Study Description

PRIMARY OBJECTIVES:

I. To compare progression-free survival between patients receiving melphalan, prednisone, and thalidomide versus melphalan, prednisone, and lenalidomide in newly diagnosed multiple myeloma patients who are not candidates for high-dose therapy.

SECONDARY OBJECTIVES:

I. To compare overall survival between the arms. II. To compare response rates and depth of response. III. To compare the incidence of toxicities. IV. To validate the translocation classification (TC) of myeloma as a prognostic tool using gene expression profiling at diagnosis.

TERTIARY OBJECTIVES:

I. To compare quality-of-life (QOL) change between arms based on the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT-Ntx) Trial Outcome Index (TOI) from registration (prior to initiation of treatment) to the end of cycle 24 (maintenance therapy).

II. To examine the impact of differential treatment response (PFS), if observed, on QOL based on the FACT-Ntx TOI up to cycle 38 (maintenance therapy).

III. To obtain prospective data on myeloma specific QOL attributes.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I:

INDUCTION THERAPY: Patients receive melphalan orally (PO) and prednisone PO once daily (QD) on days 1-4, and thalidomide PO QD on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.

MAINTENANCE THERAPY: Patients receive thalidomide PO QD and continue in the absence of disease progression.

ARM II:

INDUCTION THERAPY: Patients receive melphalan PO and prednisone PO QD on days 1-4, and lenalidomide PO on days 1-21. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.

MAINTENANCE THERAPY: Patients receive lenalidomide PO QD on days 1-21. Courses repeat every 28 days in the absence of disease progression.

After completion of study treatment, patients are followed up periodically for 10 years.

Condition or Disease	Intervention/Treatment
Multiple Myeloma	Other: Laboratory Biomarker Analysis Drug: Lenalidomide Drug: Melphalan Drug: Prednisone Other: Quality-of-Life Assessment Drug: Thalidomide

Study Design

Study Type	Interventional
Actual Enrollment	306 participants
Design Allocation	Randomized
Interventional Model	Parallel Assignment
Masking	None (Open Label)
Primary Purpose	Treatment
Official Title	An Intergroup Phase III Randomized Controlled Trial Comparing Melphalan, Prednisone and Thalidomide (MPT) Versus Melphalan, Prednisone and Lenalidomide (Revlimid(TM))(MPR) in Newly Diagnosed Multiple Myeloma Patients Who Are Not Candidates for High-Dose Therapy
Study Start Date	February 29, 2008
Actual Primary Completion Date	January 18, 2014
Anticipated Study Completion Date	February 22, 2025

Groups and Cohorts

Group/ Cohort	Intervention/ Treatment
Arm I (thalidomide) INDUCTION THERAPY: Patients receive melphalan PO and prednisone PO QD on days 1-4, and thalidomide PO QD on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive thalidomide PO QD and continue in the absence of disease progression.	Other: Laboratory Biomarker Analysis Optional correlative studies Drug: Melphalan Drug: Prednisone Other: Quality-of-Life Assessment Drug: Thalidomide
Arm II (lenalidomide) INDUCTION THERAPY: Patients receive melphalan PO and prednisone PO QD on days 1-4, and lenalidomide PO on days 1-21. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive lenalidomide PO QD on days 1-21. Courses repeat every 28 days in the absence of disease progression.	Other: Laboratory Biomarker Analysis Optional correlative studies Drug: Lenalidomide Drug: Melphalan Drug: Prednisone

Outcome Measures

Primary Outcome Measures

1. Progression-Free Survival (PFS) [Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 10 years from the date of randomization.]
   PFS is defined as the time from randomization to the earlier of progression or death of any cause.

Secondary Outcome Measures

1. Overall Survival [Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 10 years from the date of randomization.]
   Overall survival was defined as time from randomization to death from any cause.
2. Very Good Partial Response (VGPR) Rate [Assessed every cycle (1 cycle=28 days) for the first 12 cycles, and then every 2 cycles while on treatment. Post treatment assessed every 3 months < 2 years from study entry, every 6 months if 2-5 years, every 12 months if 6-10 years from study entry.]
   Response evaluation was based on the International Myeloma Working Group (IMWG) response criteria. VGPR rate was defined as patients achieving at least VGPR which include patients who achieving complete response (CR) and VGPR. CR refers to patients who have complete disappearance of an M-protein and no evidence of myeloma in the bone marrow. VGPR refers to patients who meet the following criteria: Serum and urine M-component detectable by immunofixation but not on electrophoresis; Or 90% or greater reduction in serum M-component plus urine M-component <100 mg per 24 hours; If the serum and urine M protein are unmeasurable and the immunoglobulin free light chain parameter is being used to measure response, a ≥ 90% decrease in the difference between involved and uninvolved free light chain (FLC) levels is required in place of the M protein criteria.
3. Change in Functional Assessment of Cancer Therapy-Neurotoxicity Trial Outcome Index (FACT-Ntx TOI) Score From Baseline to Cycle 12 [Administered at registration, the beginning of cycle 7 d1, the end of cycle 12 d28, then at the end of cycle 18, 24, and 38 d28. For patients who discontinue treatment early, assessed at time of discontinuation and at the next quarterly follow-up visit.]
   A combined scale was used to assess the quality of life (QOL) comprising of the well established and validated functional well-being (FWB) and physical well-being (PWB) components of FACT-G version 4 (14 questions), which will address the physical and functional well-being of multiple myeloma patients plus the FACT-neurotoxicity (NTX, 11 questions), which will evaluate symptoms of neurotoxicity. This pooled scale is referred to as the FACT Ntx TOI. The FACT-Ntx TOI has 25 items and the score ranges from 0 (worst possible outcome) to 100 (best possible outcome).

