Study to Evaluate Two Lenalidomide Dose Regimens With Low Dose Dexamethasone for the Treatment Relapsed Multiple Myeloma

Inclusion Criteria:

1. Previously diagnosed with multiple myeloma.
2. Must have relapsed or refractory disease (refractory is defined as progression duringtreatment or within 60 days after the completion of treatment) requiring 2nd or 3rdline therapy
3. Patients may have received lenalidomide and/or dexamethasone
4. Patients must have measurable disease:

• Serum monoclonal protein >0.5g/dL and/or 0.2g/24hr urine light chain excretion
• Patients with lower M-protein values or non-secretory myeloma will be eligible ifmeasurable disease can be established, such as serum FreeliteTM chain ratio >5xULN, measurable soft tissue plasmacytoma >2cm by either physical exam and/orapplicable radiographs (i.e. MRI, CT-scan) and/or bone marrow involvement >30%

5. Age >=18 years at the time of consent.
6. All necessary baseline studies for determining eligibility must be obtained within 14days prior to enrollment. Serum pregnancy tests (sensitivity of at least 25 mIU/mL),for females of childbearing potential (WCBP) must be completed. The first test must beperformed within 10-14 days, and the second test within 24 hours prior to initiationof lenalidomide.
7. Pre-study ECOG performance status 0-2. Patients with lower performance status basedsolely on bone pain will be eligible.
8. Adequate liver functions: AST and ALT =< 3xULN, alkaline phosphatase =< 3.0x ULN,except if attributed to tumor, and bilirubin =< 2xULN.
9. Have Amylase =< 2.5x ULN
10. Able to adhere to the study visit schedule and other protocol requirements
11. Must understand and voluntarily sign an informed consent document.
12. Females of childbearing potential (FCBP)† must have a negative serum or urinepregnancy test with a sensitivity of at least 50 mIU/mL 10 - 14 days prior to andagain within 24 hours of starting lenalidomide and must either commit to continuedabstinence from heterosexual intercourse or begin TWO acceptable methods of birthcontrol, one highly effective method and one additional effective method AT THE SAMETIME, at least 4 weeks before she starts taking lenalidomide. FCBP must also agree toongoing pregnancy testing. Men must agree not to father a child and agree to use acondom if his partner is of child bearing potential. All patients must be counseled ata minimum of every 28 days about pregnancy precautions and risks of fetal exposure.
13. All study participants must be registered into the mandatory RevAssist® program, andbe willing and able to comply with the requirements of RevAssist®. All counseling willbe done through RevAssist®.
14. Able to take aspirin (81 or 325 mg) daily as prophylactic anticoagulation. Patientsintolerant to ASA may use low molecular weight heparin. Lovenox is recommended.Coumadin will be allowed provided the patient is fully anticoagulate with INR 2.0 to 2.5.
15. Patients may receive a bisphosphonate.

Exclusion Criteria:

1. Any serious medical condition, laboratory abnormality, or psychiatric illness thatwould prevent the subject from signing the informed consent form.
2. Pregnant or breast feeding females.(Lactating females must agree not to breast feedwhile taking lenalidomide).
3. Any condition, including the presence of laboratory abnormalities, which places thesubject at unacceptable risk if he/she were to participate in the study or confoundsthe ability to interpret data from the study.
4. Renal insufficiency of creatinine clearance <40mL/min
5. Known hypersensitivity to thalidomide or lenalidomide.
6. Development of erythema nodosum if characterized by a desquamating rash while takingthalidomide or similar drugs.
7. Concurrent use of other anti-cancer agents or treatments.
8. Known seropositive for an active viral infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV). Patients who areseropositive because of hepatitis B virus vaccine are eligible.
9. Has hemoglobin <8.0g/dL. The use of transfusion with pRBC to correct anemia and meeteligibility criteria will not be allowed.
10. Has an absolute neutrophil count <1.0x10^9/L within 14 days before enrollment
11. Peripheral neuropathy of grade >=3. Patients with painful grade 2 neuropathy are alsoexcluded
12. Has platelet count <75x10^9/L within 14 days before enrollment.
13. Plasma cell leukemia at time of study entry.