Pomalidomide for Relapse/Refractory Waldenstrom's

The Study Drug:

Pomalidomide is designed to change the immune system, which may interfere with the
development of blood vessels that help support tumor growth. This may reduce or stop the
growth of cancer cells.

Study Groups:

If you are found to be eligible to take part in this study, you will be assigned to a dose
level of pomalidomide based on when you join this study. Up to 4 dose levels of pomalidomide
will be tested. Three (3) participants will be enrolled at each dose level. The first group
of participants will receive the lowest dose level. Each new group will receive a higher dose
than the group before it, if no intolerable side effects were seen. This will continue until
the highest tolerable dose of pomalidomide is found.

Dosing Schedules/Study Drug Administration:

You will be enrolled in one of two dosing schedules (Schedule A or Schedule B) based on how
previous participants have reacted to the study drug.

- If you are in Schedule A, you will take pomalidomide by mouth 1 time each night for 28
days in a row. These 28 days make up 1 "study cycle".

- If you are in Schedule B, you will take pomalidomide by mouth 1 time each night for 21
days in a row, followed by a 7-day "rest period".

You should take the study drug at about the same time every night. You should take it with a
glass of water on an empty stomach. Pomalidomide capsules should be swallowed whole, and
should not be broken, chewed, or opened. Pomalidomide should be taken without food, at least
2 hours before or 2 hours after a meal.

If a dose of pomalidomide is missed, it should be taken as soon as possible on the same day.
If it is missed for the entire day, it should not be made up. Rather, it should be taken at
the next scheduled time point.

Patients who take more than the prescribed dose of pomalidomide should be instructed to seek
emergency medical care if needed and contact study staff immediately. You should bring any
unused pills/bottles with you to each study visit.

You will also take aspirin every day that you take pomalidomide to help lower the chance of
side effects.

Study Drug Diary:

You will be given a study drug diary at the beginning of each cycle. You should bring the
completed diary with you to each study visit. You should write about any missed or vomited
doses in your diary. If you miss a dose of pomalidomide, it should be taken as soon as
possible on the same day. If you miss a dose for an entire day, do not try to make it up by
taking 2 doses the next day. If you vomit a dose of study drug, do not take another dose on
the same day or double the next dose.

Study Visits:

On Day 1 of each Cycle:

- You will have a physical exam, including measurement of your vital signs and weight.

- You will be asked about side effects you are having and any drugs you may be taking.

- Your performance status will be recorded.

- Blood (about 1 tablespoon) will be drawn for routine tests.

- Blood (about 1 teaspoon) and urine will be collected to check the status of the disease.
You will collect urine over a 24-hour period. You will be given a container to collect
the urine in.

- Blood (about 1 tablespoon) or urine will be taken for pregnancy test for women who are
able to have children.

On Days 8 and 22 of Cycle 1:

°Blood (about 1 tablespoon) or urine will be taken for pregnancy test for women who are able
become pregnant.

On Day 15 of Cycle 1:

- Blood (about 1 tablespoon) will be drawn for routine tests.

- You will be asked about any side effects you may be having and any drugs you may be
taking.

- Blood (about 1 tablespoon) or urine will be taken for pregnancy test for women who are
able to become pregnant.

On Day 1 of every odd cycle (Cycles 3, 5, 7 and so on):

- If your study doctor thinks it is needed, you may have a CT or MRI scan of the brain to
check the status of the disease.

- You will have an x-ray of your chest.

- If your study doctor thinks it is needed, you will have x-rays of your bones to check
for any bone lesions you may have.

Starting with Cycle 3, you will have the following tests every 4 months for the first 2
years, then once a year as long as you are on the study, and when the study doctor thinks it
is needed:

You will have CT or MRI scans of the chest, abdomen, and pelvis to check the status of the
disease.

If the disease completely responds to the drugs, you will have a bone marrow aspirate and
biopsy to confirm complete response.

Length of Study:

You will be able to take pomalidomide for as long as the doctor thinks it is in your best
interest. You will be taken off study if the disease gets worse or you have intolerable side
effects.