Eligibility Criteria

Ages Eligible for Study	18 Years and Older (Adult, Older Adult)
Sexes Eligible for Study	All
Accepts Healthy Volunteers	No
Inclusion Criteria	Patients must have a confirmed diagnosis of symptomatic myeloma; for the original diagnosis of myeloma patients should have met the following criteria at one point in their disease course: Bone marrow plasmacytosis with >= 10% plasma cells or sheets of plasma cells or biopsy proven plasmacytoma Patient must have had symptomatic disease at initial diagnosis that prompted the initiation of therapy as well as evidence of end-organ damage at the time of diagnosis namely; at least one of the following: anemia, hypercalcemia, bone disease (lytic bone lesions or pathologic fracture), or renal dysfunction NOTE: Patients with asymptomatic smoldering myeloma (serum m protein >= 3 gm/dL or bone marrow plasma cells >= 10% or greater plus no evidence of anemia, hypercalcemia, lytic bone lesions or renal dysfunction) and monoclonal gammopathy of undetermined significance (serum m protein < 3 gm/dL and bone marrow plasma cells < 10% plus no evidence of anemia, hypercalcemia, lytic bone lesions or renal dysfunction) are not eligible Patients must be > 65 and have declined alternative treatment OR patients who are >= 18 < 65 are eligible if they: Are not a candidate for autologous stem cell transplantation in the opinion of the treating physician OR Have declined transplant or other alternative treatment Eastern Cooperative Oncology Group (ECOG) performance status =< 2 All tests below must be performed within 28 days prior to randomization: Serum free light chain assay Kappa free light chain Lambda free light chain NOTE: The serum free light chain test is required to be done if the patient does not have measurable disease in the serum or urine; measurable disease in the serum is defined as having a serum M-spike >= 1 g/dL; measurable disease in the urine is defined as having a urine M-spike >= 200 mg/24 hr NOTE: urine protein electrophoresis (UPEP) (on a 24 hour collection) is required, no substitute method is acceptable; urine must be followed monthly if the baseline urine M-spike is >= 200 mg/24 hr; please note that if both serum and urine m-components are present, both must be followed in order to evaluate response Hemoglobin > 7 g/dL Platelet count > 75,000 cells/mm^3 Absolute neutrophil count > 1000 cells/mm^3 Creatinine < 2.5 mg/dL and creatinine clearance (measured or calculated) > 60 mL/min Total bilirubin =< 1.5 mg/dL Serum glutamate pyruvate transaminase (SGPT) [alanine aminotransferase (ALT)] and serum glutamic oxaloacetic transaminase (SGOT) [aspartate aminotransferase (AST)] =< 2.5 times the upper limit of normal Patients must be previously untreated for myeloma, although prior treatment for myeloma with prednisone or dexamethasone for less than 4 weeks total dosing alone or in combination with thalidomide or lenalidomide for less than 2 weeks total dosing is allowable Patients may be receiving bisphosphonates or growth factors (erythropoietin) for multiple myeloma; although erythropoietin is allowed, it is strongly discouraged due to increased risk of thrombosis when employed alongside thalidomide and/or lenalidomide therapy Patients must be willing and able to take prophylaxis with either aspirin at 325 mg/day or alternative prophylaxis with either low molecular weight heparin or Coumadin Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL within 10 - 14 days and again within 24 hours prior to starting cycle 1 of lenalidomide; further, they must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control: one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before starting lenalidomide; FCBP must also agree to ongoing pregnancy testing; men must agree to use a latex condom during sexual contact with a FCBP, even if they have had a successful vasectomy; a FCBP is a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months); all patients must be counseled by a trained counselor every 28 days about pregnancy precautions and risks of fetal exposure Patients must not have uncontrolled inter-current illness that would limit compliance with the study including: Uncontrolled hypertension Symptomatic congestive heart failure Unstable angina Uncontrolled cardiac arrhythmia Uncontrolled psychiatric illness or social situation Prior history of Stevens Johnson syndrome Patients must not have grade 2 or higher peripheral neuropathy Patients must not have an active, uncontrolled infection Female patients MUST NOT be pregnant or breastfeeding; the use of these drugs in this patient population is ABSOLUTELY CONTRAINDICATED; for women of childbearing potential, a negative serum pregnancy test is required within 10-14 days prior to randomization; for female patients of childbearing potential a negative serum pregnancy test must be repeated within 24 hours prior to initiation of treatment, weekly for the first 4 weeks of treatment and then every 4 weeks if the patient's periods are regular or every 2 weeks if they are not; women of childbearing potential must be willing to refrain from sexual intercourse or must be willing to employ a dual method of contraception, one of which is highly effective [intrauterine device (IUD), birth control pills, tubal ligation or partner's vasectomy] and another additional method (condom, diaphragm or cervical cap) starting 4 weeks prior to and while taking lenalidomide and thalidomide and for four weeks after discontinuing this therapy; the male partner of a female using a single form of birth control should use a condom regardless of his vasectomy status Sexually active males must be willing to use a condom (even if they have undergone a prior vasectomy) while having intercourse with any woman, while taking lenalidomide and thalidomide and for 4 weeks after stopping treatment Patients must not have had a second active malignancy requiring treatment within the last 2 years, with the exceptions of basal or squamous cell carcinoma of the skin, in situ ca
