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Presence of any two high risk factors is considered double\u2010hit myeloma; three or more high risk factors is triple\u2010hit myeloma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Risk\u2010adapted initial therapy<\/jats:title>\n                    <jats:p>In patients who are candidates for autologous stem cell transplantation, induction therapy consists of anti\u2010CD38 monoclonal antibody plus bortezomib, lenalidomide, dexamethasone (VRd) followed by autologous stem cell transplantation (ASCT). Selected standard risk patients can delay transplant until first relapse. Frail patients who not candidates for transplant are treated with VRd for approximately 8\u201312\u2009cycles followed by maintenance or alternatively with daratumumab, lenalidomide, dexamethasone (DRd) until progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Maintenance therapy<\/jats:title>\n                    <jats:p>Standard risk patients need lenalidomide maintenance, while bortezomib plus lenalidomide maintenance is needed for high\u2010risk myeloma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management of relapsed disease<\/jats:title>\n                    <jats:p>A triplet regimen is usually needed at relapse, with the choice of regimen varying with each successive relapse. Chimeric antigen receptor T (CAR\u2010T) cell therapy and bispecific antibodies are additional options.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ajh.27422","type":"journal-article","created":{"date-parts":[[2024,6,29]],"date-time":"2024-06-29T02:28:44Z","timestamp":1719628124000},"page":"1802-1824","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":546,"title":["Multiple myeloma: 2024 update on diagnosis, risk\u2010stratification, and management"],"prefix":"10.1002","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5862-1833","authenticated-orcid":false,"given":"S. Vincent","family":"Rajkumar","sequence":"first","affiliation":[{"name":"Division of Hematology Mayo Clinic  Rochester Minnesota 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