This finding is in keeping with a previous statement of incomplete restoration of dark adaptation,21 indicating that the kinetics of the reconstituted retinoid cycle can remain abnormally sluggish after RPE65 gene supplementation. The amount of RPE65 protein expressed could be insufficient to support normal provision of 11-cis retinal. Cideciyan et al.23 However, our discovering that the improvements in retinal sensitivity were of greater magnitude in older participants than in younger participants shows that the limitation results not from any progressively resistant barrier to diffusion but rather from small enzymatic activity that does not meet the demand of the surviving populations of photoreceptor cells. Although RPE65 insufficiency causes severe rod photoreceptor-cell dysfunction typically, cone-mediated vision is relatively very well preserved in the early stages.Horowitz, M.D., Thomas C. Shea, M.D., Steven M. Devine, M.D., Kenneth C. Anderson, M.D., and Charles Linker, M.D.: Lenalidomide after Stem-Cell Transplantation for Multiple Myeloma A goal of therapy for multiple myeloma, to induce total remission and prolong survival, is accomplished with combination therapy usually.1,2 Autologous hematopoietic stem-cell transplantation is often used after induction chemotherapy to improve the response or to consolidate complete remission.1,2 However, since most sufferers with multiple myeloma possess disease progression or recurrence after transplantation, maintenance therapies have already been used to prolong complete remission and stop relapse or progressive disease. Low-dose melphalan, interferon alfa, and glucocorticoids have already been used for maintenance after main therapy, but their long-term use is limited by toxicity and modest efficacy.3-6 Five studies involving individuals who had undergone autologous hematopoietic stem-cell transplantation showed that thalidomide maintenance therapy improved progression-free of charge survival, and 3 of the five studies showed improved general survival.7-11 However, long-term thalidomide use is bound by toxicity.