Background: Obesity is a putative risk factor for the development of monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM). Induction regimens for MM have evolved; and lenalidomide, bortezomib, and dexamethasone (RVd) produces an overall response rate of 82%. Response, tolerability and therapy duration are related to agent dose, dose intensity, and comorbidities, which may be higher in the obese. We analyzed the effect of anthropometric measures on response and therapy duration in patients (pts) receiving RVd induction. Methods: Height (cm), weight (kg), body surface area (BSA), and body mass index (BMI) were obtained from a database of 751 pts receiving RVd. Demographics including sex, self-reported race, ISS stage at diagnosis, and cytogenetic risk category were analyzed with anthropometric data in a multivariate model with response per IMWG criteria, progression-free survival (PFS) and overall survival (OS). Results: Anthropometric measures were available in 746/751 (99%) pts. Of 746 pts analyzed, 54% were male, 57% white, and 30% black. Median BMI (kg/m²) was 28 (range 17-53); BMI per category was underweight (≤ 18.5) 0.9%, normal (18.5- < 25) 25.7%, overweight (25- < 30) 35.7%, obese (30-40) 32.3%, and morbidly obese ( > 40) 5.3%. Median BSA (m²) was 1.94 (range 1.29-2.70). Median BMI and BSA were significantly higher in men (p < 0.05). Morbid obesity was more common in black versus white pts (8.4 vs 3.8%, p = 0.017) and women versus men (7.9 vs 3%, p = 0.03). Pts with BMI ≥ 40 had an estimated OS of 81 vs 98 months compared to pts with BMI < 40 (p = 0.071); unadjusted hazard ratio (HR) 1.47 (95% CI: 0.56-3.49). Response of VGPR or better did not show a significant association with higher BSA ( > 2.25) (80.3 vs 70.3%, p = NS). On multivariate analysis, PFS and OS showed no association with BMI or BSA. ISS stage 3 disease (HR 2.1; 95% CI 1.4-3.4) and high risk cytogenetics (HR 2.2; 95% CI 1.5-3.7) were significantly associated with shorter OS (p < 0.001). Conclusions: Obesity does not significantly impact depth or duration of response with RVd induction. We advocate use of full dose RVd regardless of BSA or BMI in pts with acceptable performance status and managed comorbid conditions.