Which high-risk patients with multiple myeloma (MM) are potential transplant candidates?

Updated: Mar 06, 2020
  • Author: Dhaval Shah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Patients are considered at high risk if their MM meets any of the following criteria:

  • Advanced-stage disease (stage III according to the International Staging System)
  • Poor cytogenetics, such as t (4:14), t (14:16), and t (14:20), deletion of chromosome 13, inactivation of  TP53
  • Complex karyotype
  • Very high proliferative rates 

This group represents about 25% of those with newly diagnosed MM, with an expected median survival of 2 years or less. Although they respond to traditional therapies for induction, these individuals tend to relapse rapidly. Therefore, novel agents should be considered up front for these patients.

The advent of thalidomide, lenalidomide, and bortezomib has substantially improved outcomes in these high-risk groups. In fact, these novel agents appear to overcome the influence contributed by high-risk cytogenetics. [62, 63] Once a response has been achieved, then patients can be brought to autologous stem cell transplantation.


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