Abstract
Gain of chromosome 1q (+1q) is commonly identified in multiple myeloma and has been associated with inferior outcomes. However, the prognostic implication of +1q has not been evaluated in the setting of standard triplet regimens. We retrospectively analyzed 201 consecutive patients with newly diagnosed myeloma who received induction with lenalidomide, bortezomib, and dexamethasone (RVD) and were tested for +1q at diagnosis by fluorescent in-situ hybridization. Patients with +1q (n = 94), compared to those without +1q (n = 107), had shorter median progression-free survival (PFS) (41.9 months vs 65.1 months, p = 0.002, HR = 1.90) and overall survival (median not reached (NR) for either arm, p = 0.003, HR 2.69). In subgroup analyses, patients with co-occurring +1q and t(4;14), t(14;16) or del(17p) or with 4 or more copies of 1q had significantly worse PFS (25.1 months and 34.6 months, p < 0.001 and p = 0.0063, respectively), whereas patients with three copies and no other high-risk cytogenetic abnormalities had no significant difference in PFS. These data suggest that when treated with RVD induction, patients with +1q should be considered at very high risk for early progression in multiple myeloma when ≥4 copies are detected or in the context of other high-risk cytogenetic abnormalities.
Highlights
Multiple myeloma (MM), a malignant neoplasm of plasma cells, is the second most common hematological malignancy in the Unites States and is characterized by marked clinical heterogeneity and variable outcomes
Del(17p) by fluorescence in-situ hybridization (FISH) are associated with early progression and shorter overall survival, and these have been incorporated into the Revised International Scoring System
In order to eliminate the possibility of bias due to clonal cytogenetic evolution seen at relapse, patients were excluded from the analysis if the biopsy report from diagnosis was not available, if it did not have sufficient material for cytogenetic testing, if it was not tested for +1q, or if extra copies of chromosome 1q were only detected by conventional karyotype
Summary
Multiple myeloma (MM), a malignant neoplasm of plasma cells, is the second most common hematological malignancy in the Unites States and is characterized by marked clinical heterogeneity and variable outcomes. One of the most important factors determining prognosis for patients with MM is the presence or absence of recurrent chromosomal abnormalities as detected by karyotype and/or fluorescence in-situ hybridization (FISH). It is well-established that the presence of t(4;14), t(14;16), and/. While some studies have found that +1q is an independent predictor of poor outcomes, other studies have not shown this correlation. While some studies have found that +1q is an independent predictor of poor outcomes, other studies have not shown this correlation7,8 These studies have all generally been performed prior to the widespread
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