Table 2 Key challenges in the treatment of patients with multiple myeloma with high-risk cytogenetic abnormalities

From: Front-line therapies for elderly patients with transplant-ineligible multiple myeloma and high-risk cytogenetics in the era of novel agents

Challenge

Explanation

Inconsistent definitions for high-risk CAs

The lack of consensus on precisely which CAs are considered high risk leads to variable inclusion of CAs in clinical studies, complicating data interpretation by clinicians

Limited data

Past clinical trials have not consistently included patients with high-risk CAs. In studies that do include these patients, a full subanalysis may not be executed, and the small number of patients with high-risk CAs makes it difficult to compare outcomes with SR patients or overall study populations

High cost of testing for CAs

Standard bone marrow examination, required for FISH analysis, has become more expensive [39]

Heterogeneity of CAs

Multiple CAs impart poor prognosis. Treatments may help overcome an aspect of the poor prognosis imparted by one CA but not others, or may help in TE patients but not TI patients; this requires careful consideration of therapy

Lack of treatment guidelines

Although the NCCN and ESMO MM guidelines both recognize cytogenetic abnormalities as prognostic factors, neither provides categorized treatment recommendations for patients with TI NDMM and high-risk CAs [1, 7]

  1. CA cytogenetic abnormality, ESMO European Society for Medical Oncology, FISH fluorescent in situ hybridization, MM multiple myeloma, NCCN National Comprehensive Cancer Network, NDMM newly diagnosed multiple myeloma, SR standard risk, TE transplant eligible, TI transplant ineligible