The presence of certain cytogenetic findings in a patient with multiple myeloma is associated with a worse outcome. The mSMART study classified high risk patients with myeloma into double hit (DH) or triple hit (TH) based on the number of high-risk cytogenetic abnormalities detected.

NOTE: Double and triple hit cytogenetics is distinct but overlapping with double and triple class refractory myeloma.


High risk cytogenetic findings:

(1) IgH-FGFR3 translocation = t(4;14)

(2) IgH-MAFB translocation = t(14;20)(q32;q11)

(3) TP53 deletion

(4) gain of chromosome 1q


Other high-risk findings:

(1) t(14;16)

(2) del17p or del17q

(3) del 1p


The presence of DH or TH at relapse is associated with aggressive disease and poor outcomes.

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