Fig. 1: High-risk clinical features.
From: High-risk disease in newly diagnosed multiple myeloma: beyond the R-ISS and IMWG definitions
*Large FLs (diameter >2.5 cm) associated with site-specific enrichment of HiR driver mutations consistent with them being key mediators of drug resistance and treatment failure [86,87,88,89,90,91,92,93,94,95,96,97,98,99,100]. **Certain EME sites seemed to carry worse prognosis with 3-year PFS differing according to involved organs: kidney (59.5%), skin (20.1%), lymph nodes (37.6%), CNS (47.9%), lung/respiratory tract (44.4%), GI/liver (22.5%), and spleen, ovaries, and testes (60.0%). BM bone marrow, CA cytogenetic abnormalities, CPCs circulating plasma cells, EBMT European Society for Blood and Marrow Transplantation, EME extramedullary myeloma that is extra-osseous (results from hematogenous spread and involving only soft tissues, the incidence in NDMM 1.7–3.5%90), EMB extamedullary myeloma that is paraskeletal or paraosseous plasmacytomas (consists of tumor masses adjacent to bones and arising from focal skeletal lesions, incidence in NDMM 6–34.4%90), EMM extramedullary myeloma, FL focal lesion, HR hazard ratio, ISS international staging system, MRI magnetic resonance imaging, MV multivariate, NDMM newly diagnoses multiple myeloma, NR not reached, OS overall survival, PC plasma cells, PCPI plasma cell proliferation index, PET-CT 18-fluoro-deoxyglucose emission tomography, PFS progression-free survival, R-ISS revised international staging system, TT total therapy.
