Lenalidomide (Revlimid®) Plus Low-dose Dexamethasone (Ld x 4 Cycles) Then Stem Cell Collection Followed by Randomization to Continued Ld or Stem Cell Transplantation (SCT) Plus Maintenance L
Lenalidomide (Revlimid®) Plus Low-dose Dexamethasone (Ld x 4 Cycles) Then Stem Cell Collection Followed by Randomization to Continued Ld or Stem Cell Transplantation (SCT) Plus Maintenance L
The purpose of this study is to compare the effects, good and bad, of two ways to treat
 patients with standard-risk symptomatic multiple myeloma. Patients with standard-risk myeloma
 have myeloma with specific features: levels of 2 blood tests have to be in a specific range
 and there can be no myeloma tumors found outside of the bones or bone marrow, the areas where
 myeloma is usually discovered. In past clinical studies, patients with standard-risk myeloma
 have done well with intensive therapy in the form of stem cell transplant. But multiple
 myeloma is not curable and, although it may respond to standard treatments including stem
 cell transplant, myeloma always recurs.
Inclusion Criteria:

 -  Age ≥ 18 and ≤ 75

 -  Histologic and serologic findings from MSKCC confirming the diagnosis of multiple
 myeloma. Standard diagnostic criteria for multiple myeloma will be used, as per the
 revised International Myeloma Working Group diagnostic criteria.

 -  Patients must have symptomatic multiple myeloma without advanced organ damage (such as
 multiple fractures or advanced bone disease causing immobilization, renal failure,
 spinal cord compression, or organ compromise due to soft tissue plasmacytoma). If
 immediate therapy with radiation and high-dose steroids (eg, for cord compression) or
 with bortezomib-based therapy (eg, for renal failure) is required, the patient is not
 eligible for this trial.

 -  Patients may have received 1 cycle of prior therapy with dexamethasone for multiple
 myeloma.

 -  Adequate organ function is required, defined as follows:

 -  ANC ≥ 1,500/μl and platelets ≥ 100,000/μl (unless low ANC and platelets are due to
 multiple myeloma)

 -  Serum bilirubin ≤ 2.0 mg/dl

 -  AST, ALT and alkaline phosphatase < 3 times the upper limit of laboratory normal

 -  Adequate renal function as assessed by calculated creatinine using Cockcroft-Gault
 estimation of CrCl (see Appendix I): Subjects must have calculated creatinine
 clearance ≥ 30ml/min by Cockcroft-Gault formula

 -  Performance status (ECOG) ≤ 2 (Appendix E).

 -  Eligible for SCT with LVEF ≥ 50% by MUGA or ECHO, and diffusing capacity > 50%
 predicted by pulmonary function testing

 -  Ability to understand the investigational nature of this study and to give informed
 consent

 -  All study participants must be registered into the mandatory Revlimid REMS® program,
 and be willing and able to comply with the requirements the of Revlimid REMS® program

 -  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 prior to prescribing lenalidomide for cycle 1 (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 not to father a child and 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 C: Risks of Fetal Exposure, Pregnancy Testing
 Guidelines and Acceptable Birth Control Methods.

 -  Able to take aspirin 325mg or 81mg daily as prophylactic anticoagulation (patients
 intolerant to ASA may use Coumadin or low molecular weight heparin).

 Exclusion Criteria:

 -  Prior treatment for myeloma except for one cycle of dexamethasone

 -  History of thromboembolic disease within the past 6 months regardless of
 anticoagulation

 -  Myocardial infarction within 6 months prior to enrollment, or New York Hospital
 Association (NYHA) Class III or IV heart failure (see APPENDIX F), uncontrolled
 angina, severe uncontrolled ventricular arrhythmias, electrocardiographic evidence of
 acute ischemia or active conduction system abnormalities.

 -  Pregnant or breast-feeding women are excluded due to the potential teratogenicity of
 lenalidomide.

 -  Concurrent active malignancy other than non-melanoma skin cancers or carcinoma-insitu
 of the cervix, or presence of myelodysplastic or myeloproliferative disease. Patients
 with prior malignancies with a disease-free interval of ≥ 5 years are eligible.

 -  Patients who have had prior malignancies within the past 5 years but are considered to
 be "cured" with a low likelihood of recurrence may be eligible at the discretion of
 the Principal Investigator.

 -  Active hepatitis B or C infection

 -  HIV 1 or 2 positivity

 -  Any other medical condition or laboratory evaluation that, in the treating physician's
 or principal investigator's opinion, makes the patient unsuitable to participate in
 this clinical trial