Lenalidomide and High-Dose Melphalan

Inclusion Criteria:

1. Patients with multiple myeloma with relapsed or progressive disease after achieving a partial or complete response to prior conventional therapy or autologous stem cell transplantation
2. Age 18 to 80 years
3. Performance score of at least 80% by Karnofsky or performance score of 0 or 1 (ECOG)
4. Left ventricular ejection fraction =/\> 40%. No uncontrolled arrhythmias or symptomatic cardiac disease.
5. FEV1, FVC and DLCO=/\> 40%. No symptomatic pulmonary disease.
6. Serum bilirubin \<2 x upper limit of normal, SGPT \<3x upper limit of normal. No evidence of chronic active hepatitis or cirrhosis. No pleural effusion or ascites \> 1 L prior to drainage.
7. Creatinine Clearance =/\> 50 ml/min
8. HIV negative
9. Negative beta HCG test in women with child bearing potential, defined as not post-menopausal for 24 months or no previous sterilization.
10. Patients or guardian able to sign informed consent.
11. All study participants must be registered into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist®.
12. Females of childbearing potential (FCBP) must have a negative serum pregnancy test with a sensitivity of at least 50 mIU/mL within 10 -14 days prior to and again within 24 hours of prescribing lenalidomide (prescriptions must be filled within 7 days) and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 4 weeks before she starts taking lenalidomide.
13. Contd. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with females of child bearing potential even if they have had a successful vasectomy. See Appendix F: Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods.

Exclusion Criteria:

1. Fertile men or women unwilling to use contraceptive techniques during and for 12 months following treatment.
2. Patients with uncontrolled hypertension (systolic \> 140, diastolic \>90 despite anti-hypertensive therapy.)
3. Patients with uncontrolled bacteria, viral or fungal infections (currently taking medication and progression of clinical symptoms).
4. Known hypersensitivity or desquamating rash to either thalidomide or lenalidomide.
5. Women who are pregnant (positive ß-HCG) or breastfeeding. (Lactating women must agree not to breast feed while taking lenalidomide and for 28 days after last dose of lenalidomide.)
6. New York Heart Association (NYHA) Class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmia's, or electrocardiographic evidence of acute ischemia, or a 2nd or 3rd degree AV block or new left bundle branch block on EKG.