International Myeloma Society/International Myeloma Working Group Consensus Recommendations on the Definition of High-Risk Multiple Myeloma.
- Study type
- Clinical guideline
- Study name
- IMS/IMWG High-Risk MM 2025
- Design
- Consensus recommendations of an expert panel of the International Myeloma Society (IMS) and the International Myeloma Working Group (IMWG)
- Source
- J Clin Oncol · 2025
In plain words
Myeloma does not behave the same way in everyone; in some people it is more aggressive, and this is called "high-risk". In this statement, international myeloma experts give a new, more precise definition of high-risk myeloma, based mainly on genetic changes in the myeloma cells (checked by testing a bone marrow sample) and on a blood test called beta-2 microglobulin. Knowing whether the disease is high-risk helps the doctor plan treatment and follow-up more precisely. Having one of these changes does not mean that treatment will not work.
Key guideline recommendations
- Expert consensus
Consensus genomic staging (CGS): high-risk myeloma is defined by the presence of at least one of the following four abnormalities.
Criterion 1: del(17p) with a clonal fraction above 20%, and/or TP53 mutation.
- Expert consensus
Criterion 2: an IgH translocation, i.e. t(4;14), t(14;16) or t(14;20), together with 1q+ and/or del(1p32).
- Expert consensus
Criterion 3: monoallelic del(1p32) with 1q+, or biallelic del(1p32).
- Expert consensus
Criterion 4: beta-2 microglobulin 5.5 mg/L or higher with normal creatinine (less than 1.2 mg/dL).
Study population
Patients with multiple myeloma; a definition of high-risk myeloma (HRMM) for use in routine practice and in clinical trials.
Clinical significance and place in guidelines
This IMS/IMWG consensus statement provides a practical, data-based definition of high-risk myeloma (consensus genomic staging, CGS) to replace reliance on R-ISS alone, which according to the authors does not reflect prognosis accurately in the era of triplet and quadruplet therapies. The definition is proposed for risk stratification in routine practice and in clinical trials.
Limitations
These recommendations are expert consensus. The abstract states only the four criteria that define high-risk myeloma; details of the evidence, assay methods and treatment implications are in the full text. Full application of the criteria requires genomic assays (FISH and sequencing for TP53 mutation).
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.