High Risk vs. Standard Risk Treatment

The Mayo Clinic has developed risk-adapted strategies for managing patients with myeloma based on a better understanding of the disease and factors that affect outcome. Guidelines that tailor treatment in an individualized manner to the patient were developed by a group of Mayo Clinic myeloma experts.

One of the most important advances in myeloma research is the identification of specific genetic abnormalities; these differences determine an individual response to treatment or how aggressive the disease will be. Based on this information a small group (25%) of people are classified as high-risk myeloma. Although unconfirmed, this group may benefit from a different treatment regime than one used for standard-risk disease.

For the high-risk group, newer drugs such as a bortezomib (Velcade) or lenalidomide (Revlimid) with low-dose dexamethasone or in combination with cyclophospamide, thalidomide, doxorubicin are recommended. Evidence shows this group benefits the most from a complete response.

Treatment Choices include:


Chemotherapy agents, either alone or in combination, often with corticosteroids such as prednisone or dexamethasone include these:

Other combinations include: