A 55-year-old man has multiple myeloma with del(17p) and t(4;14) detected on FISH. Serum creatinine is 2.8 mg/dL. Per current myeloma risk stratification, he is classified as:

• A Standard risk
• B Intermediate risk
• C Ultra-high risk requiring CAR-T therapy upfront
• D High risk ✓

Explanation

Per the Revised International Staging System (R-ISS) and Mayo Clinic mSMART 3.0, del(17p), t(4;14), and t(14;16) define high-risk myeloma. Del(17p) (TP53 deletion) and t(4;14) are independently high-risk cytogenetic abnormalities; their co-presence makes this ultra-high risk by some classifications but conventionally categorised as high risk under standard systems. High-risk disease requires daratumumab-based quadruplet induction and early ASCT consolidation. Standard risk includes hyperdiploidy and t(11;14). Ultra-high risk as a separate category requiring upfront CAR-T is not yet a standard classification in current guidelines.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.