{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T10:57:53Z","timestamp":1773831473216,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background: Lenalidomide maintenance after autologous stem cell transplantation (ASCT) improves progression-free survival (PFS) and overall survival (OS) in multiple myeloma; however, these benefits are attenuated in high-risk multiple myeloma (HRMM). No standard post-transplant maintenance strategy is established for HRMM, and some centers employ doublet maintenance with bortezomib plus lenalidomide (VR). We evaluated outcomes with VR versus lenalidomide alone (R) in HRMM. Methods: We conducted a multicenter retrospective study through the US Myeloma Innovations Research Collaborative (USMIRC), including adults with HRMM who received R or VR maintenance following ASCT between January 2009 and January 2024. HRMM was defined by del(17p), t(4;14), t(14;16), or t(14;20), with or without 1q gain. PFS and OS were estimated using Kaplan\u2013Meier methods. Median follow-up was 91 months. Baseline characteristics, induction regimens, and post-transplant response depth were well balanced between the groups. Median PFS was 51 months (95% CI, 20\u2013NR) with VR and 36 months (95% CI, 31\u201356) with R (p &gt; 0.05). Median OS was 103 months (95% CI, 90\u2013NR) and 110 months (95% CI, 94\u2013NR), respectively (p &gt; 0.05). VR was associated with numerically longer PFS, although the difference was not statistically significant. No treatment-related mortality occurred within 100 days post-ASCT. Conclusions: In this multicenter real-world analysis of HRMM, VR maintenance did not result in statistically significant improvements in PFS or OS compared with lenalidomide alone. These findings underscore the need for prospective, risk-adapted trials incorporating novel maintenance strategies, including CD38- and BCMA-directed therapies, in high-risk disease.<\/jats:p>","DOI":"10.3390\/curroncol33030164","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T08:26:19Z","timestamp":1773390379000},"page":"164","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maintenance Strategies in High-Risk Myeloma: A Multicenter Comparison of Bortezomib\u2013Lenalidomide Versus Lenalidomide Alone: A USMIRC Multicenter Analysis"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9140-0189","authenticated-orcid":false,"given":"Sruthi P.","family":"Ramanan","sequence":"first","affiliation":[{"name":"Division of Hematology and Cellular Therapy, AHN Cancer Institute, Allegheny Health Network, Pittsburgh, PA 15212, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2266-2120","authenticated-orcid":false,"given":"Oyepeju F.","family":"Abioye","sequence":"additional","affiliation":[{"name":"Division of Hematology and Cellular Therapy, AHN Cancer Institute, Allegheny Health Network, Pittsburgh, PA 15212, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4547-7534","authenticated-orcid":false,"given":"Shebli","family":"Atrash","sequence":"additional","affiliation":[{"name":"Levine Cancer Center, Atrium Health, Wake Forest University School of Medicine, Charlotte, NC 28204, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianzheng","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66103, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9767-1158","authenticated-orcid":false,"given":"Dinesh Pal","family":"Mudaranthakam","sequence":"additional","affiliation":[{"name":"Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS 66103, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7899-7078","authenticated-orcid":false,"given":"Anita","family":"Mazloom","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5299-4233","authenticated-orcid":false,"given":"Omar","family":"Alkharabsheh","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Mitchell Cancer Institute, University of South Alabama, Mobile, AL 36604, USA"},{"name":"Division of Hematology and Oncology, University of Cincinnati, Cincinnati, OH 45267, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mansi R.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Blood Disorders, Rutgers Cancer Institute, New Brunswick, NJ 08903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3168-2521","authenticated-orcid":false,"given":"Zahra","family":"Mahmoudjafari","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS 66205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Snyder","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS 66205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Umair","family":"Mushtaq","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS 66205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9699-3080","authenticated-orcid":false,"given":"Forat","family":"Lutfi","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS 66205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeries","family":"Kort","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS 66205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6603-185X","authenticated-orcid":false,"given":"Al-Ola","family":"Abdallah","sequence":"additional","affiliation":[{"name":"Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS 66205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7464-6898","authenticated-orcid":false,"given":"Prerna","family":"Mewawalla","sequence":"additional","affiliation":[{"name":"Division of Hematology and Cellular Therapy, AHN Cancer Institute, Allegheny Health Network, Pittsburgh, PA 15212, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1002\/ajh.27422","article-title":"Multiple myeloma: 2024 update on diagnosis, risk-stratification, and 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