From the Research
Triple hit multiple myeloma is defined as the presence of three or more high-risk cytogenetic abnormalities, including del(17p), t(4;14), t(14;16), t(14;20), gain 1q, del 1p, or p53 mutation, and is associated with poorer outcomes and shorter survival compared to standard-risk myeloma. The diagnosis of multiple myeloma requires ≥10% clonal bone marrow plasma cells or a biopsy-proven plasmacytoma plus evidence of one or more multiple myeloma defining events (MDE) 1. The presence of high-risk cytogenetic abnormalities is a key factor in determining the prognosis and treatment of multiple myeloma.
Key Characteristics of Triple Hit Multiple Myeloma
- Presence of three or more high-risk cytogenetic abnormalities
- Associated with poorer outcomes and shorter survival compared to standard-risk myeloma
- Requires more intensive treatment approaches, including proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies
- High-dose chemotherapy followed by autologous stem cell transplantation is usually recommended for eligible patients
- Maintenance therapy is crucial to extend remission duration
Treatment Approaches for Triple Hit Multiple Myeloma
- Induction therapy with bortezomib, lenalidomide, and dexamethasone (VRd) or daratumumab, bortezomib, lenalidomide, and dexamethasone (Dara-VRd) 2
- High-dose chemotherapy followed by autologous stem cell transplantation for eligible patients
- Maintenance therapy with lenalidomide or bortezomib plus lenalidomide for high-risk patients
- Consideration of novel agents, such as CAR-T cell therapy and bispecific antibodies, for relapsed or refractory disease 1
Importance of Early Identification and Risk Stratification
- Early identification of high-risk cytogenetic abnormalities through cytogenetic testing is essential for appropriate risk stratification and treatment planning
- Risk assessment is a crucial determinant of treatment and outcomes in multiple myeloma 3
- Patients with triple hit multiple myeloma require close monitoring and aggressive treatment approaches to improve outcomes.