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

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.