During consolidation therapy, hematologic adverse events occurred more often in individuals who received high-dose melphalan than in those that received MPR. These occasions were mainly grade 3 or 4 4 neutropenia and thrombocytopenia . Other grade three or four 4 adverse events that were more common in individuals who received high-dosage melphalan were gastrointestinal events , infections , and systemic events . During the maintenance phase, the most typical grade three or four 4 adverse events had been neutropenia , infections , and dermatologic events . Reduced dosages of lenalidomide were needed in 14.7 percent of individuals ; 5.2 percent of individuals discontinued lenalidomide because of toxicity . Eleven individuals had another primary cancer: lung malignancy in one patient during induction; prostate cancer in two sufferers and breast malignancy in three individuals during lenalidomide maintenance therapy; and one case each of myelodysplasia, lung tumor, bladder cancer, colon cancer, and biliary tract malignancy after consolidation therapy in sufferers who were randomly assigned to no maintenance therapy.Concerns concerning the Global Fund consist of needs for: guarantees by the national government relating to the involvement of civil culture businesses in Global Fund processes; a commitment that the amount worth focusing on around community issues will not be lost in the fund allocations process; fairness in fund allocation in light of nation competition and bans; and sound, versatile funding strategies that ensure services shall not be disrupted.