End-of-Treatment (discontinuation from study drug):

After you are taken off study, you will have an end-of-treatment visit. The following tests
and procedures will be performed:

- You will have a physical exam, including measurement of your weight and vital signs.

- You will asked about any side effects you may be having and any drugs you may be taking.

- Your performance status will be recorded.

- You will have an ECG.

- Blood (about 1 tablespoon) will be drawn for routine tests.

- Blood (about 1 teaspoon) and urine will be collected to check the status of the disease.
You will collect urine over a 24-hour period. You will be given a container to collect
the urine in.

- You will have a CT and/or MRI scan of the chest, abdomen, and pelvis to check the status
of the disease.

- If your study doctor thinks it is needed, you may have a CT or MRI scan of the brain to
check the status of the disease.

- You will have an x-ray of your chest.

- You will have x-rays of your bones to check for any bone lesions you may have.

- Blood (about 1 tablespoon) or urine will be taken for pregnancy test for women who are
able to become pregnant.

Safety assessment Visit:

After you are taken off study, you will have a safety assessment visit 30 days after your
last dose of the study drug. The following tests and procedures will be performed:

- You will have a physical exam, including measurement of your weight and vital signs.

- Your performance status will be recorded.

- Blood (about 1 tablespoon) will be drawn for routine tests.

- You will be asked about side effects you may be having.

Follow-up Phone Call:

The study staff will call you every 6 months for 1 year to ask about any new treatments you
may have started. The phone call should take about 5 minutes.

Inclusion Criteria:

1. Understand and voluntarily sign an informed consent form

2. Age >/= 18 years at the time of signing the informed consent form

3. Able to adhere to the study visit schedule and other protocol requirements

4. Waldenström's Macroglobulinemia that has relapsed and/or is refractory to at least one
prior line of therapy

5. All previous cancer therapy, including radiation, hormonal therapy and surgery, must
have been discontinued at least 4 weeks prior to treatment in this study

6. ECOG performance status of
7. Laboratory test results within these ranges: Serum creatinine Creatinine clearance >/= 45 ml/min; Total bilirubin (ULN) or Direct Bilirubin count >/= 20 K/microL; Absolute neutrophil count >/= 500 K/microL

8. Disease free of prior malignancies for >/= 5 years with exception of currently treated
basal cell, squamous cell carcinoma of the skin, or carcinoma in situ of the cervix or
breast

9. Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy
test with a sensitivity of at least 25 mIU/mL within 10 to 14 days prior to and again
within 24 hours of starting pomalidomide 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 pomalidomide

10. Continued from Inclusion #9: FCBP must also agree to ongoing pregnancy testing. Men
must agree to practice complete abstinence or agree use a latex condom during sexual
contact with a FCBP while participating in the study, during dose interruptions and
for at least 90 days following study drug discontinuation, 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

11. Able to take aspirin (325mg) daily as prophylactic anticoagulation (patients
intolerant to ASA may use therapeutic dose warfarin or low molecular weight heparin).

12. All study participants must be registered into the mandatory POMALYST REMS program,
and be willing and able to comply with the requirements of the POMALYST REMS program.

Exclusion Criteria:

1. Any serious medical condition, laboratory abnormality, or psychiatric illness that
would prevent the subject from signing the informed consent form

2. Pregnant or breast feeding females. (Lactating females must agree not to breast feed
while taking pomalidomide or for 28 days after stopping pomalidomide)

3. Any medical or psychiatric condition, including the presence of laboratory
abnormalities, which places the subject at unacceptable risk if he/she were to
participate in the study, or confounds the ability to interpret data from the study

4. Use of any other experimental drug or therapy within 28 days of the first dose of
study drug

5. Known hypersensitivity to thalidomide or lenalidomide

6. The development of erythema nodosum if characterized by a desquamating rash while
taking thalidomide or similar drugs

7. Any prior use of pomalidomide

8. Concurrent use of other anti-cancer agents or treatments

9. Known positive for HIV or acute hepatitis A or acute or chronic active hepatitis B or
C

10. Grade >2 peripheral neuropathy

11. Neutrophil count <1000K/microL and/or platelet count <100K/microL unless infiltration
by Waldenström's Macroglobulinemia equals or exceed 60% of bone marrow cellularity.