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Symptom relief during follow up visit (after 4 cycles of chemotherapy) All the patients in the study experienced symptomatic relief after treatment as per clinician��s opinion. Serum immunoglobulin levels before and after treatment [Table/Fig-4,?,55] [Table/Fig-4]: Serum Immunoglobulin levels before and after treatment [Table/Fig-5]: Response among treatment groups in terms of serum immunoglobulin levels The mean immunoglobulin levels at diagnosis in patients who later received thal/dex was 4999.1 �� 2926.6 mg/dL and 3736.4 ��1586.1mg/dL in patients who later received len/dex. The mean immunoglobulin levels after adjusting the values to baseline was 1864.7 �� 163.6 mg/dL and 1665.4 ��134.4 mg/dL after treatment with thal/dex and len/dex respectively. Using ANCOVA, it was observed that there was no significant difference between therapy with thal-dex and len-dex in decreasing serum immunoglobulin after adjusting the serum immunoglobulin values to baseline. A 50% reduction in serum immunoglobulin values from baseline after receiving treatment was p38 MAPK activation considered as partial response and in thal-dex and len-dex treated group. Remission was not achieved in 19 patients of which 9 (52.9%) and 10 (52.6 %) patients had received thal-dex and len-dex respectively. Remission in bone marrow was defined as absence of myeloma cells or less than 5% plasma cells on a bone marrow biopsy. Bone marrow reports after treatment were not available for 15 (41.7%) patients. Adverse events The adverse events which occurred during the study period have been summarised in the [Table/Fig-6]. There was no significant difference in the adverse events observed between patients who received thal-dex or len-dex. [Table/Fig-6]: Adverse effects related to the therapy Discussion In newly diagnosed multiple myeloma patients, randomized studies have shown that the thal/dex regimen is better than high-dose dexamethasone alone [12,13]. A prospective randomized study confirmed the efficacy of the thal/dex regimen in comparison with the standard VAD regimen [11]. Lenalidomide, an analog of thalidomide, is highly active with different toxicity profile and potentially safer than the parent drug. Trials conducted with lenalidomide plus dexamethasone in newly diagnosed multiple myeloma patients showed improved activity more than historic controls with lower toxicity in a phase 2 clinical trial [14,15].