High-risk cytogenetics (myeloma)
Chromosome changes such as del(17p), t(4;14), t(14;16) and extra copies of 1q that mark myeloma likely to relapse early.
IMS 2024 consensus: high risk = del(17p) with TP53 mutation or ≥20% clonal fraction, t(4;14) or t(14;16) or t(14;20) with 1q gain or del(1p), biallelic del(1p32), or β2M ≥5.5 with normal creatinine. Ultra-high risk with two or more lesions. High-risk patients gain less from most regimens; CAR-T and bispecifics narrow but do not close the gap.
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