• Response rate and duration of response [ Time Frame: After all patients have progressed ] [ Designated as safety issue: No ]
  
• Progression-free survival [ Time Frame: After all patients have progressed or become deceased ] [ Designated as safety issue: No ]
  

• Toxicity as assessed by NCI CTCAE v3.0 [ Time Frame: Up to 30 days after the last patient receives the last study treatment. ] [ Designated as safety issue: Yes ]
  
• Correlation of antiangiogenetic and costimulatory effects with clinical activity at baseline and after course 1 [ Time Frame: After all patients have completed 1 course ] [ Designated as safety issue: No ]
  
• Specific immune effector cell recruitment and augmentation of antitumor response at baseline and day 15 of course 1 (Northwestern University only) [ Time Frame: After all patients have completed thru day 15 of course 1. ] [ Designated as safety issue: No ]
  

Drug: lenalidomide
10 mg daily orally administered on days 1 - 21 followed by 7 days rest of a 28-day cycle, increasing dose by 5 mg every cycle, up to a maximum of 25 mg.

OBJECTIVES:

Primary

• Determine the response rate and duration of response in patients with relapsed mycosis fungoides/Sézary syndrome treated with lenalidomide.
• Determine the progression-free survival of patients treated with this drug.

Secondary

• Determine the toxicity of this drug in these patients.
• Correlate the antiangiogenetic and costimulatory effects of this drug with clinical activity in skin biopsies from these patients.
• Assess the specific immune effector cell recruitment and augmentation of antitumor response in these patients. (Northwestern University only)

OUTLINE: This is a multicenter study.

Patients receive oral lenalidomide once daily on days 1-21. Treatment repeats every 28 days for 2 courses. Patients with progressive disease are removed from study. Patients achieving complete response receive 2 additional courses of treatment beyond complete response. Patients achieving partial response or stable disease may continue to receive lenalidomide as above for up to 2 years. Treatment continues in the absence of disease progression or unacceptable toxicity.

Patients undergo tissue biopsies at baseline and on day 1 of course 2. Tissue specimens are analyzed for vessel density, presence of adhesion molecules, and immunophenotyping of dermal infiltrate.*

NOTE: *At Northwestern University only, blood and tissue samples from 5-10 patients are collected. Peripheral blood samples are analyzed for immune cell repertoire (CD4+, CD8+ T cells, NK cells, NKT cells, CD4+, CD25+ T-regulatory cells, monocytes, and dendritic cell subsets), cell surface molecules, and for TH1/TH2-associated cytokines, such as interleukin (IL)-2, IL-4, IL-10, IL-12, interferon gamma, and tumor necrosis factor alpha, by flow cytometry at baseline, day 15 of course 1, and at the end of course 1. Immunological activation is assessed by analyzing surface expression of CD45RO and CTLA-4 on CD4+ and CD8+ T cells in blood and skin samples. Skin specimens are stored for future research studies on predictive markers of lenalidomide activity.

After completion of study treatment, patients are followed every 3 months for 1 year.

PROJECTED ACCRUAL: A total of 35 patients will be accrued for this study.