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The diagnosis requires \u226510% clonal bone marrow plasma cells or a biopsy proven plasmacytoma\n                    <jats:italic>plus<\/jats:italic>\n                    evidence of one or more multiple myeloma defining events: CRAB (hypercalcemia, renal failure, anemia, or lytic bone lesions) features felt related to the plasma cell disorder, bone marrow clonal plasmacytosis \u226560%, serum involved\/uninvolved free light chain (FLC) ratio \u2265100 (provided involved FLC is \u2265100 mg\/L), or &gt;1 focal lesion on magnetic resonance imaging. Patients with del(17p), t(14;16), and t(14;20) have high\u2010risk multiple myeloma. Patients with t(4;14) translocation and gain(1q) have intermediate\u2010risk. All others are considered standard\u2010risk. Initial treatment consists of bortezomib, lenalidomide, dexamethasone (VRd). In high\u2010risk patients, carfilzomib, lenalidomide, dexamethasone (KRd) is an alternative to VRd. In eligible patients, initial therapy is given for approximately 3\u20104 cycles followed by autologous stem cell transplantation (ASCT). Standard risk patients can opt for delayed ASCT at first relapse. Patients not candidates for transplant are treated with VRd for approximately 8\u201012 cycles followed by lenalidomide or lenalidomide plus dexamethasone. After ASCT, lenalidomide maintenance is recommended for standard risk patients, while maintenance with a bortezomib\u2010based regimen is needed for patients with intermediate or high\u2010risk disease. Most patients require a triplet regimen at relapse, with the choice of regimen varying with each successive relapse. Aggressive relapse with extramedullary plasmacytomas or plasma cell leukemia may require anthracycline containing combination chemotherapy regimens.\n                  <\/jats:p>","DOI":"10.1002\/ajh.25117","type":"journal-article","created":{"date-parts":[[2018,8,16]],"date-time":"2018-08-16T10:48:47Z","timestamp":1534416527000},"page":"1091-1110","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":168,"title":["Multiple myeloma: 2018 update on diagnosis, risk\u2010stratification, and management"],"prefix":"10.1002","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5862-1833","authenticated-orcid":false,"given":"S. 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