High‑risk and extramedullary myeloma: biology, imaging and multidisciplinary management

High-risk and extramedullary multiple myeloma (MM) represent some of the most challenging entities in contemporary myeloma care. Cytogenetic and molecular abnormalities such as 1q gain, 1p loss, and high-risk translocations, together with plasma cell leukemia and extramedullary spread, are associated with aggressive clinical behavior, treatment resistance, and poor survival. These forms frequently present with bulky lesions, spinal cord compression, pathologic fractures, and soft-tissue masses that require urgent local control strategies. Advances in whole-body imaging (PET/CT, MRI) and modern systemic therapies have improved detection and disease control, yet optimal integration of surgery, interventional radiology, and radiation therapy with systemic treatment remains poorly defined. There is an urgent need to better characterize the biology and natural history of high-risk and extramedullary MM and to standardize multidisciplinary approaches to these complex presentations. This Research Topic aims to address the unmet needs in the management of high-risk and extramedullary MM by integrating biological insights, advanced imaging, and multidisciplinary treatment strategies. Specifically, it seeks to clarify how cytogenetic and molecular high-risk features, immune and microenvironmental factors, and patterns of dissemination influence prognosis and therapeutic decision-making. A key objective is to define the role and timing of local interventions—such as spinal stabilization, decompressive surgery, orthopedic fixation, and resection or ablation of extramedullary masses—in the era of novel agents, transplant, and cellular therapies. We encourage contributions that explore how PET/CT, whole-body MRI, and other imaging modalities guide risk stratification, treatment selection, and response assessment in these patients. By bringing together hematologists, surgical oncologists, orthopedic and spine surgeons, radiologists, and radiation oncologists, this Topic aims to promote evidence-based, multidisciplinary care pathways that improve symptom control, functional outcomes, and survival in patients with high-risk and extramedullary MM. We welcome Original Research, Review, Mini Review, and Perspective articles on themes including, but not limited to: - Biological and molecular determinants of high-risk and extramedullary MM (e.g., 1q/1p abnormalities, double‑hit disease, plasma cell leukemia) - Imaging strategies (PET/CT, whole-body MRI, functional imaging) for detection, staging, and response assessment in extramedullary and high-burden disease - Multidisciplinary management of spinal cord compression, pathologic fractures, and bulky extramedullary lesions (surgery, interventional radiology, radiation therapy) - Integration of local therapies with systemic treatment, transplant, and cellular therapies - Real-world outcomes, prognostic models, and treatment algorithms for high-risk and extramedullary MM Please note: manuscripts consisting solely of bioinformatics or computational analysis of public databases, without validation in an independent cohort or biological validation in vitro or in vivo, are out of scope for this section and will not be accepted as part of this Research Topic. Topic editors: Francesca Cottini, Saurabh Zanwar Source: https://www.frontiersin.org/research-topics/76531/high-risk-and-extramedullary-myeloma-biology-imaging-and-multidisciplinary-management