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However, patients with high\u2010risk multiple myeloma (HRMM) do not derive the same survival benefit from lenalidomide maintenance compared with standard\u2010risk patients. The authors sought to determine the outcomes of bortezomib\u2010based maintenance compared with lenalidomide maintenance in patients with HRMM undergoing ASCT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In total, the authors identified 503 patients with HRMM who were undergoing ASCT within 12\u00a0months of diagnosis from January 2013 to December 2018 after receiving triplet novel\u2010agent induction in the Center for International Blood and Marrow Transplant Research database. HRMM was defined as deletion 17p, t(14;16), t(4;14), t(14;20), or chromosome 1q gain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three hundred fifty\u2010seven patients (67%) received lenalidomide alone, and 146 (33%) received bortezomib\u2010based maintenance (with bortezomib alone in 58%). Patients in the bortezomib\u2010based maintenance group were more likely to harbor two or more high\u2010risk abnormalities and International Staging System stage III disease (30% vs. 22%; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.01) compared with the lenalidomide group (24% vs. 15%; <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.01). Patients who were receiving lenalidomide maintenance had superior progression\u2010free survival at 2\u00a0years compared with those who were receiving either bortezomib monotherapy or combination therapy (75% vs. 63%; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.009). Overall survival at 2\u00a0years was also superior in the lenalidomide group (93% vs. 84%; <jats:italic>p<\/jats:italic>\u00a0=\u00a0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>No superior outcomes were observed in patients with HRMM who received bortezomib monotherapy or (to a lesser extent) in those who received bortezomib in combination as maintenance compared with lenalidomide alone. Until prospective data from randomized clinical trials are available, post\u2010transplant therapy should be tailored to each patient with consideration for treating patients in clinical trials that target novel therapeutic strategies for HRMM, and lenalidomide should remain a cornerstone of treatment.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.34778","type":"journal-article","created":{"date-parts":[[2023,4,6]],"date-time":"2023-04-06T08:49:57Z","timestamp":1680770997000},"page":"2179-2191","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Impact of bortezomib\u2010based versus lenalidomide maintenance therapy on outcomes of patients with high\u2010risk multiple myeloma"],"prefix":"10.1002","volume":"129","author":[{"given":"Naresh","family":"Bumma","sequence":"first","affiliation":[{"name":"James Cancer Center Ohio State Medical Center  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4377-9742","authenticated-orcid":false,"given":"Binod","family":"Dhakal","sequence":"additional","affiliation":[{"name":"Bone Marrow Transplant and Cellular Therapy Program Division of Hematology\/Oncology Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Fraser","sequence":"additional","affiliation":[{"name":"Division of Biostatistics Institute for Health and Equity Medical College of Wisconsin  Milwaukee Wisconsin USA"},{"name":"Center for International Blood and Marrow Transplant Research (CIBMTR) Department of Medicine Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel","family":"Estrada\u2010Merly","sequence":"additional","affiliation":[{"name":"Center for International Blood and Marrow Transplant Research (CIBMTR) Department of Medicine Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Anderson","sequence":"additional","affiliation":[{"name":"Dana\u2010Farber Cancer Institute  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9sar O.","family":"Freytes","sequence":"additional","affiliation":[{"name":"Bone Marrow Transplant Program University of Texas Health Science Center at San Antonio  San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard C.","family":"Hildebrandt","sequence":"additional","affiliation":[{"name":"Markey Cancer Center University of Kentucky  Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leona","family":"Holmberg","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Research Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell M.","family":"Krem","sequence":"additional","affiliation":[{"name":"Division of Hematology\/BMT Kansas City Veterans Affairs Medical Center  Kansas City Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Hematology, Royal Adelaide Hospital  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lazaros","family":"Lekakis","sequence":"additional","affiliation":[{"name":"Division of Transplantation and Cellular Therapy University of Miami Hospital and Clinics Sylvester Comprehensive Cancer Center  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillard M.","family":"Lazarus","sequence":"additional","affiliation":[{"name":"University Hospital Seidman Cancer Center Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1584-1067","authenticated-orcid":false,"given":"Hira","family":"Mian","sequence":"additional","affiliation":[{"name":"Department of Oncology McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemant S.","family":"Murthy","sequence":"additional","affiliation":[{"name":"Blood and Marrow Transplantation Program Division of Hematology\u2010Oncology Mayo Clinic  Jacksonville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunita","family":"Nathan","sequence":"additional","affiliation":[{"name":"Section of Bone Marrow Transplant and Cell Therapy Division of Hematology, Oncology, and Cell Therapy Rush University Medical Center  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2621-7924","authenticated-orcid":false,"given":"Taiga","family":"Nishihori","sequence":"additional","affiliation":[{"name":"Department of Blood and Marrow Transplant and Cellular Immunotherapy H. 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