Proposed risk-scoring model for estimating the prognostic impact of 1q gain in patients with newly diagnosed multiple myeloma
Proposed risk-scoring model for estimating the prognostic impact of 1q gain in patients with newly diagnosed multiple myeloma
复制标题
拟议的风险评分模型，用于评估新诊断的多发性骨髓瘤患者 1q 增益的预后影响
DOI：
10.1002/ajh.26774
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Jin F
中科院分区：
文献类型：
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作者：
Yang P;Chen H;Liang X;Xu W;Yu S;Huang W;Yi X;Guo Q;Tian M;Yue T;Li M;Zhang Y;Zhang M;Yan Y;Hu Z;Kumar SK;Zhou F;Dai Y;Jin F
1q增益（+1q）是多发性骨髓瘤（MM）患者中最常见的高危细胞遗传学异常（HRCA）。然而，在新药物时代，其预后价值尚不清楚。在这里，我们回顾性分析了+1q对934例新诊断为MM的患者结局的影响。53.1%的患者发现+1q，并证实+1q是较差总生存（OS）的独立变量（风险比为1.400；95%可信区间为1.097-1.787;p= 0.007）。其他hrca的并发（尤其是t（14;16）和del(17p)）进一步加重了+1q患者的预后，提示预后异质性。因此，基于四个风险变量（t(14;16)，高钙血症，ISS III和高LDH）的风险评分算法被开发来估计+1q患者的结局。其中，376名可评估的+1q患者被重新分层为低（31.6%）、中（61.7%）和高风险（6.7%）组，无进展生存期和OS有显著差异（p< 0.05）。0001)，与疾病的早期复发有关。该模型的预后价值在compass队列中得到了验证。虽然获得无法检测到的MRD在很大程度上规避了+1q的不利影响，但它几乎不能改善高风险患者的预后，这些患者可能代表了生存率极低的患者的一部分。因此，+1q患者是一组异质性的高风险患者，因此强调了对他们进行重新分层的必要性。提出的简单风险评分模型可以估计+1q患者的结果，这可能有助于指导此类患者的风险适应治疗。
1q gain (+1q) is the most common high‐risk cytogenetic abnormality (HRCA) in patients with multiple myeloma (MM). However, its prognostic value remains unclear in the era of novel agents. Here, we retrospectively analyzed the impact of +1q on the outcomes of 934 patients newly diagnosed with MM. +1q was identified in 53.1% of patients and verified as an independent variate for inferior overall survival (OS) (hazard ratio, 1.400; 95% confidence interval, 1.097–1.787;p= .007). Concurrence of other HRCAs (particularly t(14;16) and del(17p)) further exacerbated the outcomes of patients with +1q, suggesting prognostic heterogeneity. Thus, a risk‐scoring algorithm based on four risk variates (t(14;16), hypercalcemia, ISS III, and high LDH) was developed to estimate the outcomes of patients with +1q. Of the patients, 376 evaluable patients with +1q were re‐stratified into low (31.6%), intermediate (61.7%), and high risk (6.7%) groups, with significantly different progression‐free survival and OS (p< .0001), in association with early relapse of the disease. The prognostic value of this model was validated in the CoMMpass cohort. While attaining undetectable MRD largely circumvented the adverse impact of +1q, it scarcely ameliorated the outcome of the patients with high risk, who likely represent a subset of patients with extremely poor survival. Hence, patients with +1q are a heterogeneous group of high‐risk patients, therefore underlining the necessity for their re‐stratification. The proposed simple risk‐scoring model can estimate the outcomes of patients with +1q, which may help guide risk‐adapted treatment for such patients.