Azacitidine and Lenalidomide for Relapsed and Refractory Patients With Acute Myeloid Leukemia

Inclusion Criteria

• • World Health Organization (WHO)-confirmed AML, other than Acute Promyelocytic Leukemia (APL)
• Age >18 years
• White blood cell count (WBC) at initiation of treatment ≤ 10,000/L

o If WBC is > 10,000/L patients may be started on an appropriate dose of hydroxyurea (to be determined by the investigators), until WBC 2 months

• All study participants must be registered into the mandatory RevAssist® program, and be willing and able to comply with the requirements of RevAssist® (RevAssist is a restricted distribution program for receiving lenalidomide)
• Females of childbearing potential (FCBP)† must have a negative serum or urine pregnancy test with a sensitivity of at least 50 million International Units per milliliter (mIU/mL) 10 - 14 days prior to study enrollment 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 28 days before she starts taking lenalidomide. FCBP 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. See Appendix F: Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods
• Willing and able to understand and voluntarily sign a written informed consent
• Able to adhere to the study visit schedule and other protocol requirements

Exclusion Criteria

• • Known or suspected hypersensitivity to azacitidine or mannitol
• Patients with advanced malignant hepatic tumors.
• Treatment less than four weeks prior to enrollment with other experimental therapies or antineoplastic agents, with the exception of hydroxyurea
• Inability to swallow or absorb drug
• Prior treatment with lenalidomide for AML
• Active opportunistic infection or treatment for opportunistic infection within four weeks of first day of study drug dosing
• New York Heart Association Class III or IV heart failure
• Unstable angina pectoris
• Significant uncontrolled cardiac arrhythmias
• Uncontrolled psychiatric illness that would limit compliance with requirements
• Known Human immunodeficiency virus (HIV) infection
• Graft vs. host disease ≥ grade 2
• Relapse after allogeneic stem cell transplantation prior to post-transplant day 30
• Pregnant or breast feeding females; lactating females must agree not to breast feed while taking lenalidomide
• Other medical or psychiatric illness or organ dysfunction or laboratory abnormality which in the opinion of the investigator would compromise the patient's safety or interfere with data interpretation
• Laboratory abnormalities:
• Either creatinine >2.0 mg/dL or creatinine clearance 2 x institutional upper limit of normal (ULN) (unless documented Gilbert's syndrome)
• Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) > 3 x institutional ULN