Tadalafil and Lenalidomide Maintenance With or Without Activated Marrow Infiltrating Lymphocytes (MILs) in High Risk Myeloma

Inclusion Criteria: * Age 18 - 80 years old; * Patients with active myeloma requiring systemic treatment; * Newly diagnosed patients. Relapsed myeloma patients that have not previously had a transplant; * Meeting criteria for high-risk disease; * Measurable serum and/or urine M-protein from prior to induction therapy documented and available. A positive serum free lite assay is acceptable; * Eastern Cooperative Oncology Group (ECOG) performance status of 0 - 2 (see Appendix C). * Meet all institutional requirements for autologous stem cell transplantation; * The patient must be able to comprehend and have signed the informed consent; * Patients must have had \> than PR after last therapy. Exclusion Criteria: * Diagnosis of any of the following cancers: * POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein \[M-protein\] and skin changes); * Non-secretory myeloma (no measurable protein on Serum Free Lite Assay); * Plasma cell leukemia; * Diagnosis of amyloidosis; * Failed to achieve at least a partial response (PR) to latest therapy; * Previous hematopoietic stem cell transplantation;Patients can have had prior relapsed disease as long as they have never been previously transplanted; * Known history of HIV infection; * Use of corticosteroids (glucocorticoids) within 21 days of bone marrow collection; * Use of any myeloma-specific therapy within 21 days of bone marrow collection; * Infection requiring treatment with antibiotics, antifungal, or antiviral agents within seven days of registration; * Participation in any clinical trial within 28 days of registration on this trial, which involved an investigational drug or device; * History of malignancy other than multiple myeloma within five years of registration, except adequately treated basal or squamous cell skin cancer; * Active autoimmune disease (e.g., rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosis) requiring active systemic treatment. Hypothyroidism without evidence of Grave's disease or Hashimoto's thyroiditis is permitted. * Human T-lymphotropic virus (HTLV) 1 or 2 positive; * Known hypersensitivity to Prevnar or any of its components; * Contraindication to phosphodiesterase-5 inhibitors (e.g. currently on nitrates).