BETA - How is risk stratification used in making treatment decisions?

Risk can be used to determine therapies only in a very limited fashion. Currently, there are clinical trials underway to try and understand if patients with higher risk should be managed differently, but there are a few things that need to be considered. One, there have been trials in Europe that demonstrate that patients who have high risk disease may benefit from two consecutive transplants instead of one. Now, whether that's applicable globally is difficult because in the European Union access to the same medication that we have in the United States, it isn't the same. And so whether the availability of modern drugs obviates the need for two transplants is unclear, but certainly in the EU, high risk is considered for two transplants. Some clinicians change the way in which they do maintenance therapy in high risk versus standard risk. Outside of a clinical trial, some centers will use two or three medications for maintenance therapy instead of one medication for maintenance therapy for high risk because of their concern that they have an increased risk of early recurrence of the disease. And in some instances, risk may determine how long you're going to give maintenance therapy, whether it has to be abbreviated or whether it will be more about indefinitely defined duration of therapy. But a lot of the research ongoing now is trying to figure out whether high-risk patients should be treated with four medications at induction at diagnosis versus three medications at diagnosis, but these are still the subject of research and it's hard to definitively say whether risk should be used in day-to-day clinical decision-making. The final is that there can be targeted therapies for one of the bad genetic variables, the 414 translocation, which is considered a high-risk feature. Those patients may be uniquely sensitive to the oral medication benetoclax, and for patients who have that genetic abnormality, some physicians will consider the use of that drug benetoclax as as part of this management of their disease.