Propylene Glycol-Free Melphalan Hydrochloride (Evomela) in AL Amyloidosis Patients

Inclusion Criteria: * Age 18 years or older * Eastern Cooperative Oncology Group Performance Status 0-2 * Histologic diagnosis of primary systemic (AL) amyloidosis based on: * Deposition of amyloid material by Congo red stain showing characteristic apple green birefringence AND * Evidence of a clonal plasma cell dyscrasia with monoclonal protein in the serum or urine by immunofixation electrophoresis AND/OR abnormal serum free light chain assay AND/OR clonal plasma cells in the bone marrow exam demonstrated by immunohistochemistry, flow cytometry, or in situ hybridization AND * Evidence of organ involvement * Eligible for treatment with high dose melphalan and stem cell transplantation per institutional guidelines * Ability to understand and willingness to sign informed consent * Pulmonary Function Test demonstrating a diffusion capacity of lung for carbon monoxide ≥ 50% * Left ventricular ejection fraction ≥40% * Systolic blood pressure \>90 mm Hg (supine position) * Eastern Cooperative Oncology Group Performance status of 2 or better (unless patient is diagnosed with AL amyloidosis involving the gastrointestinal and peripheral/autonomic nervous systems, then performance status of 3 is acceptable) Exclusion Criteria: * Previous high-dose melphalan and stem cell transplant * Previous total cumulative dose of oral melphalan \> 300 mg * Cytotoxic chemotherapy within the previous 28 days * New York Heart Association ≥3 * Decompensated or uncontrolled heart failure * Oxygen dependence * epidermal growth factor receptor \< 30 ml/min * Active infection (i.e HIV, Hepatitis B or C) * Pregnancy or breastfeeding * Exposure to another investigational drug within 3-4 weeks prior to start of study treatment * Ongoing alcohol or drug addiction * Unable or unwilling to comply with the protocol