How do you risk stratify complex karyotype in newly diagnosed multiple myeloma in the absence of specific high-risk cytogenetic abnormalities?  

Complex karyotype with >3 abnormalities is high risk independent of high risk FISH abnormalities. It tells you that the cancer cell is able to divide in culture and that is a bad sign as they are able to survive outside the marrow. It typically portends a highly proliferative signature of myeloma...

Karyotype is less likely to lead to a benefit in the age of the revised international staging system (R-ISS) and with better characterization of R-ISS 2 patients as presented at ASH 2020 (https://ash.confex.com/ash/2020/webprogram/Paper137021.html). It's hard to justify adding on karyotype (patient...