***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We report feasibility and response results of a phase II study investigating prolonged weekly bortezomib and dexamethasone followed by thalidomide and dexamethasone as maintenance therapy after single autologous stem cell transplantation ( ASCT ) in patients with multiple myeloma . Within 4 to 8 weeks of ASCT , patients received weekly bortezomib and dexamethasone for six cycles , followed by thalidomide and dexamethasone for six more cycles . Thalidomide alone was continued until disease progression . Forty-five patients underwent ASCT . Forty patients started maintenance therapy ; of these , 36 patients received four cycles , and 32 completed six cycles of maintenance bortezomib . Of these 40 patients , nine ( 22 % ) were in complete response ( CR ) before ASCT , 13 ( 32 % ) achieved CR after ASCT but before bortezomib maintenance therapy , and 21 ( 53 % ) achieved CR after bortezomib maintenance therapy . Nine patients not previously in CR ( 33 % ) up grade d their response to CR with bortezomib maintenance . At 1 year post-ASCT , 20 patients achieved CR , and two achieved very good partial response . Twenty-seven patients experienced peripheral neuropathy during bortezomib therapy , all grade 1 or 2 . Our findings indicate that prolonged sequential weekly bortezomib , dexamethasone , and thalidomide maintenance therapy after single ASCT is feasible and well tolerated .  Bortezomib maintenance treatment up grade d post-ASCT CR responses with no severe grade 3/4 peripheral neuropathy BACKGROUND Thalidomide plus dexamethasone ( TD ) is a st and ard induction therapy for myeloma . We aim ed to assess the efficacy and safety of addition of bortezomib to TD ( VTD ) versus TD alone as induction therapy before , and consolidation therapy after , double autologous stem-cell transplantation in newly diagnosed multiple myeloma . METHODS Patients ( aged 18 - 65 years ) with previously untreated symptomatic myeloma were enrolled from 73 sites in Italy between May , 2006 , and April , 2008 , and data collection continued until June 30 , 2010 . Patients were r and omly allocated ( 1:1 ratio ) by a web-based system to receive three 21-day cycles of thalidomide ( 100 mg daily for the first 14 days and 200 mg daily thereafter ) plus dexamethasone ( 40 mg daily on 8 of the first 12 days , but not consecutively ; total of 320 mg per cycle ) , either alone or with bortezomib ( 1·3 mg/m(2 ) on days 1 , 4 , 8 , and 11 ) . The r and omisation sequence was computer generated by the study coordinating team and was stratified by disease stage . After double autologous stem-cell transplantation , patients received two 35-day cycles of their assigned drug regimen , VTD or TD , as consolidation therapy . The primary endpoint was the rate of complete or near complete response to induction therapy . Analysis was by intention to treat . Patients and treating physicians were not masked to treatment allocation . This study is still underway but is not recruiting participants , and is registered with Clinical Trials.gov , number NCT01134484 , and with EudraCT , number 2005 - 003723 - 39 . FINDINGS 480 patients were enrolled and r and omly assigned to receive VTD ( n=241 patients ) or TD ( n=239 ) . Six patients withdrew consent before start of treatment , and 236 on VTD and 238 on TD were included in the intention-to-treat analysis . After induction therapy , complete or near complete response was achieved in 73 patients ( 31 % , 95 % CI 25·0 - 36·8 ) receiving VTD , and 27 ( 11 % , 7·3 - 15·4 ) on TD ( p<0·0001 ) . Grade 3 or 4 adverse events were recorded in a significantly higher number of patients on VTD ( n=132 , 56 % ) than in those on TD ( n=79 , 33 % ; p<0·0001 ) , with a higher occurrence of peripheral neuropathy in patients on VTD ( n=23 , 10 % ) than in those on TD ( n=5 , 2 % ; p=0·0004 ) . Resolution or improvement of severe peripheral neuropathy was recorded in 18 of 23 patients