Treatment: Patients, who are randomized to receive plasma exchange, undergo 5-7 plasma exchange procedures within the first 10 days of study entry, concurrent with the initiation of chemotherapy. They receive a routine plasma exchange of 50 ml/kg with acid citrate dextrose as the anticoagulant via a Gambro BCT, Spectra cell separator using 5% human serum albumin and normal saline as the replacement solutions. Chemotherapy will be either Melphalan and prednisone taken daily for 4 days every 28 days for up to 12 cycles or with 4 days of slow intravenous infusion of Vincristine and Adriamycin coupled with Dexamethasone (VAD) given on days 1 to 4, 9 to 12 and 17 to 20 for 28 day cycles up to 6 cycles. Those allocated to plasma exchange, have the VAD stopped 1.5 hours before the plasma exchange and no VAD will be given during the plasma exchange. Following the exchange, subjects receive a bolus volume of VAD that would have been the amount infused during this time period.