{"entity":{"id":"paper-ifm-2009-attal-nejm-2017","kind":"paper","name":"IFM 2009: lenalidomide, bortezomib and dexamethasone with or without upfront transplantation for myeloma","aka":[],"tldr":"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.\n\nMedian 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.","asOf":"2026-09-17","links":[{"label":"N Engl J Med 2017","url":"https://doi.org/10.1056/NEJMoa1611750"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/28379796/"}],"tags":[],"related":[],"cancers":["myeloma-transplant-eligible"],"sections":[],"technologies":[],"targets":[],"drugs":["bortezomib","dexamethasone","lenalidomide"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["ifm-2009"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2017,"doi":"10.1056/NEJMoa1611750","pmid":"28379796","authors":"Attal M, Lauwers-Cances V, Hulin C, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true,"participants":700},"route":"/key-papers/paper-ifm-2009-attal-nejm-2017/","neighbours":{"cancer":[{"id":"myeloma-transplant-eligible","kind":"cancer","name":"Newly diagnosed multiple myeloma, transplant-eligible","route":"/cancers/myeloma-transplant-eligible/"}],"drug":[{"id":"bortezomib","kind":"drug","name":"Bortezomib","route":"/drugs/bortezomib/"},{"id":"dexamethasone","kind":"drug","name":"Dexamethasone","route":"/drugs/dexamethasone/"},{"id":"lenalidomide","kind":"drug","name":"Lenalidomide","route":"/drugs/lenalidomide/"}],"trial":[{"id":"ifm-2009","kind":"trial","name":"IFM 2009","route":"/trials/ifm-2009/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}]}}