Risk stratification

Last medical review:

Doctors can predict which people with multiple myeloma are most likely to have the best or worst outcome based on the number of changes in the chromosomes. This is called risk stratification. Risk stratification can also be used to make treatment decisions. Risk stratification is calculated when you are first diagnosed and may be repeated if there is a relapse.

Risk stratification can be calculated using the Revised International Staging System as well as the Mayo Stratification for Myeloma and Risk-Adapted Therapy (mSMART).

Standard-risk multiple myeloma is when the myeloma cells have any of the following changes in the chromosomes:

  • trisomy
  • translocation of chromosomes 11 and 14, which is also called t(11;14)
  • translocation of chromosomes 6 and 14, which is also called t(6;14)

High-risk multiple myeloma is when the myeloma cells have any of the following changes in the chromosomes:

  • translocation of chromosomes 4 and 14, which is also called t(4;14)
  • translocation of chromosomes 14 and 16, which is also called t(14;16)
  • translocation of chromosomes 14 and 20, which is also called t(14;20)
  • an extra copy of the long arm "q" of chromosome 1, which is also called gain(1q)
  • a missing short arm "p" of chromosome 1, which is also called 1p deletion or del(1p)
  • a missing short arm "p" of chromosome 17, which is also called 17p deletion or del(17p)
  • fewer chromosomes than normal, which is also called hypodiploidy

If the myeloma cells have 2 high-risk chromosome changes, this is sometimes called double-hit myeloma.

If the myeloma cells have 3 high-risk chromosome changes, this is sometimes called triple-hit myeloma.

Expert review and references

  • Guido Lancman, MD, MSc
  • Mikhael J, Ismaila N, Cheung MC, et al. Treatment of multiple myeloma: ASCO and CCO joint clinical practice guideline. Journal of Clinical Oncology. 2019: 37(14):1228–1263.
  • Palumbo A, Avet-Loiseau H, Oliva S, et al. Revised international staging system for multiple myeloma: A report from International Myeloma Working Group. Journal of Clinical Oncology. 2015: 33(26):2863–2869.
  • Rajkumar SV. Multiple myeloma: 2022 update on diagnosis, risk-stratification and management. American Journal of Hematology. 2022: 97(8):1086–1107.

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