# IFM 2009: lenalidomide, bortezomib and dexamethasone with or without upfront transplantation for myeloma

Source: https://onco.cc/key-papers/paper-ifm-2009-attal-nejm-2017/  
OnCo record `paper-ifm-2009-attal-nejm-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding an early autologous stem cell transplant to modern three-drug therapy delayed relapse in newly diagnosed myeloma, though overall survival was similar because patients in the drug-only arm could have a transplant later.

## Summary

Phase 3 trial of 700 adults up to 65 with newly diagnosed multiple myeloma randomised to lenalidomide, bortezomib and dexamethasone (RVD) alone (eight cycles) or RVD with high-dose melphalan and autologous transplant, both followed by a year of lenalidomide maintenance.

Median progression-free survival was 50 months with transplant against 36 months without; complete response 59 versus 48 percent. Four-year overall survival was 81 versus 82 percent, with most drug-only patients receiving transplant at relapse.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2017
- DOI: 10.1056/NEJMoa1611750
- Authors: Attal M, Lauwers-Cances V, Hulin C, et al.
- Findings: Median progression-free survival 50 vs 36 months (hazard ratio 0.65).; Complete response 59 percent vs 48 percent; no overall survival difference at four years.
- What it means: Upfront transplant remains standard for fit patients because it lengthens the first remission, but deferring it to first relapse is a reasonable choice for some, particularly with deeper modern induction.
- Caveats: Lenalidomide maintenance was limited to one year, shorter than current practice.; Quadruplet induction with daratumumab was not used.

## Sources

- N Engl J Med 2017: https://doi.org/10.1056/NEJMoa1611750
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28379796/

## Connected records

- cancers: [Newly diagnosed multiple myeloma, transplant-eligible](https://onco.cc/cancers/myeloma-transplant-eligible/)
- drugs: [Bortezomib](https://onco.cc/drugs/bortezomib/), [Dexamethasone](https://onco.cc/drugs/dexamethasone/), [Lenalidomide](https://onco.cc/drugs/lenalidomide/)
- trials: [IFM 2009](https://onco.cc/trials/ifm-2009/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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