Lenalidomide & High Dose Dexamethasone for Untreated Multiple Myeloma Renal Failure Patients

Inclusion Criteria:

• Subjects must meet the following inclusion/exclusion criteria to be eligible for the study.

Inclusion criteria

Patients must fulfill all of the following criteria to be eligible for admission to the study:

1. Understand and voluntarily sign an informed consent form
2. Age≥18 years at the time of signing the informed consent form.
3. Able to adhere to the study visit schedule and other protocol requirements.

4. Previously untreated, symptomatic multiple myeloma as defined by ALL 3 criteria below:

   • Monoclonal plasma cells in the bone marrow ≥10% and/or presence of a biopsy-proven plasmacytoma
   • Monoclonal protein present in the serum and/or urine
   • Myeloma-related organ dysfunction (at least one of the following):

   C - Calcium elevation in blood (serum calcium >upper limit of normal) R - Renal insufficiency (serum creatinine >177umol/L) A - Anemia (hemoglobin <100g/L or 20g/L below normal) B - Lytic bone lesions or osteoporosis

5. Eligible for autologous stem cell transplantation as per Princess Margaret Hospital criteria.
6. Disease measurable by serum or urine M (monoclonal) protein, free light chain assay, bone marrow plasmacytosis or plasmacytoma.
7. No prior myeloma therapy (Exception: up to 480 mg of dexamethasone is allowed within the past 28 days, as well as palliative, localized radiation therapy, without the requirement of a washout period prior enrollment).
8. ECOG (Eastern Cooperative Oncology Group) performance status of ≤ 2 at study entry.

9. Laboratory test results within these ranges:

   • Absolute neutrophil count ≥ 1,000/mm³
   • Platelet count ≥ 50,000/mm³ (untransfused)
   • Total bilirubin ≤ 22 umol/L
   • Aspartate transaminase (AST) also called serum glutamic oxaloacetic transaminase (SGOT) and Alanine transaminase (ALT) also called serum glutamic pyruvic transaminase (SGPT) ≤ 2 x ULN (upper limit number) or ≤ 5 x ULN if hepatic metastases are present.
   • Renal function must be measured by 24hour urine for creatinine clearance (CrCl) - any level of CrCl is allowed for eligibility.
10. Disease free of prior malignancies for ≥ 5 years with exception of currently treated basal cell, squamous cell carcinoma of the skin, or carcinoma "insitu" of the cervix or breast.
11. Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL ( milli-International Units per milliliter ) within 7 - 14 days prior to and again within 24 hours of starting lenalidomide 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 28 days before she starts taking lenalidomide. FCBP (Females of childbearing potential) must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a successful vasectomy. All patients must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure.
12. Able to take aspirin 81mg daily as prophylactic anticoagulation [patients intolerant to ASA (Acetyl Salicylic acid - Aspirin) may use low molecular weight heparin].

Exclusion Criteria:

• Patients who fulfill any of the following criteria are not eligible for admission to the study:

  1. Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from signing the informed consent form.
  2. Pregnant or breast-feeding females. (Lactating females must agree not to breast feed while taking lenalidomide).
  3. Any condition, including the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study.
  4. Use of any other experimental drug or therapy, except for up to 480 mg of dexamethasone or palliative, localized radiation therapy, without the requirement of a washout period prior enrollment.
  5. Known hypersensitivity to thalidomide.
  6. The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs.
  7. Any prior use of lenalidomide.
  8. Concurrent use of other anti-cancer agents or treatments.
  9. Known positive for HIV (Human immunodeficiency virus) or infectious hepatitis, type B or C.
  10. Evidence of AL (amyloid light chain) amyloidosis