Abstract 1914

Background:

Although chromosomal aberrations (CA) have emerged as important outcome predictors in multiple myeloma (MM), the prognostic significance of many recurring genomic changes is still unknown. Moreover, there is only scarce data on the implication of CA in elderly patients (pts.) receiving high-dose chemotherapy (HD-CTX) followed by autologous stem cell transplantation (ASCT).

Aims:

To evaluate the prognostic relevance of recurring CA as detected by cIg-FISH for elderly pts. with MM receiving HD-CTX and ASCT.

Patients and Methods:

Between 05/2001 and 08/2006, 549 pts. 60–70 yrs. of age with newly diagnosed symptomatic MM entered the DSMM II trial of the Deutsche Studiengruppe Multiples Myelom to receive two cycles of HD-CTX (melphalan 140 mg/sqm) followed by ASCT after 3–4 cycles of dexamethason-based induction chemotherapy (IC; arm A1) or no IC (arm A2). cIg-FISH and DNA probes mapping to chromosome bands 1p22, 1q21.2, 6q21, 8p11.2, 9q34, 11q25, 13q14, 14q32, 17p13, and 22q11 were applied to all pts. with sufficient bone marrow specimen at diagnosis. 289 pts. with a median age of 64 yrs. were included in the present analysis.

Results:

After a median follow-up of 82 weeks (w) the following CA were associated with a significantly shorter event-free survival (EFS): 17p13 deletion (17p–; 55 vs. 93 w, p<.0001); translocation t(4;14) (t(4;14); 65 vs. 95 w, p<.001), 1q21.2 gains (+1q21.2; 79 vs. 99 w, p=.0002); 13q14 deletion (13q–; 82 vs. 99 w, p=.03); and 8p11.2 deletion (8p–; 80 vs. 95 w, p=.04). Overall survival (OS) was significantly shorter in pts. with +1q21.2 (148 vs. 231 w, p<.0001); 17p– (118 vs. 219 w, p=.001); and t(4;14) (t(4;14); 195 vs. 223 w, p=.017). In a multivariable analysis t(4;14) (p<.001); 17p– (p=.0089); +1q21.2 (p=.031); and beta-2-microglobulin (p=.033) independently predicted outcome.

Conclusion:

In this large cohort of uniformly treated elderly pts. with newly diagnosed MM, CA – in particular 17p–, t(4;14), and +1q21.2 – remain strong predictive markers for outcome.

Supported by a grant from the Else Kröner-Fresenius-Stiftung to P.L. and H.D.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
autologous stem cell transplant, chromosome abnormality, melphalan, multiple myeloma, older adult, brachial plexus neuritis, fibronectins, beta 2-microglobulin, bone marrow specimen, chemotherapy regimen

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2010 by The American Society of Hematology
2010
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