Phase II Study of Biaxin, Revlimid, and Dexamethasone for Untreated Multiple Myeloma

Inclusion Criteria:

Subject must voluntarily sign and understand written informed consent.
Histologically confirmed Durie-Salomon stage II or III MM (see Appendix II). Stage I MM patients will be eligible if they display poor prognostic factors (ß2M > or = 5.5 mg/L, plasma cell proliferation index > or = 5%, albumin of less then 3.0, and unfavorable cytogenetics).
Measurable disease as defined by > 1.0 g/dL serum monoclonal protein, >0.1 g/dL serum free light chains, > 0.2 g/24 hrs urinary M-protein excretion, and/or measurable plasmacytoma(s).
Age > or = 18 years at the time of signing the informed consent form.
Karnofsky performance status > or = 70% (>60% if due to bony involvement of myeloma (see Appendix V).
No prior treatment or less than one full course of first-line therapy. Patients may be receiving adjuvant antiresorptive therapy (i.e., pamidronate or zoledronic acid) as routine care.
If the patient is a woman of childbearing age, she must have a negative serum or urine pregnancy test within 7 days of starting study.
Due to the unknown risk of teratogenic side effects, subjects (women and men) must agree to use effective contraception throughout the duration of the study and for at least 1 month after discontinuation of study drugs.
Life expectancy > 3 months
Absolute neutrophil count (ANC)> or = 1000 cells/mm3 (1.0 x 109/L)
Platelets count > or = 75,000/mm3 (75 x 109/L)
Serum SGOT/AST < 3.0 x upper limits of normal (ULN)
Serum SGPT/ALT < 3.0 x upper limits of normal (ULN)
Serum creatinine < 2.5 mg/dL (221 µmol/L)
Serum total bilirubin < 2.0 mg/dL (34 µmol/L)

Exclusion Criteria:

Patients with non-secretory MM (no measurable monoclonal protein, free light chains, and/or M-spike in blood or urine).
Prior history of other malignancies (except for basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix or breast) unless disease free for ³ 5 years.
NYHA Class III or IV heart disease. History of active angina, congestive heart disease, or myocardial infarction within 6 months.
Pregnant or lactating women are ineligible.
Known HIV positivity
Active viral or bacterial infections or any coexisting medical problem that would significantly increase the risks of this treatment program.
Known hypersensitivity to dexamethasone, clarithromycin, lenalidomide, or thalidomide.
Prior therapy for the treatment of MM
History of thromboembolic event or other condition currently requiring anticoagulation with warfarin (Coumadin). Patients whose therapy is changed to heparin are eligible.