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Patients with t(4;14) translocation, karyotypic deletion 13, or hypodiploidy are considered to have intermediate\u2010risk disease. All others are considered to have standard\u2010risk myeloma.<\/jats:p><jats:p><jats:italic>Risk\u2010adapted therapy:<\/jats:italic> Standard\u2010risk patients are treated with nonalkylator\u2010based therapy such as lenalidomide plus low\u2010dose dexamethasone (Rd) followed by autologous stem\u2010cell transplantation (ASCT). An alternative strategy is to continue initial therapy after stem\u2010cell collection, reserving ASCT for first relapse. Intermediate\u2010risk and high\u2010risk patients are treated with a bortezomib\u2010based induction followed by ASCT and then bortezomib\u2010based maintenance. Patients not eligible for ASCT can be treated with Rd for standard risk disease, or with a bortezomib\u2010based regimen if intermediate\u2010risk or high\u2010risk features are present. To reduce toxicity, when using bortezomib, the once\u2010weekly subcutaneous dose is preferred; similarly, when using dexamethasone, the low\u2010dose approach (40 mg once a week) is preferred, unless there is a need for rapid disease control.<\/jats:p><jats:p><jats:italic>Management of refractory disease:<\/jats:italic> Patients with indolent relapse can be treated first with two\u2010drug or three\u2010drug combinations. Patients with more aggressive relapse often require therapy with a combination of multiple active agents. The most promising new agents in development are pomalidomide and carfilizomib. Am. J. Hematol., 2012. \u00a9 2011 Wiley Perodicals, Inc.<\/jats:p>","DOI":"10.1002\/ajh.22237","type":"journal-article","created":{"date-parts":[[2011,12,17]],"date-time":"2011-12-17T06:39:18Z","timestamp":1324103958000},"page":"78-88","source":"Crossref","is-referenced-by-count":107,"title":["Multiple myeloma: 2012 update on diagnosis, risk\u2010stratification, and management"],"prefix":"10.1002","volume":"87","author":[{"given":"S. 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