aberrations, altered drug metabolism, and enhanced cellular repair processes. In contrast, the median OS for the 14 patients undergoing an ASCT was not reached, suggesting perhaps continued response to alkylator-based therapy.Among the 74 patients, 31 had high-risk disease based on the presence of one or more of the following abnormalities (Del 13 by metaphase cytogenetics, hypodiploidy, del 17p, t(4;14) or t(14;16)). The median OS from the time of progression was 9.5 months for the high-risk group compared with 14.7 months for the rest; P ¼ 0.4. The higher than average proportion of patients with high-risk disease likely reflects a selection bias in favor of patients relapsing rapidly after currently available treatments.Our study represents a unique description of response to salvage therapies and outcome of patients progressing on pomalidomide, the latest IMiD to reach clinical trials. Several important conclusions can be derived from these clinical results. It confirms poor outcome of the patients relapsing after novel therapies. We also provide evidence of retained activity of lenalidomide in a proportion of patients relapsing on pomalidomide, suggesting that a trial of lenalidomide in these patients is justified. Finally, even in this relapsed and refractory population, ASCT when feasible is associated with high response rates.