Exclusion Criteria	Patients must have a confirmed diagnosis of symptomatic myeloma; for the original diagnosis of myeloma patients should have met the following criteria at one point in their disease course: Bone marrow plasmacytosis with >= 10% plasma cells or sheets of plasma cells or biopsy proven plasmacytoma Patient must have had symptomatic disease at initial diagnosis that prompted the initiation of therapy as well as evidence of end-organ damage at the time of diagnosis namely; at least one of the following: anemia, hypercalcemia, bone disease (lytic bone lesions or pathologic fracture), or renal dysfunction NOTE: Patients with asymptomatic smoldering myeloma (serum m protein >= 3 gm/dL or bone marrow plasma cells >= 10% or greater plus no evidence of anemia, hypercalcemia, lytic bone lesions or renal dysfunction) and monoclonal gammopathy of undetermined significance (serum m protein < 3 gm/dL and bone marrow plasma cells < 10% plus no evidence of anemia, hypercalcemia, lytic bone lesions or renal dysfunction) are not eligible Patients must be > 65 and have declined alternative treatment OR patients who are >= 18 < 65 are eligible if they: Are not a candidate for autologous stem cell transplantation in the opinion of the treating physician OR Have declined transplant or other alternative treatment Eastern Cooperative Oncology Group (ECOG) performance status =< 2 All tests below must be performed within 28 days prior to randomization: Serum free light chain assay Kappa free light chain Lambda free light chain NOTE: The serum free light chain test is required to be done if the patient does not have measurable disease in the serum or urine; measurable disease in the serum is defined as having a serum M-spike >= 1 g/dL; measurable disease in the urine is defined as having a urine M-spike >= 200 mg/24 hr NOTE: urine protein electrophoresis (UPEP) (on a 24 hour collection) is required, no substitute method is acceptable; urine must be followed monthly if the baseline urine M-spike is >= 200 mg/24 hr; please note that if both serum and urine m-components are present, both must be followed in order to evaluate response Hemoglobin > 7 g/dL Platelet count > 75,000 cells/mm^3 Absolute neutrophil count > 1000 cells/mm^3 Creatinine < 2.5 mg/dL and creatinine clearance (measured or calculated) > 60 mL/min Total bilirubin =< 1.5 mg/dL Serum glutamate pyruvate transaminase (SGPT) [alanine aminotransferase (ALT)] and serum glutamic oxaloacetic transaminase (SGOT) [aspartate aminotransferase (AST)] =< 2.5 times the upper limit of normal Patients must be previously untreated for myeloma, although prior treatment for myeloma with prednisone or dexamethasone for less than 4 weeks total dosing alone or in combination with thalidomide or lenalidomide for less than 2 weeks total dosing is allowable Patients may be receiving bisphosphonates or growth factors (erythropoietin) for multiple myeloma; although erythropoietin is allowed, it is strongly discouraged due to increased risk of thrombosis when employed alongside thalidomide and/or lenalidomide therapy Patients must be willing and able to take prophylaxis with either aspirin at 325 mg/day or alternative prophylaxis with either low molecular weight heparin or Coumadin Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL within 10 - 14 days and again within 24 hours prior to starting cycle 1 of lenalidomide; further, they must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control: one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before starting lenalidomide; FCBP must also agree to ongoing pregnancy testing; men must agree to use a latex condom during sexual contact with a FCBP, even if they have had a successful vasectomy; a FCBP is a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months); all patients must be counseled by a trained counselor every 28 days about pregnancy precautions and risks of fetal exposure Patients must not have uncontrolled inter-current illness that would limit compliance with the study including: Uncontrolled hypertension Symptomatic congestive heart failure Unstable angina Uncontrolled cardiac arrhythmia Uncontrolled psychiatric illness or social situation Prior history of Stevens Johnson syndrome Patients must not have grade 2 or higher peripheral neuropathy Patients must not have an active, uncontrolled infection Female patients MUST NOT be pregnant or breastfeeding; the use of these drugs in this patient population is ABSOLUTELY CONTRAINDICATED; for women of childbearing potential, a negative serum pregnancy test is required within 10-14 days prior to randomization; for female patients of childbearing potential a negative serum pregnancy test must be repeated within 24 hours prior to initiation of treatment, weekly for the first 4 weeks of treatment and then every 4 weeks if the patient's periods are regular or every 2 weeks if they are not; women of childbearing potential must be willing to refrain from sexual intercourse or must be willing to employ a dual method of contraception, one of which is highly effective [intrauterine device (IUD), birth control pills, tubal ligation or partner's vasectomy] and another additional method (condom, diaphragm or cervical cap) starting 4 weeks prior to and while taking lenalidomide and thalidomide and for four weeks after discontinuing this therapy; the male partner of a female using a single form of birth control should use a condom regardless of his vasectomy status Sexually active males must be willing to use a condom (even if they have undergone a prior vasectomy) while having intercourse with any woman, while taking lenalidomide and thalidomide and for 4 weeks after stopping treatment Patients must not have had a second active malignancy requiring treatment within the last 2 years, with the exceptions of basal or squamous cell carcinoma of the skin, in situ carcinoma of the cervix

