In the age of novel therapies, what defines high-risk multiple myeloma?

Multiple myeloma is characterized by clinical and biologic heterogenicity. Recently, genetic analysis has provided predictable prognosis across different types of treatment. These advances have allowed patients to be categorized into different risk groups and have been particularly useful in defining a high-risk group with short survival after standard- and high-dose chemotherapies. Preliminary studies have shown promising outcomes after the use of novel agents, such as bortezomib, thalidomide, and lenalidomide in high-risk patients, including those eligible for autologous stem cell transplantation and those who cannot or will not undergo transplantation. The application of risk-based therapy and the potential of the new agents to abrogate the influence of adverse prognostic features may improve outcomes in these patients.