on VTD , and in three of five patients on TD . INTERPRETATION VTD induction therapy before double autologous stem-cell transplantation significantly improves rate of complete or near complete response , and represents a new st and ard of care for patients with multiple myeloma who are eligible for transplant . FUNDING Seràgnoli Institute of Haematology at the University of Bologna , Bologna , Italy PURPOSE To evaluate the activity of thalidomide in patients with asymptomatic multiple myeloma and of thalidomide-dexamethasone in patients with previously untreated symptomatic myeloma . PATIENTS AND METHODS Twenty-eight patients with previously untreated asymptomatic myeloma were treated with thalidomide 100 to 200 mg orally ( PO ) at bedtime ( qhs ) with serial increments of 50 to 100 mg at weekly intervals , as tolerated to a maximum of 600 mg PO qhs . Forty consecutive previously untreated patients with symptomatic myeloma were also treated as above ( maximum dose 400 mg ) and received dexamethasone 20 mg/m(2 ) for 4 days beginning on days 1 , 9 , and 17 ; the second and third cycles of repeated dexamethasone were begun on day 30 . Both groups of patients were treated for at least 3 months . RESULTS The response rate was 36 % for patients treated with thalidomide alone and 72 % for patients treated with thalidomide-dexamethasone , the latter including complete remission in 16 % of patients . The median time to remission was 4.2 months with thalidomide alone and 0.7 months with thalidomide-dexamethasone .  Grade 3 toxicity included infections ( nine patients ) and thrombotic/embolic events ( seven patients ) . Five deaths have occurred as a result of multiple myeloma ( two patients ) , infection ( one patient ) , unknown cause ( one patient ) , and a possible thromboembolic event ( one patient ) . CONCLUSION Thalidomide alone was effective in patients with newly diagnosed myeloma . The combination with dexamethasone induced a high frequency of response , rapid onset of remission , and low incidence of serious irreversible toxicity . These observations support further studies of this promising combination for patients with newly diagnosed multiple myeloma In the FIRST trial ( MM‐020 ) , lenalidomide plus low‐dose dexamethasone ( Rd ) reduced the risk of disease progression or death compared with combination melphalan – prednisone – thalidomide . As the FIRST trial did not include any Japanese patients , the efficacy and safety of continuous treatment with Rd was evaluated in 26 Japanese patients with newly diagnosed multiple myeloma ( NDMM ) in a single‐arm , multicenter , open‐label phase II trial ( MM‐025 ) . Patients received lenalidomide on days 1–21 of each 28‐day cycle , with a starting dose of 25 mg/day ( dose adjusted for renal impairment ) , and 40 mg/day dexamethasone ( dose adjusted for age ) on days 1 , 8 , 15 and 22 of each 28‐day cycle until disease progression or discontinuation for any reason . In the efficacy evaluable population , overall response rate was 87.5 % , including 29.2 % of patients who achieved a complete response/very good partial response . Median duration s of response , progression‐free survival and overall survival have not been reached . The most common grade 3–4 adverse events were neutropenia ( 23 % ) and anemia ( 19 % ) . The efficacy and safety of Rd were consistent with data from larger studies , including the FIRST trial , thereby supporting the use of Rd continuous in Japanese patients with NDMM who are ineligible for stem cell transplantation PURPOSE This phase I study evaluated elotuzumab , lenalidomide , and dexamethasone in patients with relapsed or refractory multiple myeloma ( MM ) . PATIENTS AND METHODS Three cohorts were enrolled and treated with elotuzumab ( 5.0 , 10 , or 20 mg/kg intravenously ) on days 1 , 8 , 15 , and 22 of a 28-day cycle in the first two cycles , and days 1 and 15 of each subsequent cycle ; lenalidomide 25 mg orally [ PO ] on days 1 to 21 ; and