Inclusion Criteria: 

• A clinical diagnosis of HHT as defined by the Curacao criteria.
• Age > 18 years.
• Platelet count ≥ 100,000/µl 4. WBC ≥ 2,500/µl.
• INR ≤ 1.4 and normal activated partial thromboplastin time by local laboratory criteria (aPTT).
• Epistaxis severity score ≥ 3 measured over the preceding three months, measured at the screening visit.
• A requirement for parenteral infusion of at least 250 mg of iron or transfusion of 1 unit of blood over the preceding 24 weeks.
• Females of childbearing potential (FCBP) must adhere to the scheduled pregnancy testing (once very two weeks) as required in the POMALYST REMS program. FCBP must a negative serum pregnancy test with a sensitivity of at least 50 mIU/mL within 10 - 14 days prior to and again within 24 hours of prescribing 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. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a vasectomy. 
• Ability to understand and sign informed consent.
• All study participants must agree to be registered into the FDA mandated POMALYST REMS program, and be willing and able to comply with the requirements of the POMALYST REMS program

Exclusion Criteria: 

• Women currently breast feeding.
• Renal insufficiency, serum creatinine > 2.0 mg/dl.
• GI bleeding thought to be related to hepatic insufficiency, bilirubin > 2.0 or transaminases > 3.0 x normal.
• Prior treatment with thalidomide or other imid drugs within previous 6 months.
• Prior treatment with bevacizumab (systemic or nasal) within previous 8 weeks.
• The use of octreotide or estrogens within the previous month.
• History of prior thromboembolism confirmed by venous ultrasound or other imaging modalities.
• Peripheral neuropathy, confirmed by neurologic consultation.
• Known underlying hypoproliferative anemia (i.e., myelodysplasia, aplastic anemia).
• Currently enrolled in other interventional trials.
• Known hypersensitivity to thalidomide or lenalidomide.
• The development of erythema nodosum if characterized by a desquamating rash while taking thalidomide or similar drugs. 
• Known SMAD-4 mutation.
• Anything that in the investigator's opinion is likely to interfere with completion of the study.