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Yes, continuing the VRd regimen (Bortezomib, Lenalidomide, and Dexamethasone) for 40 months can cause an increased risk of a second cancer, primarily due to the lenalidomide component.

Going back to original concern about lenalidomide causing a second blood cancer (like MDS or AML) when those secondary conditions develop, the bone marrow struggles, causing overall blood work to decline. The fact with absolute numbers are stable and organ function is good means bone marrow is tolerating the VRd well.

Given ultra-high-risk genetics [t(4;14), del(17p), TP53], this degree of stability at 40 months is an excellent outcome. doctor will likely want to keep doing exactly what they are doing: monitoring these labs every few weeks to ensure the
stay stable

I'm a little tired, but made chicken noodle soup, walked 3100 steps so far, & getting ready to make steak & rice for dinner.

From what I understand, the secondary cancers that develop are predominantly bone marrow disorders- like Myelodysplastic Syndrome (MDS) and Leukemia. These cancers do not show up in your monthly blood draws for m-spike, light chains, and immunoglobulins, but do affect your standard blood cell count numbers. Secondary cancers cause your platelets, red and white blood cells numbers to drop as your body fails to produce healthy cells. Your doctors are monitoring all the results from your blood work and if they see a drop in your complete blood count (CBC) -red cells, white cells, and platelets, they then check your red cells for abnormalities. If they see abnormal cells, a bone biopsy is done to confirm the secondary cancer.

Mary 919, usually blood work is adequate to monitor myeloma. Unless you have non secretory myeloma that doesn't show up in blood work. Let you doctor know if you have new bone pain. Every center is different. I get a bone marrow biopsy yearly. This is my 9th year with myeloma. I'm getting a PET scan next month to see how things are.

Best wishes