dexamethasone 40 mg PO weekly . Dose-limiting toxicities ( DLTs ) were assessed during cycle 1 of each cohort , and clinical responses were evaluated during each cycle . The first five patients received up to six cycles of therapy ; subsequent patients were treated until disease progression . RESULTS Twenty-nine patients with advanced MM and a median of three prior MM therapies were enrolled ; 28 patients were treated , three each in the 5.0-mg/kg and 10-mg/kg cohorts and 22 in the 20-mg/kg cohort . No DLTs were observed up to the maximum proposed dose of 20 mg/kg . The most frequent grade 3 to 4 toxicities were neutropenia ( 36 % ) and thrombocytopenia ( 21 % ) . Two patients experienced a serious infusion reaction ( one grade 4 anaphylactic reaction and one grade 3 stridor ) during the first treatment cycle . Objective responses were obtained in 82 % ( 23 of 28 ) of treated patients . After a median of 16.4 months follow-up , the median time to progression was not reached for patients in the 20-mg/kg cohort who were treated until disease progression . CONCLUSION The combination of elotuzumab , lenalidomide , and low-dose dexamethasone was generally well tolerated and showed encouraging response rates in patients with relapsed or refractory MM BACKGROUND High-dose melphalan plus autologous stem-cell transplantation ( ASCT ) is the st and ard approach in transplant-eligible patients with newly diagnosed myeloma . Our aims were to compare consolidation with high-dose melphalan plus ASCT versus chemotherapy ( cyclophosphamide and dexamethasone ) plus lenalidomide , and maintenance with lenalidomide plus prednisone versus lenalidomide alone . METHODS We did an open-label , r and omised , multicentre , phase 3 study at 59 centres in Australia , Czech Republic , and Italy . We enrolled transplant-eligible patients with newly diagnosed myeloma aged 65 years or younger . Patients received a common induction with four 28-day cycles of lenalidomide ( 25 mg , days 1 - 21 ) and dexamethasone ( 40 mg , days 1 , 8 , 15 , and 22 ) and subsequent chemotherapy with cyclophosphamide ( 3 g/m(2 ) ) followed by granulocyte colony-stimulating factor for stem-cell mobilisation and collection . Using a 2 × 2 partial factorial design , we r and omised patients to consolidation with either chemotherapy plus lenalidomide ( six cycles of cyclophosphamide [ 300 mg/m(2 ) , days 1 , 8 , and 15 ] , dexamethasone [ 40 mg , days 1 , 8 , 15 , and 22 ] , and lenalidomide [ 25 mg , days 1 - 21 ] ) or two courses of high-dose melphalan ( 200 mg/m(2 ) ) and ASCT . We also r and omised patients to maintenance with lenalidomide ( 10 mg , days 1 - 21 ) plus prednisone ( 50 mg , every other day ) or lenalidomide alone . A simple r and omisation sequence was used to assign patients at enrolment into one of the four groups ( 1:1:1:1 ratio ) , but the treatment allocation was disclosed only when the patient reached the end of the induction and confirmed their eligibility for consolidation . Both the patient and the treating clinician did not know the consolidation and maintenance arm until that time . The primary endpoint was progression-free survival assessed by intention-to-treat . The trial is ongoing and some patients are still receiving maintenance . This study is registered at Clinical Trials.gov , number NCT01091831 . FINDINGS 389 patients were enrolled between July 6 , 2009 , and May 6 , 2011 , with 256 eligible for consolidation ( 127 high-dose melphalan and ASCT and 129 chemotherapy plus lenalidomide ) and 223 eligible for maintenance ( 117 lenalidomide plus prednisone and 106 lenalidomide alone ) . Median follow-up was 52·0 months ( IQR 30·4 - 57·6 ) . Progression-free survival during consolidation was significantly shorter with chemotherapy plus lenalidomide compared with high-dose melphalan and ASCT ( median 28·6 months [  
    Output:
    
The current evidence suggests that patients with MM treated with IMiDs are at a high risk of serious infection