Risk-adapted treatment for multiple myeloma: assessing the current potential and a roadmap for the future

Over the past two decades, new agents for multiple myeloma (MM) have significantly improved patient outcomes, particularly for those with standard-risk disease, who now have a median overall survival of over a decade. However, this benefit is less pronounced in high-risk and ultra-high-risk MM, where median survival ranges from 3 to 5 years. The definition of HRMM continues to evolve and is driven by the genomic features, disease burden, and medical comorbidities. Various risk stratification tools are available to gauge the risk status of the disease. Recently, a slew of single-arm phase 2 trials for high-risk MM have been reported with a general theme of intensification of various phases of treatment. Additionally, minimal residual disease testing in treatment escalation/de-escalation is being actively investigated. This review summarizes the existing evidence for risk-adapted treatment in patients with MM.