Understanding Functional High-Risk Myeloma 

This week's "Ask Dr. Durie" is from a patient who has a question about high-risk myeloma. This patient has heard about a term that we have been using more recently called "functional high risk." This patient wants to know, what is functional high-risk myeloma? Obviously, it is a very good question and something that we are more focused on in the myeloma community in these last two or three years. 

Traditionally, high-risk myeloma has been based on the detection of abnormal chromosomes in the bone marrow, using the fluorescent in situ hybridization (FISH) testing, looking for high-risk chromosomes such as 17p-, 14q+, or 1q+. Functional high risk is a much more practical approach because it focuses on what is high-risk myeloma, which is a type of myeloma where the relapse occurs much sooner than expected or that we would like. 

Functional high risk is defined as relapse that occurs within 12 months of having had an autologous stem cell transplant or within 12 months of the original diagnosis or the start of treatment. Therefore, someone who has had an early relapse is automatically someone who falls into this high-risk category. 

It becomes quite practical in terms of designing new and better therapy for patients who fall into this functional high-risk category. Right now, there is no standard protocol for this group of patients. New trials are ongoing now to identify which could be good options for better outcomes in the high-risk setting. 

We are optimistic that some of the new immune therapies, such as CAR-T therapies or bispecific monoclonal antibodies, can do a good job in this setting. But the bottom line is you're probably going to hear more about functional high risk and also more about possible therapies that can provide better outcomes for patients in this category.