Cytogenetic Risk Stratification in a Centre Colombian Multiple Myeloma Patients

Introduction:

Multiple myeloma (MM) is a heterogeneous disease with patient outcomes influenced by guest factors, clinical presentation, and genetic abnormalities. This study aimed to classify MM patients into risk groups based on cytogenetic markers and assess their impact on survival.

Methods:

We conducted a prospective cross-sectional study involving 50 MM patients (aged >18 years) treated at Clinica Foscal between October 1, 2021, and July 31, 2023. Patients with smoldering MM were excluded. Genetic studies (FISH, molecular studies, and karyotyping) were performed.

Results:

The cohort consisted of 52% men with a median age of 67 years (range: 46-91). Most patients were urban residents (86%) with health insurance coverage (62%). The most common MM subtype was IgG kappa (38%), followed by IgG lambda (18%) and IgA kappa (12%). Cytogenetic abnormalities included del13q (32.5%), amp1q21 (20%), t(4;14) (15%), and t(11;14) (12%). Abnormal karyotypes were observed in 69% of patients.

Using the Mayo Stratification for Myeloma and Risk-Adapted Therapy (mSMART) scale, 46% of patients were classified as high risk, while 18% were categorized as standard risk. According to the Revised International Staging System (R-ISS), 14% were classified as stage I, 56% as stage II, and 18% as stage III. Among those with abnormal karyotypes, 27.6% were high-risk by mSMART, and 58.6% were stage II by R-ISS.

First-line chemotherapy included Lenalidomide-Bortezomib-Dexamethasone (VRD) in 54.5% of patients, Cyclophosphamide-Bortezomib-Dexamethasone (CyBorD) in 27.3%, Daratumumab plus VRD in 2.3%, and other regimens in 15.9%. No patient achieved complete remission before 4 cycles. Due to the sample size and limited follow-up, the impact of risk stratification on treatment response could not be fully assessed.

Regarding overall survival (OS), at the time of analysis, only the R-ISS showed a statistically significant difference in OS, favoring patients classified as stage I.

Conclusion:

Cytogenetic markers are crucial prognostic factors in MM. In this study, only the R-ISS scale demonstrated utility in refining risk stratification within the follow-up period. Extended follow-up is necessary to establish the prognostic value of other risk stratification scales and to evaluate their potential role in guiding first-line treatment decisions.

No relevant conflicts of interest to declare.