Cytogenetic and clinical risk factors for assessment of ultra high-risk multiple myeloma

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• 作者：Junling Zhuang ; Yi Da ; Hui Li ; Bing Han ; Xia Wan ; Tienan Zhu ; Miao Chen ; Minghui Duan ; Ying Xu ; Yongqiang Zhao ; Ti Shen ; Yongji Wu ; Daobin Zhou
• 关键词：Multiple myeloma ; Ultra high-risk ; Cytogenetic ; Prognosis ; Risk factors ; Lactate dehydrogenase
• 刊名：Leukemia Research
• 出版年：February, 2014
• 年：2014
• 卷：38
• 期：2
• 页码：188-193
• 全文大小：825 K

文摘

Background

Cytogenetic assessments can improve conventional clinical risk assessment for ultra-high risk (UHR) multiple myeloma (MM) patients.

Objective

Cytogenetic and clinical risk factors were examined in UHR MM patients.

Methods

Consecutive MM patients (n = 168) were retrospectively screened for untreated, symptomatic MM between July 2008 and March 2011, including UHR (n = 35) and control (n = 60) patients with 鈮?2 or >12 month survival, respectively. Treatment outcomes; clinical, radiological, histological factors; and fluorescence in situ hybridization (FISH)-indicated cytogenetic abnormalities (CAs) were compared.

Results

Included UHR patients exhibited lower median overall survival (OS) (5 vs. >24 months); overall response rates (ORRs) (31.4% vs. 83.3%); complete response (CR), near CR (nCR), or very good partial response (VGPR) (8.6% vs. 51.7%) (all P < 0.001); and partial response (PR) (22.9% vs. 31.7%, P = 0.358). UHR patients exhibited more renal failure (54.3% vs. 28.3%), hypercalcemia (11.4% vs. 0), elevated lactate dehydrogenase (LDH) (25.7% vs. 5%), secondary plasma cell leukemia (14.3% vs. 0), International Staging System (ISS) stage III (77.1% vs. 45%), and 1q21+ and 17p鈭?(42.9% vs. 18.3%; 17.1% vs. 3.3%) (all P < 0.05). 鈮? CAs indicated poor survival (36.7% vs. 16.1%, P = 0.035). Multivariate analysis showed ISS stage and LDH correlated with UHR (P = 0.05 and P = 0.01, respectively), and 1q21+ and 17p鈭?were increased but non-significantly correlated with UHR (P = 0.15 and P = 0.2, respectively).

Conclusions

Combined clinical and cytogenetic assessments optimally indicate UHR MM patients鈥?prognosis, allowing earlier risk-adapted interventions.