Treatment options for multiple myeloma patients with high-risk disease

Multiple myeloma is a heterogeneous malignant disorder with a variable clinical course suggestive of diverse biological factors that have important prognostic implications. Despite development of several new therapeutic agents and substantially effective novel combination regimens, myeloma remains an incurable disease. There is an emphasis to define new biologic parameters to accurately identify patients with aggressive disease biology. This will allow more informed treatment decisions based on the biology of the disease, resulting in further optimization of management strategies in specific patient subgroups. Among biological parameters of risk stratification, cytogenetics has emerged as arguably the most important dependable and clinically convenient. These are being increasingly utilized to develop therapeutic stratification in newer clinical trials. Appraisal of current data suggests that patients with high-risk cytogenetics have a worse prognosis. However, treatment with novel agents has changed this variable. There is emerging evidence that patients with aggressive disease biology are fairing better with innovative treatment regimens utilizing a combination of conventional and novel agents. This review focuses on current and emerging data about defining high-risk disease in multiple myeloma and the various therapeutic options for this group of patients.