A rational approach to functional high-risk myeloma

Multiple mye loma is a clin i cally and bio log i cally highly het ero ge neous dis ease, as the over all sur vival can vary from more than a decade in patients with standard risk dis ease treated with inten sive che mo ther apy to 2-3 years in patients with high - risk fea tures. The cur rent stag ing sys tems, which rely on base line bio log i cal risk fac tors to strat ify patients into groups with dif fer ing risks of pro gres sion or death, are some times sub op ti mal tools for iden ti fy ing high - risk patients. This is particularly evident when considering the so-called functional high-risk patients-patients who do not necessarily dis play base line high - risk fea tures but typ i cally show a sub op ti mal response to induc tion ther apy or relapse early after treat ment ini ti a tion: the sur vival of these patients is par tic u larly poor even in the con text of newer ther a pies. The prompt iden ti fi ca tion, as well as a con sis tent defi ni tion, of this sub set of patients, as well as their man age ment, cur rently repre sents an unmet med i cal need. In this review we explore the main char ac ter is tics of func tional high - risk patients, the avail able known risk fac tors and scor ing sys tems, and the pos si ble man age ment.