Junling Zhuang1, Yi Da2, Hui Li3, Bing Han4, Xia Wan5, Tienan Zhu6, Miao Chen7, Minghui Duan8, Ying Xu9, Yongqiang Zhao10, Ti Shen11, Yongji Wua12, Daobin Zhou13. 1. Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: zhuangjunling@hotmail.com. 2. Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: da_yi@sina.com. 3. Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: lh10205@sina.com. 4. Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: hanbing_li@sina.com. 5. Department of Epidermiology, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730 China. Electronic address: wanxiasnake@163.com. 6. Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: tienanzhu@gmail.com. 7. Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: zhenyucmpal@sina.com. 8. Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: mhduan@sina.com. 9. Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: xy901@tom.com. 10. Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: pumchzhaoyq@aliyun.com. 11. Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: shent@pumch.cn. 12. Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: emmyzhuang@sina.com. 13. Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: daobinzhou@yahoo.com.
Abstract
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 ≤ 12 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- (42.9% vs. 18.3%; 17.1% vs. 3.3%) (all P<0.05). ≥ 3 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- 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' prognosis, allowing earlier risk-adapted interventions. Crown
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 MMpatients. METHODS: Consecutive MMpatients (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 ≤ 12 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- (42.9% vs. 18.3%; 17.1% vs. 3.3%) (all P<0.05). ≥ 3 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- 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 MMpatients' prognosis, allowing earlier risk-adapted interventions. Crown