How would you treat a fit, newly diagnosed, high-risk multiple myeloma patient with multiple poor risk factors and circulating plasma cells?

So...on most iFISH, we see a deletion of p53, but we don't know about the mutation. Similarly on iFISH we see trisomies and tetrasomies of 1q23, often CKS1B, but not genetic amplification. Finally circulating plasma cells are often missed when less than 5% even at large academic centers, and while t...