How do you treat newly diagnosed multiple myeloma with 1q gain?

Given the recent reclassification of gain(1q21) as a high risk cytogenetic abnormality, has this changed your practice in managing newly diagnosed patients?

Specific issues to address:

1. Is intensified induction therapy (eg. KRd) preferred over more conventional triplet therapy (eg. VRd) as some would suggest for fit, high-risk patients?

2. Should upfront autologous transplant be considered in all eligible patients?

3. Following autologous SCT what type of post-transplant maintenance therapy would you choose, if any? PI monotherapy, IMiD monotherapy, or a combination?

Answer from: Medical Oncologist at Academic Institution

There is still a lack of randomized phase 3 data demonstrating that KRD is superior to VRD for patients with high-risk cytogenetics. However, the recently presented ENDURANCE study only excluded t(14;20), t(14;16) and del(17p) and did include +1q (ASCO 2020 LBA3). The investigators did not report on...

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