▁place bo - ▁in ▁patients ▁with ▁ 1 q 2 1 ▁ampl ification , ▁and ▁in ▁the ▁" expand ed ▁high - ris k " ▁group , ▁defined ▁as ▁those ▁with ▁high - ris k ▁c yt ogen etic ▁ab normal ities ▁and / or ▁ 1 q 2 1 ▁ampl ification . ▁IR d ▁demonstrated ▁substantial ▁benefit ▁compared ▁with ▁place bo ▁in ▁rela ps ed / ref ract ory ▁multiple ▁my el oma ▁patients ▁with ▁high - ris k ▁and ▁standard - ris k ▁c yt ogen et ics , ▁and ▁impro ves ▁the ▁poor ▁P FS ▁associated ▁with ▁high - ris k ▁c yt ogen etic ▁ab normal ities . ▁ ▁P reg n ancy ▁and ▁breast feed ing ▁I x az om ib ▁and ▁len al id om ide ▁are ▁ter at ogen ic ▁in ▁animal ▁studies . ▁The ▁latter ▁is ▁contra ind ic ated ▁in ▁pre gn ant ▁women , ▁making ▁this ▁ther apy ▁reg imen ▁un su itable ▁for ▁this ▁group . ▁It ▁is ▁not ▁known ▁whether ▁i x az om ib ▁or ▁its ▁met abol ites ▁pass ▁into ▁the ▁breast ▁milk . ▁ ▁Side ▁effects ▁Common ▁side ▁effects ▁of ▁the ▁i x az om ib + len al id om ide + dex am eth as one ▁study ▁ther apy ▁included ▁di arr ho ea ▁( 4 2 % ▁versus ▁ 3 6 % ▁under ▁place bo + len al id om ide + dex am eth as one ), ▁const ip ation ▁( 3 4 %