Abstract
Patients with multiple myeloma with t(11;14) have been considered to have standard-risk disease. However, several recent reports have shown contradictory results. We identified 95 patients with multiple myeloma with t(11;14) on FISH studies, who underwent upfront autologous hematopoietic stem cell transplant (auto-HCT) at our center. We compared their outcome with a group of standard-risk patients with multiple myeloma who had diploid cytogenetics by both conventional cytogenetics (CC) and FISH (n = 287). To reduce the bias between the groups, we performed a 1:1 propensity score matching technique for analysis. A total of 160 patients, 80 in each group, were identified. Patients in the 2 groups were matched for age, International staging system stage at diagnosis, serum creatinine at presentation, disease status at auto-HCT, type of preparative regimens, dose of melphalan used for conditioning, and induction and maintenance regimens. Patients in t(11;14) group had a post auto-HCT overall response rate (ORR) of 97.5% (78/80), compared with 100% (80/80) in the standard-risk control group (P = 0.50). Complete response rate in the t(11;14) group was 35% (28/80), compared with 45% (36/80) in the standard-risk control group (P = 0.26). The 4-year PFS rates were 40.8% (95% CI, 29.6%-56.1%) and 51.1% (95% CI, 39.4%-66.3%) in the t(11;14) and standard-risk control groups, respectively (P = 0.14). The 4-year OS rates were 74.9% (95% CI, 63.3%-88.7%) and 88.3% (95% CI, 80.4%-97.0%) in the t(11;14) and standard-risk control groups, respectively (P = 0.17). Also, patients with t(11;14) with concurrent cytogenetics had significantly poor PFS and OS compared with a propensity matched standard-risk control group. Our study confirms that t(11;14) multiple myeloma undergoing upfront autologous transplantation had similar outcomes as patients with multiple myeloma with normal cytogenetic and FISH studies. Existence of additional genomic aberrations by CC or FISH was associated with a worse outcome.
Highlights
Multiple myeloma, a plasma cell neoplasm, is characterized by cytogenetic abnormalities that are relevant to disease biology and prognosis, but may play a role inNote: Supplementary data for this article are available at Clinical Cancer Research Online.therapeutic decision making (1)
Our study confirms that t(11;14) multiple myeloma undergoing upfront autologous transplantation had similar outcomes as patients with multiple myeloma with normal cytogenetic and FISH studies
Existence of additional genomic aberrations by CC or FISH was associated with a worse outcome
Summary
A plasma cell neoplasm, is characterized by cytogenetic abnormalities that are relevant to disease biology and prognosis, but may play a role inNote: Supplementary data for this article are available at Clinical Cancer Research Online (http://clincancerres.aacrjournals.org/).therapeutic decision making (1). A plasma cell neoplasm, is characterized by cytogenetic abnormalities that are relevant to disease biology and prognosis, but may play a role in. The most common primary oncogenic events in multiple myeloma are either Immunoglobulin heavy chain gene (IgH) locus translocations or hyperdiploidy, involving odd-numbered chromosomes. Abnormal plasma cell clones acquire secondary abnormalities, such as copy number alterations (1p deletion, 1q gain, 17p loss) and/or other genetic mutations, which can alter the disease biology, drive clonal progression, and influence clinical outcomes (4). Patients with multiple myeloma with t(11;14) have been considered to have standard-risk disease. That is because abnormalities on CC analysis represent high proliferation rates in clonal plasma cells and portend poor survival.
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