest ECHO

 -  Diffusing capacity ≥ 45% (adjusted for hemoglobin) predicted by pulmonary function
 testing

 -  Performance status (ECOG) ≤ 2

 -  A willingness to avoid pregnancy or fathering children in male and female
 subjects respectively

 -  A woman of childbearing potential must have a negative serum pregnancy test (β-human
 chorionic gonadotropin [β-hCG]) at screening and must be willing to avoid pregnancy
 during the study treatment period and for a specified duration (1 year post HCT) after
 the end of treatment.

 -  Women of childbearing potential who have a negative serum pregnancy test at screening
 must practice a highly effective method of birth control (with at least 99% certainty)
 from screening through safety follow-up. Permitted methods that are at least 99%
 effective in preventing pregnancy should be communicated to the subject and their
 understanding confirmed.

 -  Men who are enrolled must agree to take appropriate precautions to avoid fathering
 children (with at least 99% certainty) from screening through safety follow-up.
 Permitted methods that are at least 99% effective in preventing pregnancy should be
 communicated to the subject and their understanding confirmed

 Exclusion Criteria:

 -  Unstable angina or myocardial infarction within 4 months of initiating therapy on
 trial, NYHA Class III or IV heart failure, uncontrolled angina, severe uncontrolled
 ventricular arrhythmias, sick sinus syndrome, or electrocardiographic evidence of
 acute ischemia or Grade 3 conduction system abnormalities unless subject has a
 pacemaker

 -  Light chain (AL) amyloidosis patients with Mayo Cardiac Stage IIIB (defined as
 NT-proBNP>8500 ng/L and Cardiac troponin (cTnT) >0.035 μg/L)

 -  Pregnant or lactating females

 -  Nonhematologic malignancy within the past 3 years with the exception of a) adequately
 treated basal cell carcinoma, squamous cell skin cancer, or thyroid cancer; b)
 carcinoma in situ of the cervix or breast; c) prostate cancer of Gleason Grade 6 or
 less with stable prostate-specific antigen levels; or d) cancer considered cured by
 surgical resection or unlikely to impact survival during the duration of the study,
 such as localized transitional cell carcinoma of the bladder or benign tumors of the
 adrenal or pancreas

 -  Contraindication to CE melphalan or any of the required supportive treatments,
 including hypersensitivity to G-CSF or pegfilgrastim

 -  Any other medical condition or laboratory evaluation that, in the treating physician's
 or principal investigator's opinion, makes the patient unsuitable to participate in
 this clinical trial

 -  Any known allergy or allergic reactions to Captisol