Usmani et al reported criteria for ultra high risk multiple myeloma. This is defined as a patient who has a survival of less than 2 years. The authors are from Carolinas Healthcare System, Clinica Universidad de Navarra, and University Hospital of Salamanca.


(1) number of adverse cytogenetic features

(2) serum LCH

(3) ISS stage

(4) response to therapy

(5) number of circulating plasma cells (absolute plasma cell count)


Criteria for ultra high risk multiple myeloma - one or more of the following:

(1) >= 2 adverse cytogenetic features

(2) both of the following:

(2a) 1 adverse cytogenetic finding

(2b) one of the following:

(2b1) high serum LDH

(2b2) ISS stage III (serum beta-2 microglobulin >= 5.5 mg/L)

(2b3) less than complete response after induction

(2b4) failure to eradicate residual disease after autologous stem cell transplant (ASCT)

(3) absolute plasma cell count in the peripheral blood > 400 per µL

(4) failure to respond (less than partial response) to an optimized induction regimen with a proteasome inhibitor and immunomodulatory drugs


Adverse cytogenetic features:

(1) t(4;14)

(2) del(17p)

(3) t(14;16)

(4) 1q gains

(5) complex karyotype

(6) hypodiploidy with high risk by gene expression profiling

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