title: Management of high-risk Myeloma: an evidence-based review of treatment strategies.
abstract: BACKGROUND
  Despite the progress made in the treatment of patients with multiple myeloma over recent decades, a significant cohort with high-risk disease as defined by specific clinical and genetic criteria continue to respond poorly to standard treatment. These patients represent a particular challenge to the treating physician and require early identification as well as personalized treatment strategies.
  
  
  METHODS
  In this review, we discuss the prognostic impact of adverse clinical, radiological and genetic factors, evaluate available scoring systems and highlight key aspects of the therapeutic management of high-risk myeloma. MEDLINE and recent scientific meetings' databases were searched for the keywords 'high-risk' and 'multiple myeloma' and relevant studies relating to both diagnostic and therapeutic approaches were identified. Expert commentary: A case is made for intensive induction using combinations of novel agents, early high-dose therapy supported by autologous stem cell transplantation and the widespread use of maintenance therapies. Novel therapeutic options, especially in the field of immunotherapy, are currently explored in clinical trials and have the potential to further improve outcomes for patients with high-risk multiple myeloma.
authors.affiliation: a Department of Hematology , University Hospital of Heidelberg , Heidelberg , Germany.
authors.forename: Nicola
authors.initials: N
authors.lastname: Lehners
authors.affiliation: b Academic Department of Haematology , St. James's Hospital, Trinity College Dublin, College Green , Dublin 2 , Ireland.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Hayden
authors.affiliation: a Department of Hematology , University Hospital of Heidelberg , Heidelberg , Germany.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
authors.affiliation: a Department of Hematology , University Hospital of Heidelberg , Heidelberg , Germany.
authors.forename: Marc-Steffen
authors.initials: MS
authors.lastname: Raab
mesh_terms: D000465:Algorithms; D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D019468:Disease Management; D019008:Drug Resistance, Neoplasm; D019317:Evidence-Based Medicine; D020022:Genetic Predisposition to Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D009101:Multiple Myeloma / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
keywords: Multiple myeloma; allogeneic transplantation; autologous transplantation; high-risk myeloma; maintenance therapy; novel agents; risk factors