title: Impact of risk stratification on outcome among patients with multiple myeloma receiving initial therapy with lenalidomide and dexamethasone.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Division of Hematology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Prashant
authors.initials: P
authors.lastname: Kapoor
authors.forename: Shaji
authors.initials: S
authors.lastname: Kumar
authors.forename: Rafael
authors.initials: R
authors.lastname: Fonseca
authors.forename: Martha Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Witzig
authors.forename: Suzanne R
authors.initials: SR
authors.lastname: Hayman
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: Francis
authors.initials: F
authors.lastname: Buadi
authors.forename: P Leif
authors.initials: PL
authors.lastname: Bergsagel
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Dalton
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Mikhael
authors.forename: David
authors.initials: D
authors.lastname: Dingli
authors.forename: Craig B
authors.initials: CB
authors.lastname: Reeder
authors.forename: John A
authors.initials: JA
authors.lastname: Lust
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Russell
authors.forename: Vivek
authors.initials: V
authors.lastname: Roy
authors.forename: Steven R
authors.initials: SR
authors.lastname: Zeldenrust
authors.forename: A Keith
authors.initials: AK
authors.lastname: Stewart
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.forename: Philip R
authors.initials: PR
authors.lastname: Greipp
authors.forename: S Vincent
authors.initials: SV
authors.lastname: Rajkumar