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:


Your physician will work with you to decide which drug or combination of drugs is most appropriate for you. Chemotherapy agents, either alone or in combination, often with corticosteroids such as prednisone or dexamethasone include these drugs currently listed by the BC Cancer Agency.

Drug Class Name Abbreviations Brand
Proteasome inhibitors ixazomib I Ninlaro®
carfilzomib cfz, car, K Kyprolis®
bortezomib btz, bor, V Velcade®
Immunomodulators pomalidomide pom, P Pomalyst®
lenalidomide len, R Revlimid®
thalidomide thal, T Thalomid®
Alkylating agents melphalan mel, M Alkeran®, Alphalan®
cyclophosphamide CTX, Cy, C Cytoxan®
Corticosteroids dexamethasone D, d, dex, DXM Decadron®
prednisone pred, P Delatsone®
methylprednisolone none yet Medrol®
Bone-modifying agents zoledronic acid zol Zometa®
pamidronate pmd Aredia®
Monoclonal antibodies daratumumab dara Darzalex®