Evidence for Cytogenetic and Fluorescence In Situ Hybridization Risk Stratification of Newly Diagnosed Multiple Myeloma in the Era of Novel Therapies
Evidence for Cytogenetic and Fluorescence In Situ Hybridization Risk Stratification of Newly Diagnosed Multiple Myeloma in the Era of Novel Therapies
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DOI：
10.4065/mcp.2009.0677
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发表时间：
2010-06-01
影响因子：
8.9
通讯作者：
Kumar, Shaji
中科院分区：
文献类型：
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作者：
Kapoor, Prashant;Fonseca, Rafael;Kumar, Shaji
随着多发性骨髓瘤 (MM) 中新型药物的使用增加，总生存期 (OS) 有所改善。然而，病程仍然存在很大差异，异质性很大程度上反映了不同的遗传异常。我们研究了新疗法时代梅奥多发性骨髓瘤风险分层模型对患者结果的影响，评估了该模型的每个单独组成部分——荧光原位杂交 (FISH)、传统细胞遗传学 (CG) 和浆细胞标记指数——将患者分为高风险和标准风险类别。该报告由 290 名新诊断的 MM 患者组成，主要接受新型药物治疗，在诊断时对他们进行了风险分层，并对 OS 进行了随访。在这些患者中，81% 主要接受沙利度胺 (n=50)、来那度胺 (n=199) 或硼替佐米 (n=79) 作为一线或挽救治疗。我们的回顾性分析验证了目前提出的 Mayo 风险分层模型（高风险和标准风险患者的中位 OS 分别为 37 个月和未达到；P=.003）。尽管 FISH 或 CG 测试识别出风险比分别为 2.1 (P=.006) 和 2.5 (P=.006) 的高风险队列，但 3% 的浆细胞标记指数截止值无法独立预测患者风险（风险比为 1.4；P=.41）。在通过 2 项测试（FISH 或 CG）之一分层为标准风险的患者中，另一项测试似乎具有额外的预后意义。这项研究验证了 Mayo 风险分层模型中 FISH 和 CG 定义的高风险特征，适用于主要接受基于免疫调节剂的新型疗法的 MM 患者。梅奥临床进程。 2010;85(6):532-537
Overall survival (OS) has improved with increasing use of novel agents In multiple myeloma (MM). However, the disease course remains highly variable, and the heterogeneity largely reflects different genetic abnormalities. We studied the impact of the Mayo risk-stratification model of MM on patient outcome in the era of novel therapies, evaluating each individual component of the model-fluorescence in situ hybridization (FISH), conventional cytogenetics (CG), and the plasma cell labeling index-that segregates patients into high- and standard-risk categories. This report consists of 290 patients with newly diagnosed MM, predominantly treated with novel agents, who were risk-stratified at diagnosis and were followed up for OS. Of these patients, 81% had received primarily thalidomide (n=50), lenalidomide (n=199), or bortezomib (n=79) as frontline or salvage therapies. Our retrospective analysis validates the currently proposed Mayo risk-stratification model (median OS, 37 months vs not reached for high- and standard-risk patients, respectively; P=.003). Although the FISH or CG test identifies a high-risk cohort with hazard ratios of 2.1 (P=.006) and 2.5 (P=.006), respectively, the plasma cell labeling index cutoff of 3% fails to independently prognosticate patient risk (hazard ratio, 1.4; P=.41). In those stratified as standard-risk by one of the 2 tests (FISH or CG), the other test appears to be of additional prognostic significance. This study validates the high-risk features defined by FISH and CG in the Mayo risk-stratification model for patients with MM predominantly treated with novel therapies based on immunomodulatory agents. Mayo Clin Proc. 2010;85(6):532-537