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2009Kapoor Prashant; Kumar Shaji; Fonseca Rafael; Lacy Martha Q; Witzig Thomas E; Hayman Suzanne R; Dispenzieri Angela; Buadi Francis; Bergsagel P Leif; Gertz Morie A; Dalton Robert J; Mikhael Joseph R; Dingli David; Reeder Craig B; Lust John A; Russell Stephen J; Roy Vivek; Zeldenrust Steven R; Stewart A Keith; Kyle Robert A; Greipp Philip R; Rajkumar S Vincent
Impact of risk stratification on outcome among patients with multiple myeloma receiving initial therapy with lenalidomide and dexamethasone.
Blood 2009;114(3):518-21.
The outcome of patients with multiple myeloma is dictated primarily by cytogenetic abnormalities and proliferative capacity of plasma cells. We studied the outcome after initial therapy with lenalidomide-dexamethasone among 100 newly diagnosed patients, risk-stratified by genetic abnormalities and plasma cell labeling index. A total of 16% had high-risk multiple myeloma, defined by the presence of hypodiploidy, del(13q) by metaphase cytogenetics, del(17p), IgH translocations [t(4;14), or t(14;16)] or plasma cell labeling index more than or equal to 3%. Response rates were 81% vs 89% in the high-risk and standard-risk groups, respectively. The median progression-free survival was shorter in the high-risk group (18.5 vs 36.5 months, P < .001), but overall survival was comparable. Because of unavailability of all tests for every patient, we separately analyzed 55 stringently classified patients, and the results were similar. In conclusion, high-risk patients achieve less durable responses with lenalidomide-dexamethasone compared with standard-risk patients; no significant differences in overall survival are apparent so far. These results need confirmation in larger, prospectively designed studies.

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