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