Bendamustine Hydrochloride, Lenalidomide, and Dexamethasone in Treating Patients With Relapsed Multiple Myeloma

Inclusion:

• Diagnosis of MM and documentation of at least 1 prior therapy (induction therapy followed by stem cell transplantation is considered one prior therapy) but not more than two previous therapies
• Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again within 24 hours of starting lenalidomide
• 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
• Ability to understand the purpose and risks of the study and provide signed and dated informed consent and authorization to use protected health information
• Able to take aspirin (325 mg) daily as prophylactic anticoagulation (patients intolerant to ASA or at high risk of developing thrombosis may use warfarin or low molecular weight heparin)
• AST (SGOT) and ALT (SGPT) = = 60 mL/min (Cockcroft-Gault calculation) for patients enrolled in Phase 1 and Creatinine clearance >= 30 mL/min (Cockcroft-Gault calculation) for patients enrolled in phase 2 portion
• Patients with measurable disease, defined by any of the following: serum monoclonal protein >= 1.0 g by protein electrophoresis; > 200 mg of monoclonal protein in the urine on 24-hour electrophoresis; serum immunoglobulin free light chain >= 10 mg/dL AND abnormal serum immunoglobulin kappa to lambda free light chain ratio; or monoclonal bone marrow plasmacytosis >= 30% (evaluable disease)
• All necessary baseline studies for determining eligibility must be obtained within 21 days prior to enrollment
• Subject has an ECOG = = 60% performance status; patients with lower performance status based solely on bone pain secondary to multiple myeloma will be eligible
• FCBP 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 must also agree to ongoing pregnancy testing
• Absolute neutrophil count (ANC) >= 1, 000 cells/dL (1.0 x 10^9/L) (growth factors cannot be used within 14 days of first drug administration)
• Untransfused platelet count >= 75, 000 cells/dL (50 x 10^9/L) for patients in whom =50,000/dL for patients in whom 50% of bone marrow nucleated cells are plasma cells
• Total Bilirubin = = 8.0 g/dl

Exclusion:

• Diagnosed or treated for another malignancy within 3 years of enrollment, with the exception of complete resection of basal cell carcinoma or squamous cell carcinoma of the skin, an in situ malignancy, or low-risk prostate cancer after curative therapy
• Patients may be receiving concomitant therapy with bisphosphonates and low dose corticosteroids (e.g., prednisone up to but no more than 10 mg p.o. q.d. or its equivalent) for symptom management and comorbid conditions; doses of corticosteroid should be stable for at least 7 days prior to study treatment
• Prior radiation therapy within 2 weeks of the first dose of study treatment
• Known active infection requiring parenteral or oral anti-infective treatment
• Serious psychiatric illness, active alcoholism, or drug addiction that may hinder or confuse follow-up evaluation
• Patient has hypersensitivity to any of the components of study therapy - Known HIV or active hepatitis B or C viral infection
• Known hypersensitivity to required prophylactic medications
• Patient has received other investigational drugs within 14 days before enrollment
• Pregnant or breast-feeding females (lactating females must agree not to breast feed while taking lenalidomide)
• Subjects with evidence of mucosal or internal bleeding and/or platelet transfusion refractory (i.e., unable to maintain a platelet count >= 50,000 cells/mm^3)
• Concurrent therapy with a marketed or investigationa