t(11;14) Is Infrequent in Long-Term Myeloma Survivors.

The translocation t(11;14) involving immunoglobulin heavy chain gene switch region and cyclin D1 is the most common IgH translocation (15–20%) in multiple myeloma (MM). MM patients with t(11;14) are considered to have a better prognosis when treated with either conventional chemotherapy or autologous stem cell transplant. In contrast, patients with chromosome 13q deletions (40–50% of patients) have a poor prognosis. To address whether long-term survivors of MM more frequently harbor a t(11;14) but not 13q deletions, we used cytoplasmic Ig-enhanced interphase fluorescence in situ hybridization (cIg-FISH) to evaluate clonal plasma cells for t(11;14) and 13q status from 20 long-term survivor MM cases. These patients met the diagnostic criteria for MM before May of 1996 and have survived more than 8 years. The 11 male and 9 female had a median age of 52 (range 39–62) at diagnosis. Eleven had IgG, 6 IgA, 2 free light chains, and 1 non-secretory. Of the 20 patients, 17 received autologous stem cell transplants. The median duration between diagnosis and transplant was 24 months (range 5–149), the median progression free survival (PFS) after transplant was 32 months (range, 1–62). One patient died 3 years after transplant and 10 years after diagnosis. The 19 other patients remain alive. Translocation t(11;14) was detected in only one of 20 patients with 94% of clonal plasma cells involved. This patient had PFS of 20 months after transplant and is alive 3 years post-transplant and 10.5 years after diagnosis. Chromosome 13q deletions were detected in only 3 cases (15%). Despite its association with a better prognosis, our results indicate that t(14;14) is infrequent in long-term myeloma survivors. As anticipated, 13q deletions were infrequent.