Refusal to accept allogeneic or autologous blood transfusion Unable to accept blood product transfusions Must be willing and able to accept at least three leukapheresis procedures Unwillingness to accept the treatment; Must be willing and able to accept at least three leukapheresis procedures Willing to consent and accept randomization Patients must be willing to accept blood product transfusions Must be willing and able to accept two leukapheresis procedures Must be willing and able to accept the leukapheresis procedure Must be willing and able to accept at least two leukapheresis procedures Must be willing and able to accept at least two tumor biopsies Must be willing and able to accept two leukapheresis procedures Must be willing and able to accept at least two leukapheresis procedures Must be willing and able to accept at least two tumor biopsies Subjects must be willing to accept/continue transfusions to treat low hemoglobin levels Unwilling to accept blood product transfusions Willingness to accept randomization to each of the three arms Must have, or accept to have, an acceptable central catheter for infusion of melflufen