A comprehensive 2026 update on the diagnosis, risk-stratification, and management of multiple myeloma (MM), covering criteria for MM-defining events, high-risk cytogenetic definitions, frontline quadruplet regimens, maintenance strategies, and relapsed/refractory options.
Frontline standard-of-care is now a quadruplet (anti-CD38 + bortezomib/lenalidomide/dexamethasone) followed by ASCT in eligible patients; high-risk MM is redefined to include bi-allelic del(1p), combination cytogenetic lesions with gain(1q) or del(1p), and p53 mutation; daratumumab for 3 years is recommended for high-risk smoldering MM.
This is a narrative review/guideline update, not a primary clinical trial — it synthesizes existing evidence without new original data or formal meta-analysis.
Upgrade frontline-eligible patients to anti-CD38–based quadruplet therapy (Dara- or Isa-VRd) and reassess high-risk status using the expanded cytogenetic criteria including gain(1q)/del(1p) combinations. For high-risk smoldering MM, consider 3 years of daratumumab to delay progression.
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