Samarium Sm 153 Lexidronam Pentasodium Combined With Zoledronic Acid or Pamidronate in Treating Patients With Relapsed or Refractory Multiple Myeloma and Bone Pain

DISEASE CHARACTERISTICS:

• Diagnosis of multiple myeloma

  • Relapsed or refractory disease, meeting 1 of the following criteria:

    • Recurrent disease after stem cell transplantation
    • Recurrent or progressive disease despite treatment with ≥ 1 standard regimen (e.g., an alkylating agent plus glucocorticoid and/or the combination of vincristine, doxorubicin hydrochloride, and dexamethasone)

• Measurable or evaluable disease, defined by at least 1 of the following:

  • Monoclonal protein ≥ 1.0 g by serum protein electrophoresis
  • Monoclonal protein ≥ 200 mg by 24-hour urine electrophoresis
  • Serum immunoglobulin free light chain ≥ 10 mg/dL AND abnormal serum immunoglobulin kappa to lambda free light chain ratio
  • Monoclonal bone marrow plasmacytosis ≥ 30% (evaluable disease)
• Patients must have already undergone hematopoietic stem cell collection, if believed to be a transplant candidate OR not eligible for a hematopoietic stem cell transplant

PATIENT CHARACTERISTICS:

• ECOG performance status (PS) 0-2 (ECOG PS 3 allowed if secondary to pain)
• ANC ≥ 1,000/mm^3
• Platelet count ≥ 75,000/mm^3
• Hemoglobin ≥ 8.0 g/dL (transfusions allowed)
• Creatinine ≤ 3 mg/dL
• Calcium < 15 mg/dL
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 4 weeks after completion of study therapy
• No impending long bone fracture
• No active malignancy except for nonmelanoma skin cancer or carcinoma in situ of the cervix or breast
• No uncontrolled infection
• No other co-morbidity that would interfere with the patient's ability to participate in this trial
• No known hypersensitivity to any of the components of samarium Sm 153 lexidronam pentasodium or bisphosphonates

PRIOR CONCURRENT THERAPY:

• Recovered from all prior surgery, radiotherapy, or other antineoplastic therapy
• More than 4 weeks since prior melphalan or other myelosuppressive agents
• More than 2 weeks since prior nonmyelosuppressive agents (e.g., thalidomide or high-dose corticosteroids)
• More than 30 days since prior and no other concurrent investigational therapy
• No prior samarium Sm 153 lexidronam pentasodium or strontium chloride Sr 89
• No concurrent external beam radiotherapy

• No concurrent high-dose corticosteroids

  • Concurrent chronic steroids (maximum dose of 20 mg/day prednisone equivalent) allowed for disorders other than myeloma (i.e., adrenal insufficiency or rheumatoid arthritis)
  • Low-dose steroids allowed for replacement or inhalation therapy

• No other concurrent medications, including any of the following:

  • Cytotoxic chemotherapy
  • Systemic antineoplastic therapy including, but not limited to, immunotherapy, hormonal therapy, or monoclonal antibody therapy

  • Prophylactic hematopoietic growth factors

    • Hematopoietic growth factors allowed for established cytopenia therapy