Time to say adieu to FISH in myeloma diagnostics

In this issue of Blood, Schavgoulidze et al 1 interrogated the largest series of patients with newly diagnosed multiple myeloma (NDMM) to assess the prevalence and the clinical impact of the new International Myeloma Society and International Myeloma Working Group consensus genomic staging for defining high-risk (HR) multiple myeloma (MM). 2 In addition to defining highrisk disease by the occurrence of t(4;14), t(14;16), or t(14;20) with 1q+ and/or del (1p32); monoallelic del(1p32) with 1q+; or β2M ≥5.5 mg/L with normal creatinine, a key innovation of this new classification is the inclusion of TP53 status and biallelic 1p32 deletion.In addition to improving prognostication and identification of HRMM, this represents a pivotal turning point in MM management: after more than 20 years, fluorescence in situ hybridization (FISH) alone is no longer sufficient, and DNA sequencing needs to be incorporated into the arena.