Fig. 3: Cytogenetic risk assessment and reporting for MM according to the 2025 IMS/IMWG risk stratification.

Following FISH detection, laboratories should provide a report using clear language that interprets the FISH results with accurate classification into standard-risk and high-risk based on the 2025 IMS/IMWG Risk Stratification guidelines. Cytogenetic high-risk includes the presence of at least one of the following cytogenetic abnormalities: TP53 deletion or TP53 mutation, 1p biallelic deletion, t(4;14) plus 1q gain or amplification or 1p deletion, t(14;16) plus 1q gain or amplification or 1p deletion, t(14;20) plus 1q gain or amplification or 1p deletion, 1q gain or amplification plus 1p deletion. 17p deletion should have clonality of ≥20%. Standard-risk includes the absense of a high-risk cytogenetic abnormality and can include isolated hyperdiploidy, t(11;14) or t(6;14). Other features such as β2 microglobulin and creatinine also impact the overall IMS/IMWG risk stratification-please refer to Avet-Loiseau, et al. [5] for a complete risk stratification incorporating these variables along with the cytogenetics.