Pharmacogenomic Study in Myeloma Patients Treated With Melphalan-prednisone-thalidomide or Lenalidomide-dexamethasone

Inclusion Criteria:

* Understand and voluntarily sign an informed consent form
* Age ≥ 65 years at the time of signing consent
* Previously untreated, symptomatic multiple myeloma as defined by the 3 criteria below: MM diagnostic criteria (all 3 required)

  * Monoclonal plasma cells in the bone marrow ≥10% and/or presence of a biopsy-proven plasmacytoma
  * Monoclonal protein present in the serum and/or urine
  * Myeloma-related organ dysfunction (at least one of the following):

    * Calcium elevation in the blood (serum calcium \> 10.5 mg/l or upper limit of normal)
    * Renal insufficiency (serum creatinine \> 2 mg/dl)
    * Anemia (hemoglobin \< 10 g/dl or 2 g \< normal)
    * Lytic bone lesions or osteoporosis
* have measurable disease by protein electrophoresis analyses as defined by the following:

  * IgG multiple myeloma: Serum monoclonal paraprotein (M-protein)level ≥ 1.0 g/dL or urine M-protein level ≥ 200 mg/24 h
  * IgA multiple myeloma: Serum M-protein level ³ 0.5 mg/dL or urine M-protein level³ 200 mg/24 h
  * IgM multiple myeloma (IgM M-protein plus lytic bone disease documented by skeletal survey plain films): Serum M-protein level ≥ 1.0 g/dL or urine Mprotein level ≥ 200 mg/24h
  * IgD multiple myeloma: Serum M-protein level ≥ 0.05 g/dL or urine M-protein level ≥ 200 mg/24h
  * Light chain multiple myeloma: Serum M-protein level ≥ 1.0 g/dL or urine Mprotein level ≥ 200 mg/24 hours
* ECOG performance status of 0, 1, or 2
* Treated by either melphalan-prednisone-thalidomide or lenalidomide- dexamethasone

Exclusion Criteria:

* Previous treatment with antimyeloma therapy (does not include radiotherapy, bisphosphonates, or a single short course of steroid \[i.e., less than or equal to the equivalent of dexamethasone 40 mg/day for 4 days; such a short course of steroid treatment must not have been given within 28 days (4 weeks) of randomization\]
* Any serious medical condition that places the patient at an unacceptable risk if he or she participates in this study
* Any of the following laboratory abnormalities :

  * Absolute neutrophil count (ANC) \< 1,000 cells/µL (1.0 x 109/L)
  * Platelet count \< 50,000 cells/µL (50 x 109/L) for patients in whom \< 50% of bone marrow nucleated cells are plasma cells; but platelet count \< 30,000/µL for patients in whom ≥ 50% of bone marrow nucleated cells are plasma cells
  * Serum SGOT/AST or SGPT/ALT \> 3.0 x upper limit of normal (ULN)
  * Creatinine clearance ≤ 30 mL/min (Cockroft-Gault calculation)
* Prior history of malignancies, other than multiple myeloma, unless the subject has been free of the disease for ≥ 3 years. Exceptions include the following:

  * Basal cell carcinoma of the skin
  * Squamous cell carcinoma of the skin
  * Carcinoma in situ of the cervix
  * Carcinoma in situ of the breast
  * Incidental histological finding of prostate cancer (TNM stage of T1a or T1b)
* Patients who have are unable or unwilling to undergo antithrombotic therapy
* Peripheral neuropathy of \> grade 2 severity
* Known HIV positivity or active infectious hepatitis, type A, B, or C.
* Primary AL amyloidosis and myeloma complicated by amyloidosis.
* Renal failure requiring dialysis