Contacts and Locations

Sponsors and Collaborators	National Cancer Institute (NCI)
Locations	Providence Hospital | Mobile, Alabama, United States, 36608 Mayo Clinic in Arizona | Scottsdale, Arizona, United States, 85259 Sparks Regional Medical Center | Fort Smith, Arkansas, United States, 72901 UC San Diego Moores Cancer Center | La Jolla, California, United States, 92093 Fremont - Rideout Cancer Center | Marysville, California, United States, 95901 Memorial Medical Center | Modesto, California, United States, 95355 University of California Davis Comprehensive Cancer Center | Sacramento, California, United States, 95817 UC San Diego Medical Center - Hillcrest | San Diego, California, United States, 92103 Kaiser Permanente-San Diego Mission | San Diego, California, United States, 92108 San Diego VA Medical Center | San Diego, California, United States, 92161 Gene Upshaw Memorial Tahoe Forest Cancer Center | Truckee, California, United States, 96161 The Medical Center of Aurora | Aurora, Colorado, United States, 80012 Boulder Community Hospital | Boulder, Colorado, United States, 80301 Penrose-Saint Francis Healthcare | Colorado Springs, Colorado, United States, 80907 Porter Adventist Hospital | Denver, Colorado, United States, 80210 Presbyterian - Saint Lukes Medical Center - Health One | Denver, Colorado, United States, 80218 SCL Health Saint Joseph Hospital | Denver, Colorado, United States, 80218 Rose Medical Center | Denver, Colorado, United States, 80220 Western States Cancer Research NCORP | Denver, Colorado, United States, 80222 Swedish Medical Center | Englewood, Colorado, United States, 80113 Poudre Valley Hospital | Fort Collins, Colorado, United States, 80524 Saint Mary's Hospital and Regional Medical Center | Grand Junction, Colorado, United States, 81501 Banner North Colorado Medical Center | Greeley, Colorado, United States, 80631 Saint Anthony Hospital | Lakewood, Colorado, United States, 80228 Sky Ridge Medical Center | Lone Tree, Colorado, United States, 80124 Longmont United Hospital | Longmont, Colorado, United States, 80501 Banner McKee Medical Center | Loveland, Colorado, United States, 80539 Saint Mary Corwin Medical Center | Pueblo, Colorado, United States, 81004 North Suburban Medical Center | Thornton, Colorado, United States, 80229 Intermountain Health Lutheran Hospital | Wheat Ridge, Colorado, United States, 80401 Hartford Hospital | Hartford, Connecticut, United States, 06102 MedStar Georgetown University Hospital | Washington, District of Columbia, United States, 20007 Holy Cross Hospital | Fort Lauderdale, Florida, United States, 33308 Broward Health Medical Center | Fort Lauderdale, Florida, United States, 33316 Mayo Clinic in Florida | Jacksonville, Florida, United States, 32224-9980 Jupiter Medical Center | Jupiter, Florida, United States, 33458 Mount Sinai Medical Center | Miami Beach, Florida, United States, 33140 Phoebe Putney Memorial Hospital | Albany, Georgia, United States, 31701 Piedmont Hospital | Atlanta, Georgia, United States, 30309 Emory University Hospital/Winship Cancer Institute | Atlanta, Georgia, United States, 30322 Atlanta Regional CCOP | Atlanta, Georgia, United States, 30342 Emory Saint Joseph's Hospital | Atlanta, Georgia, United States, 30342 Northside Hospital | Atlanta, Georgia, United States, 30342 Augusta University Medical Center | Augusta, Georgia, United States, 30912 WellStar Cobb Hospital | Austell, Georgia, United States, 30106 John B Amos Cancer Center | Columbus, Georgia, United States, 31904 Dekalb Medical Center | Decatur, Georgia, United States, 30033 Dublin Hematology Oncology Care PC | Dublin, Georgia, United States, 31021 Piedmont Fayette Hospital | Fayetteville, Georgia, United States, 30214 Northside Hospital - Gwinnett | Lawrenceville, Georgia, United States, 30046 Wellstar Kennestone Hospital | Marietta, Georgia, United States, 30060 Southern Regional Medical Center | Riverdale, Georgia, United States, 30274 Harbin Clinic Medical Oncology and Clinical Research | Rome, Georgia, United States, 30165 OSF Saint Anthony's Health Center | Alton, Illinois, United States, 62002 Rush - Copley Medical Center | Aurora, Illinois, United States, 60504 OSF Saint Joseph Medical Center | Bloomington, Illinois, United States, 61701 Illinois CancerCare-Bloomington | Bloomington, Illinois, United States, 61704 Graham Hospital Association | Canton, Illinois, United States, 61520 Illinois CancerCare-Canton | Canton, Illinois, United States, 61520 Illinois CancerCare-Carthage | Carthage, Illinois, United States, 62321 Memorial Hospital | Carthage, Illinois, United States, 62321 Mount Sinai Hospital Medical Center | Chicago, Illinois, United States, 60608 University of Illinois | Chicago, Illinois, United States, 60612 Swedish Covenant Hospital | Chicago, Illinois, United States, 60625 University of Chicago Comprehensive Cancer Center | Chicago, Illinois, United States, 60637 Heartland Cancer Research NCORP | Decatur, Illinois, United States, 62526 Eureka Hospital | Eureka, Illinois, United States, 61530 Illinois CancerCare-Eureka | Eureka, Illinois, United States, 61530 NorthShore University HealthSystem-Evanston Hospital | Evanston, Illinois, United States, 60201 Saint Francis Hospital | Evanston, Illinois, United States, 60202 Galesburg Cottage Hospital | Galesburg, Illinois, United States, 61401 Illinois CancerCare-Cottage | Galesburg, Illinois, United States, 61401 Illinois CancerCare-Galesburg | Galesburg, Illinois, United States, 61401 Western Illinois Cancer Treatment Center | Galesburg, Illinois, United States, 61401 Illinois CancerCare-Havana | Havana, Illinois, United States, 62644 Mason District Hospital | Havana, Illinois, United States, 62644 Hinsdale Hematology Oncology Associates Incorporated | Hinsdale, Illinois, United States, 60521 Hopedale Medical Complex - Hospital | Hopedale, Illinois, United States, 61747 Duly Health and Care Joliet | Joliet, Illinois, United States, 60435 Illinois CancerCare-Kewanee Clinic | Kewanee, Illinois, United States, 61443 Kewanee Hospital | Kewanee, Illinois, United States, 61443 AMITA Health Adventist Medical Center | La Grange, Illinois, United States, 60525 Illinois CancerCare-Macomb | Macomb, Illinois, United States, 61455 Mcdonough District Hospital | Macomb, Illinois, United States, 61455 Garneau, Stewart C MD (UIA Investigator) | Moline, Illinois, United States, 61265 Porubcin, Michael MD (UIA Investigator) | Moline, Illinois, United States, 61265 Sharis, Christine M MD (UIA Investigator) | Moline, Illinois, United States, 61265 Spector, David MD (UIA Investigator) | Moline, Illinois, United States, 61265 Stoffel, Thomas J MD (UIA Investigator) | Moline, Illinois, United States, 61265 Trinity Medical Center | Moline, Illinois, United States, 61265 Holy Family Medical Center | Monmouth, Illinois, United States, 61462 Illinois CancerCare-Monmouth | Monmouth, Illinois, United States, 61462 Good Samaritan Regional Health Center | Mount Vernon, Illinois, United States, 62864 Carle BroMenn Medical Center | Normal, Illinois, United States, 61761 Carle Cancer Institute Normal | Normal, Illinois, United States, 61761 Illinois CancerCare-Community Cancer Center | Normal, Illinois, United States, 61761 Illinois CancerCare-Ottawa Clinic | Ottawa, Illinois, United States, 61350 Ottawa Regional Hospital and Healthcare Center | Ottawa, Illinois, United States, 61350 Illinois CancerCare-Pekin | Pekin, Illinois, United States, 61554 OSF Saint Francis Radiation Oncology at Pekin | Pekin, Illinois, United States, 61554 Pekin Hospital | Pekin, Illinois, United States, 61554 Proctor Hospital | Peoria, Illinois, United States, 61614 Illinois CancerCare-Peoria | Peoria, Illinois, United States, 61615 Methodist Medical Center of Illinois | Peoria, Illinois, United States, 61636 OSF Saint Francis Medical Center | Peoria, Illinois, United States, 61637 Illinois CancerCare-Peru | Peru, Illinois, United States, 61354 Illinois Valley Hospital | Peru, Illinois, United States, 61354 Valley Radiation Oncology | Peru, Illinois, United States, 61354 Illinois CancerCare-Princeton | Princeton, Illinois, United States, 61356 Perry Memorial Hospital | Princeton, Illinois, United States, 61356 Swedish American Hospital | Rockford, Illinois, United States, 61104 Illinois CancerCare-Spring Valley | Spring Valley, Illinois, United States, 61362 Saint Margaret's Hospital | Spring Valley, Illinois, United States, 61362 Springfield Memorial Hospital | Springfield, Illinois, United States, 62781 Carle Cancer Center | Urbana, Illinois, United States, 61801 Franciscan Saint Francis Health-Beech Grove | Beech Grove, Indiana, United States, 46107 IU Health Arnett Cancer Care | Lafayette, Indiana, United States, 47904 Franciscan Saint Anthony Health-Michigan City | Michigan City, Indiana, United States, 46360 The Community Hospital | Munster, Indiana, United States, 46321 Reid Health | Richmond, Indiana, United States, 47374 McFarland Clinic - Ames | Ames, Iowa, United States, 50010 Constantinou, Costas L MD (UIA Investigator) | Bettendorf, Iowa, United States, 52722 University of Iowa Healthcare Cancer Services Quad Cities | Bettendorf, Iowa, United States, 52722 Mission Cancer and Blood - West Des Moines | Clive, Iowa, United States, 50325 Genesis Medical Center - East Campus | Davenport, Iowa, United States, 52803 Genesis Cancer Care Institute | Davenport, Iowa, United States, 52804 Mercy Capitol | Des Moines, Iowa, United States, 50307 Iowa Methodist Medical Center | Des Moines, Iowa, United States, 50309 Iowa-Wide Oncology Research Coalition NCORP | Des Moines, Iowa, United States, 50309 Mission Cancer and Blood - Des Moines | Des Moines, Iowa, United States, 50309 Mercy Medical Center - Des Moines | Des Moines, Iowa, United States, 50314 Mission Cancer and Blood - Laurel | Des Moines, Iowa, United States, 50314 Iowa Lutheran Hospital | Des Moines, Iowa, United States, 50316 University of Iowa/Holden Comprehensive Cancer Center | Iowa City, Iowa, United States, 52242 Iowa City VA Healthcare System | Iowa City, Iowa, United States, 52246 Mercy Medical Center - North Iowa | Mason City, Iowa, United States, 50401 Ottumwa Regional Health Center | Ottumwa, Iowa, United States, 52501 Siouxland Regional Cancer Center | Sioux City, Iowa, United States, 51101 Mercy Medical Center-Sioux City | Sioux City, Iowa, United States, 51102 Saint Luke's Regional Medical Center | Sioux City, Iowa, United States, 51104 Cedar Valley Medical Specialists | Waterloo, Iowa, United States, 50701 MercyOne Waterloo Cancer Center | Waterloo, Iowa, United States, 50702 Lawrence Memorial Hospital | Lawrence, Kansas, United States, 66044 Cotton O'Neil Cancer Center / Stormont Vail Health | Topeka, Kansas, United States, 66606 Wesley Medical Center | Wichita, Kansas, United States, 67214 Doctors Carrol, Sheth, Raghavan | Louisville, Kentucky, United States, 40215 Owensboro Health Mitchell Memorial Cancer Center | Owensboro, Kentucky, United States, 42303 Ochsner Health Center-Summa | Baton Rouge, Louisiana, United States, 70809 Ochsner Health Center-Covington | Covington, Louisiana, United States, 70433 Ochsner Medical Center Jefferson | New Orleans, Louisiana, United States, 70121 Mercy Hospital | Portland, Maine, United States, 04101 Greater Baltimore Medical Center | Baltimore, Maryland, United States, 21204 Walter Reed National Military Medical Center | Bethesda, Maryland, United States, 20889-5600 Lahey Hospital and Medical Center | Burlington, Massachusetts, United States, 01805 Addison Gilbert Hospital | Gloucester, Massachusetts, United States, 01930 Michigan Cancer Research Consortium NCORP | Ann Arbor, Michigan, United States, 48106 Trinity Health Saint Joseph Mercy Hospital Ann Arbor | Ann Arbor, Michigan, United States, 48106 Corewell Health Dearborn Hospital | Dearborn, Michigan, United States, 48124 Henry Ford Health Saint John Hospital | Detroit, Michigan, United States, 48236 Hurley Medical Center | Flint, Michigan, United States, 48503 Genesys Regional Medical Center-West Flint Campus | Flint, Michigan, United States, 48532 Allegiance Health | Jackson, Michigan, United States, 49201 Bronson Methodist Hospital | Kalamazoo, Michigan, United States, 49007 West Michigan Cancer Center | Kalamazoo, Michigan, United States, 49007 Ascension Borgess Hospital | Kalamazoo, Michigan, United States, 49048 University of Michigan Health - Sparrow Lansing | Lansing, Michigan, United States, 48912 Trinity Health Saint Mary Mercy Livonia Hospital | Livonia, Michigan, United States, 48154 Trinity Health Saint Joseph Mercy Oakland Hospital | Pontiac, Michigan, United States, 48341 Lake Huron Medical Center | Port Huron, Michigan, United States, 48060 MyMichigan Medical Center Saginaw | Saginaw, Michigan, United States, 48601 Henry Ford Health Warren Hospital | Warren, Michigan, United States, 48093 Sanford Joe Lueken Cancer Center | Bemidji, Minnesota, United States, 56601 Essentia Health Saint Joseph's Medical Center | Brainerd, Minnesota, United States, 56401 Fairview Ridges Hospital | Burnsville, Minnesota, United States, 55337 Mercy Hospital | Coon Rapids, Minnesota, United States, 55433 Essentia Health Cancer Center | Duluth, Minnesota, United States, 55805 Essentia Health Saint Mary's Medical Center | Duluth, Minnesota, United States, 55805 Miller-Dwan Hospital | Duluth, Minnesota, United States, 55805 Fairview Southdale Hospital | Edina, Minnesota, United States, 55435 Lake Region Healthcare Corporation-Cancer Care | Fergus Falls, Minnesota, United States, 56537 Unity Hospital | Fridley, Minnesota, United States, 55432 Hutchinson Area Health Care | Hutchinson, Minnesota, United States, 55350 Meeker County Memorial Hospital | Litchfield, Minnesota, United States, 55355 Minnesota Oncology Hematology PA-Maplewood | Maplewood, Minnesota, United States, 55109 Saint John's Hospital - Healtheast | Maplewood, Minnesota, United States, 55109 Abbott-Northwestern Hospital | Minneapolis, Minnesota, United States, 55407 Virginia Piper Cancer Institute | Minneapolis, Minnesota, United States, 55407 Hennepin County Medical Center | Minneapolis, Minnesota, United States, 55415 Minneapolis VA Medical Center | Minneapolis, Minnesota, United States, 55417 North Memorial Medical Health Center | Robbinsdale, Minnesota, United States, 55422 Mayo Clinic in Rochester | Rochester, Minnesota, United States, 55905 Metro Minnesota Community Oncology Research Consortium | Saint Louis Park, Minnesota, United States, 55416 Park Nicollet Clinic - Saint Louis Park | Saint Louis Park, Minnesota, United States, 55416 Regions Hospital | Saint Paul, Minnesota, United States, 55101 Saint Joseph's Hospital - Healtheast | Saint Paul, Minnesota, United States, 55102 United Hospital | Saint Paul, Minnesota, United States, 55102 Saint Francis Regional Medical Center | Shakopee, Minnesota, United States, 55379 Lakeview Hospital | Stillwater, Minnesota, United States, 55082 Ridgeview Medical Center | Waconia, Minnesota, United States, 55387 Rice Memorial Hospital | Willmar, Minnesota, United States, 56201 Minnesota Oncology Hematology PA-Woodbury | Woodbury, Minnesota, United States, 55125 Woodwinds Health Campus | Woodbury, Minnesota, United States, 55125 Singing River Hospital | Pascagoula, Mississippi, United States, 39581 Central Care Cancer Center - Bolivar | Bolivar, Missouri, United States, 65613 Cox Cancer Center Branson | Branson, Missouri, United States, 65616 Southeast Missouri Hospital | Cape Girardeau, Missouri, United States, 63701 Saint Francis Medical Center | Cape Girardeau, Missouri, United States, 63703 Southeast Cancer Center | Cape Girardeau, Missouri, United States, 63703 Saint Luke's Hospital | Chesterfield, Missouri, United States, 63017 MU Health Care Goldschmidt Cancer Center | Jefferson City, Missouri, United States, 65109 Saint Louis Cancer and Breast Institute-South City | Saint Louis, Missouri, United States, 63109 Missouri Baptist Medical Center | Saint Louis, Missouri, United States, 63131 Center for Cancer Care and Research | Saint Louis, Missouri, United States, 63141 Comprehensive Cancer Care PC | Saint Louis, Missouri, United States, 63141 Mercy Hospital Saint Louis | Saint Louis, Missouri, United States, 63141 Saint Louis-Cape Girardeau CCOP | Saint Louis, Missouri, United States, 63141 Cancer Research for the Ozarks NCORP | Springfield, Missouri, United States, 65804 Mercy Hospital Springfield | Springfield, Missouri, United States, 65804 CoxHealth South Hospital | Springfield, Missouri, United States, 65807 Billings Clinic Cancer Center | Billings, Montana, United States, 59101 Northern Rockies Radiation Oncology Center | Billings, Montana, United States, 59101 Saint Vincent Healthcare | Billings, Montana, United States, 59101 Montana Cancer Consortium NCORP | Billings, Montana, United States, 59102 Saint Vincent Frontier Cancer Center | Billings, Montana, United States, 59102 Bozeman Health Deaconess Hospital | Bozeman, Montana, United States, 59715 Saint James Community Hospital and Cancer Treatment Center | Butte, Montana, United States, 59701 Benefis Sletten Cancer Institute | Great Falls, Montana, United States, 59405 Berdeaux, Donald MD (UIA Investigator) | Great Falls, Montana, United States, 59405 Great Falls Clinic | Great Falls, Montana, United States, 59405 Northern Montana Hospital | Havre, Montana, United States, 59501 Saint Peter's Community Hospital | Helena, Montana, United States, 59601 Glacier Oncology PLLC | Kalispell, Montana, United States, 59901 Kalispell Medical Oncology | Kalispell, Montana, United States, 59901 Logan Health Medical Center | Kalispell, Montana, United States, 59901 Montana Cancer Specialists | Missoula, Montana, United States, 59802 Saint Patrick Hospital - Community Hospital | Missoula, Montana, United States, 59802 Community Medical Center | Missoula, Montana, United States, 59804 Guardian Oncology and Center for Wellness | Missoula, Montana, United States, 59804 CHI Health Good Samaritan | Kearney, Nebraska, United States, 68847 Nebraska Cancer Research Center | Lincoln, Nebraska, United States, 68510 Missouri Valley Cancer Consortium | Omaha, Nebraska, United States, 68106 Alegent Health Immanuel Medical Center | Omaha, Nebraska, United States, 68122 Alegent Health Bergan Mercy Medical Center | Omaha, Nebraska, United States, 68124 Creighton University Medical Center | Omaha, Nebraska, United States, 68131 University of Nebraska Medical Center | Omaha, Nebraska, United States, 68198 University Medical Center of Southern Nevada | Las Vegas, Nevada, United States, 89102 Nevada Cancer Institute-Summerlin Campus | Las Vegas, Nevada, United States, 89135 Nevada Cancer Research Foundation NCORP | Las Vegas, Nevada, United States, 89169 Veterans Adminstration New Jersey Health Care System | East Orange, New Jersey, United States, 07018-1095 Virtua Memorial | Mount Holly, New Jersey, United States, 08060 Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital | New Brunswick, New Jersey, United States, 08903 Rutgers Cancer Institute of New Jersey | New Brunswick, New Jersey, United States, 08903 Rutgers New Jersey Medical School | Newark, New Jersey, United States, 07101 Virtua Voorhees | Voorhees, New Jersey, United States, 08043 Montefiore Medical Center-Wakefield Campus | Bronx, New York, United States, 10466 Kings County Hospital | Brooklyn, New York, United States, 11203 State University of New York Downstate Medical Center | Brooklyn, New York, United States, 11203 Roswell Park Cancer Institute | Buffalo, New York, United States, 14263 Hematology Oncology Associates of Central New York-East Syracuse | East Syracuse, New York, United States, 13057 Veterans Affairs New York Harbor Healthcare System-Manhattan Campus | New York, New York, United States, 10010 University of Rochester | Rochester, New York, United States, 14642 Stony Brook University Medical Center | Stony Brook, New York, United States, 11794 Syracuse Veterans Administration Medical Center | Syracuse, New York, United States, 13210 Novant Health Presbyterian Medical Center | Charlotte, North Carolina, United States, 28204 Southeastern Medical Oncology Center-Goldsboro | Goldsboro, North Carolina, United States, 27534 Wayne Memorial Hospital | Goldsboro, North Carolina, United States, 27534 Margaret R Pardee Memorial Hospital | Hendersonville, North Carolina, United States, 28791 ECU Health Oncology Kinston | Kinston, North Carolina, United States, 28501 UNC Rex Healthcare | Raleigh, North Carolina, United States, 27607 Mid Dakota Clinic | Bismarck, North Dakota, United States, 58501 Saint Alexius Medical Center | Bismarck, North Dakota, United States, 58501 Sanford Bismarck Medical Center | Bismarck, North Dakota, United States, 58501 Sanford Broadway Medical Center | Fargo, North Dakota, United States, 58122 Summa Health System - Akron Campus | Akron, Ohio, United States, 44304 Summa Health System - Barberton Campus | Barberton, Ohio, United States, 44203 Mary Rutan Hospital | Bellefontaine, Ohio, United States, 43311 Cleveland Clinic Mercy Hospital | Canton, Ohio, United States, 44708 Aultman Health Foundation | Canton, Ohio, United States, 44710 Adena Regional Medical Center | Chillicothe, Ohio, United States, 45601 Case Western Reserve University | Cleveland, Ohio, United States, 44106 MetroHealth Medical Center | Cleveland, Ohio, United States, 44109 Riverside Methodist Hospital | Columbus, Ohio, United States, 43214 Columbus NCI Community Oncology Research Program | Columbus, Ohio, United States, 43215 Grant Medical Center | Columbus, Ohio, United States, 43215 Mount Carmel Health Center West | Columbus, Ohio, United States, 43222 Doctors Hospital | Columbus, Ohio, United States, 43228 Grandview Hospital | Dayton, Ohio, United States, 45405 Good Samaritan Hospital - Dayton | Dayton, Ohio, United States, 45406 Miami Valley Hospital | Dayton, Ohio, United States, 45409 Miami Valley Hospital North | Dayton, Ohio, United States, 45415 Dayton Veterans Affairs Medical Center | Dayton, Ohio, United States, 45428 Dayton NCI Community Oncology Research Program | Dayton, Ohio, United States, 45459 Grady Memorial Hospital | Delaware, Ohio, United States, 43015 Blanchard Valley Hospital | Findlay, Ohio, United States, 45840 Atrium Medical Center-Middletown Regional Hospital | Franklin, Ohio, United States, 45005-1066 Wayne Hospital | Greenville, Ohio, United States, 45331 Kettering Medical Center | Kettering, Ohio, United States, 45429 Fairfield Medical Center | Lancaster, Ohio, United States, 43130 Saint Rita's Medical Center | Lima, Ohio, United States, 45801 Marietta Memorial Hospital | Marietta, Ohio, United States, 45750 Knox Community Hospital | Mount Vernon, Ohio, United States, 43050 Licking Memorial Hospital | Newark, Ohio, United States, 43055 Springfield Regional Medical Center | Springfield, Ohio, United States, 45504 Upper Valley Medical Center | Troy, Ohio, United States, 45373 Saint Ann's Hospital | Westerville, Ohio, United States, 43081 Clinton Memorial Hospital/Foster J Boyd Regional Cancer Center | Wilmington, Ohio, United States, 45177 Greene Memorial Hospital | Xenia, Ohio, United States, 45385 Genesis Healthcare System Cancer Care Center | Zanesville, Ohio, United States, 43701 Cancer Centers of Southwest Oklahoma Research | Lawton, Oklahoma, United States, 73505 Clackamas Radiation Oncology Center | Clackamas, Oregon, United States, 97015 Legacy Mount Hood Medical Center | Gresham, Oregon, United States, 97030 Providence Milwaukie Hospital | Milwaukie, Oregon, United States, 97222 Providence Newberg Medical Center | Newberg, Oregon, United States, 97132 Providence Willamette Falls Medical Center | Oregon City, Oregon, United States, 97045 Legacy Good Samaritan Hospital and Medical Center | Portland, Oregon, United States, 97210 Providence Portland Medical Center | Portland, Oregon, United States, 97213 Adventist Medical Center | Portland, Oregon, United States, 97216 Providence Saint Vincent Medical Center | Portland, Oregon, United States, 97225 Compass Oncology Rose Quarter | Portland, Oregon, United States, 97227 Legacy Emanuel Hospital and Health Center | Portland, Oregon, United States, 97227 Legacy Meridian Park Hospital | Tualatin, Oregon, United States, 97062 Bryn Mawr Hospital | Bryn Mawr, Pennsylvania, United States, 19010 Adams Cancer Center | Gettysburg, Pennsylvania, United States, 17325 WellSpan Medical Oncology and Hematology | Hanover, Pennsylvania, United States, 17331 Penn State Milton S Hershey Medical Center | Hershey, Pennsylvania, United States, 17033-0850 Central PA Hematology-Medical Oncology Associates PC | Lemoyne, Pennsylvania, United States, 17043 Lewistown Hospital | Lewistown, Pennsylvania, United States, 17044 Paoli Memorial Hospital | Paoli, Pennsylvania, United States, 19301 Einstein Medical Center Philadelphia | Philadelphia, Pennsylvania, United States, 19141 Phoenixville Hospital | Phoenixville, Pennsylvania, United States, 19460 Guthrie Medical Group PC-Robert Packer Hospital | Sayre, Pennsylvania, United States, 18840 Mount Nittany Medical Center | State College, Pennsylvania, United States, 16803 UPMC Susquehanna | Williamsport, Pennsylvania, United States, 17701 Lankenau Medical Center | Wynnewood, Pennsylvania, United States, 19096 Main Line Health NCORP | Wynnewood, Pennsylvania, United States, 19096 WellSpan Health-York Cancer Center | York, Pennsylvania, United States, 17403 WellSpan Health-York Hospital | York, Pennsylvania, United States, 17403 Rapid City Regional Hospital | Rapid City, South Dakota, United States, 57701 Sanford Cancer Center Oncology Clinic | Sioux Falls, South Dakota, United States, 57104 Avera Cancer Institute | Sioux Falls, South Dakota, United States, 57105 Medical X-Ray Center | Sioux Falls, South Dakota, United States, 57105 Avera McKennan Hospital and University Health Center | Sioux Falls, South Dakota, United States, 57117-5045 Sanford USD Medical Center - Sioux Falls | Sioux Falls, South Dakota, United States, 57117-5134 Cookeville Regional Medical Center | Cookeville, Tennessee, United States, 38501 Jackson-Madison County General Hospital | Jackson, Tennessee, United States, 38301 The Jackson Clinic PA | Jackson, Tennessee, United States, 38301 Vanderbilt University/Ingram Cancer Center | Nashville, Tennessee, United States, 37232 Scott and White Memorial Hospital | Temple, Texas, United States, 76508 University of Virginia Cancer Center | Charlottesville, Virginia, United States, 22908 Danville Regional Medical Center | Danville, Virginia, United States, 24541 Sovah Health Martinsville | Martinsville, Virginia, United States, 24112 MultiCare Auburn Medical Center | Auburn, Washington, United States, 98001 Providence Regional Cancer System-Centralia | Centralia, Washington, United States, 98531 Saint Francis Hospital | Federal Way, Washington, United States, 98003 Saint Clare Hospital | Lakewood, Washington, United States, 98499 Providence - Saint Peter Hospital | Olympia, Washington, United States, 98506-5166 MultiCare Good Samaritan Hospital | Puyallup, Washington, United States, 98372 Swedish Medical Center-First Hill | Seattle, Washington, United States, 98122 MultiCare Allenmore Hospital | Tacoma, Washington, United States, 98405 MultiCare Tacoma General Hospital | Tacoma, Washington, United States, 98405 Northwest NCI Community Oncology Research Program | Tacoma, Washington, United States, 98405 Saint Joseph Medical Center | Tacoma, Washington, United States, 98405 PeaceHealth Southwest Medical Center | Vancouver, Washington, United States, 98664 Legacy Salmon Creek Hospital | Vancouver, Washington, United States, 98686 West Virginia University Charleston Division | Charleston, West Virginia, United States, 25304 Camden Clark Medical Center | Parkersburg, West Virginia, United States, 26101 Princeton Community Hospital | Princeton, West Virginia, United States, 24740 ThedaCare Regional Cancer Center | Appleton, Wisconsin, United States, 54911 HSHS Sacred Heart Hospital | Eau Claire, Wisconsin, United States, 54701 Marshfield Clinic Cancer Center at Sacred Heart | Eau Claire, Wisconsin, United States, 54701 Saint Agnes Hospital/Agnesian Cancer Center | Fond Du Lac, Wisconsin, United States, 54935 University of Wisconsin Carbone Cancer Center - Johnson Creek | Johnson Creek, Wisconsin, United States, 53038 Gundersen Lutheran Medical Center | La Crosse, Wisconsin, United States, 54601 SSM Health Dean Medical Group - South Madison Campus | Madison, Wisconsin, United States, 53715 University of Wisconsin Carbone Cancer Center - University Hospital | Madison, Wisconsin, United States, 53792 Marshfield Medical Center-Marshfield | Marshfield, Wisconsin, United States, 54449 Marshfield Medical Center | Marshfield, Wisconsin, United States, 54449 Marshfield Medical Center - Minocqua | Minocqua, Wisconsin, United States, 54548 ProHealth Oconomowoc Memorial Hospital | Oconomowoc, Wisconsin, United States, 53066 Aspirus Cancer Care - James Beck Cancer Center | Rhinelander, Wisconsin, United States, 54501 Marshfield Medical Center-Rice Lake | Rice Lake, Wisconsin, United States, 54868 Aspirus Cancer Care - Stevens Point | Stevens Point, Wisconsin, United States, 54481 ProHealth Waukesha Memorial Hospital | Waukesha, Wisconsin, United States, 53188 Aspirus Regional Cancer Center | Wausau, Wisconsin, United States, 54401 Marshfield Clinic-Wausau Center | Wausau, Wisconsin, United States, 54401 Marshfield Medical Center - Weston | Weston, Wisconsin, United States, 54476 Aspirus Cancer Care - Wisconsin Rapids | Wisconsin Rapids, Wisconsin, United States, 54494 Marshfield Clinic - Wisconsin Rapids Center | Wisconsin Rapids, Wisconsin, United States, 54494 Rocky Mountain Oncology | Casper, Wyoming, United States, 82609 Welch Cancer Center | Sheridan, Wyoming, United States, 82801 Rambam Medical Center | Haifa, Israel, 31096 Shaare Zedek Medical Center | Jerusalem, Israel, 91031
Investigators	Principal Investigator: Alexander K Stewart, ECOG-ACRIN Cancer Research Group

More Information

Additional Information

• Data Available: Select individual patient-level data from this trial can be requested from the NCTN/NCORP Data Archive.

Publications

• Stewart AK, Jacobus S, Fonseca R, Weiss M, Callander NS, Chanan-Khan AA, Rajkumar SV. Melphalan, prednisone, and thalidomide vs melphalan, prednisone, and lenalidomide (ECOG E1A06) in untreated multiple myeloma. Blood. 2015 Sep 10;126(11):1294-301. doi: 10.1182/blood-2014-12-613927. Epub 2015 Jul 8.

Additional Relevant MeSH Terms

• Multiple Myeloma
• Neoplasms, Plasma Cell
• Neoplasms by Histologic Type
• Neoplasms
• Hemostatic Disorders
• Vascular Diseases
• Cardiovascular Diseases
• Paraproteinemias
• Blood Protein Disorders
• Hematologic Diseases
• Hemorrhagic Disorders
• Lymphoproliferative Disorders
• Immunoproliferative Disorders
• Immune System Diseases