Bortezomib and Dexamethasone With or Without Lenalidomide in Treating Patients With Multiple Myeloma Previously Treated With Dexamethasone

Inclusion Criteria:

   - Symptomatic multiple myeloma, that was symptomatic at time of initial diagnosis, but
   may be asymptomatic at the time of registration based on induction therapy

   - For the original diagnosis of myeloma, patients must have met the following criteria
   at one point in their disease course: bone marrow plasmacytosis (>10% plasma cells or
   sheets of plasma cells) or a biopsy proven plasmacytoma, and evidence of end-organ
   damage due to multiple myeloma including anemia, hypercalcemia, bone disease (lytic
   bone lesions or pathologic fractures) or renal dysfunction.

   - Patients may have prior exposure to bortezomib

   - Patients must have received a minimum of 1 cycle, maximum of 6 cycles, of a
   dexamethasone-based regimen; patient must not have experienced progressive disease on
   such therapy

   - The following induction regimens were considered adequate for enrollment:
   dexamethasone alone; vincristine, doxorubicin and dexamethasone; thalidomide and
   dexamethasone; lenalidomide and dexamethasone; liposomal doxorubicin and
   dexamethasone; the combination of any of the above agents and dexamethasone; or
   cyclophosphamide, lenalidomide and dexamethasone

   - Patients must have received the minimum cumulative dose of dexamethasone of 160 mg
   (sum of induction treatment) with no maximum dose specified

   - Patients must have been offered and refused front-line stem cell transplant OR not
   have been eligible for front-line stem cell transplant.

   - Bone marrow aspiration and/or biopsy must be obtained =< 28 days prior to
   randomization

   - All tests below must be performed =< 28 days prior to randomization:

      - Kappa free light chain mg/dL

      - Lambda free light chain mg/dL

      - Serum M-protein by serum protein electrophoresis (SPEP)

      - Urine M-protein light chain excretion by urine protein electrophoresis (UPEP)

   - Adequate laboratory levels within 7 days prior to randomization: hemoglobin > 7 g/dL,
   platelet count > 75,000 cells/mm^3, absolute neutrophil count > 1000 cells/mm^3,
   creatinine < 2.5 mg/dL, creatinine clearance (measured or calculated) >= 60 mL/min,
   direct bilirubin =< 1.5 mg/dL, serum glutamate pyruvate transaminase (SGPT) (alanine
   aminotransferase [ALT]) and serum glutamic oxaloacetic transaminase (SGOT) (aspartate
   aminotransferase [AST]) =< 2.5 times the upper limit of normal

   - Patients may be receiving bisphosphonates or erythropoietin growth factors
   (erythropoietic agents) for multiple myeloma

   - Prior palliative and/or localized radiation therapy is permitted, provided at least 14
   days have passed from date of last radiation therapy to date of randomization

   - Patients must be willing and able to take prophylaxis with either aspirin at 325
   mg/day or alternative prophylaxis with either low molecular weight heparin or coumadin
   (patients with prior deep vein thrombosis [DVT] are eligible provided they remain on
   the anticoagulation regimen that was prescribed for treatment of the DVT throughout
   the protocol therapy)

   - Patients must be competent to understand the study as explained in the consent form

   - Eastern Cooperative Oncology Group (ECOG) performance status 0, 1, or 2

   - Sexually active males must be willing to use a condom (even if they have undergone a
   prior vasectomy) while having intercourse with any woman, while taking lenalidomide,
   and for 4 weeks after stopping treatment

   - Patients with a history of prior malignancy are eligible provided there is no active
   malignancy and a low expectation of recurrence within 6 months

   - Age >=18 years

Exclusion Criteria:

   - More than 8 weeks from the last day of last cycle of induction treatment

   - Active, uncontrolled seizure disorder; seizures in the last 6 months

   - Uncontrolled inter-current illness that would limit compliance with the study
   including uncontrolled hypertension, symptomatic congestive heart failure, unstable
   angina, uncontrolled cardiac arrhythmia, uncontrolled psychiatric illness or social
   situation, prior history of Stevens Johnson syndrome

   - Grade 2 or higher peripheral neuropathy by Common Terminology Criteria for Adverse
   Events (CTCAE) version 3.0

   - Active, uncontrolled infection

   - Smoldering myeloma or monoclonal gammopathy of undetermined significance

   - Pregnant or nursing women were not eligible. Women of child-bearing potential
   unwilling to use a dual method of contraception and men who were unwilling to use a
   condom were not eligible