principal investigator signature page
appendix vii lenalidomide and dexamethasone

Cycle \# : Date of day 1 of above cycle: Patient study number:
Revlimid® (lenalidomide) should be taken from day 1-21 and dexamethasone on day 1, 8, 15, and 22. On the table "R" represents Revlimid® and "D" represents dexamethasone.  
Please call you study nurse when you take the 21st dose of Revlimid®, to allow time for the next order and ensure you have Revlimid® on time for the next cycle.  
Please cross out the R if you took Revlimid® and cross out the D if you took dexamethasone on the indicated days. Please leave blank if you did not take the indicated drugs on the respective day, irrespective of the reason, whether you were advised by your physician or simply forgot.  
| Day 1   | Day 2   | Day 3   | Day 4   | Day 5   | Day 6   | Day 7    |
|---------|---------|---------|---------|---------|---------|----------|
| R       | RD      | R       | R       | R       | R       | R        |
| Day 8   | Day 9   | Day 10  | Day 11  | Day 12  | Day 13  | Day 14   |
| R       | RD      | R       | R       | R       | R       | R        |
| Day 15  | Day 16  | Day 17  | Day 18  | Day 19  | Day 20  | Day 21   |
| R       | RD      | R       | R       | R       | R       | R (call) |
| Day 22  | Day 23  | Day 24  | Day 25  | Day 26  | Day 27  | Day 28   |
| D       |         |         |         |         |         |          |  
Received by study nurse on: (date as MM/DD/YY) Name of study nurse: Signature of study nurse: