POOR-PROGNOSIS IN MULTIPLE-MYELOMA IS ASSOCIATED ONLY WITH PARTIAL OR COMPLETE DELETIONS OF CHROMOSOME-13 OR ABNORMALITIES INVOLVING 11Q AND NOT WITH OTHER KARYOTYPE ABNORMALITIES
POOR-PROGNOSIS IN MULTIPLE-MYELOMA IS ASSOCIATED ONLY WITH PARTIAL OR COMPLETE DELETIONS OF CHROMOSOME-13 OR ABNORMALITIES INVOLVING 11Q AND NOT WITH OTHER KARYOTYPE ABNORMALITIES
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DOI：
10.1182/blood.v86.11.4250.bloodjournal86114250
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发表时间：
1995-12-01
期刊：
影响因子：
20.3
通讯作者：
SAWYER, JR
中科院分区：
文献类型：
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作者：
TRICOT, G;BARLOGIE, B;SAWYER, JR
染色体异常在白血病中具有重要的生物学意义和预后意义。典型的低增殖性多发性骨髓瘤（MM）的细胞遗传学信息有限，因为难以获得可分析的中期分裂相。在这项研究中，分析了155名新诊断的MM患者的核型和其他已知的预后因素，这些患者接受了两次自体移植的强化治疗计划。使用标准统计方法分析完全缓解（CR）、无事件（EFS）和总生存期（OS）。在39%的患者中发现异常细胞遗传学，并且与CR率显著较低相关（27% v48%; P = 0.008）。与其他患者相比，13号染色体部分或完全缺失或11 q异常（“不可检测”核型）的患者的EFS和OS较差（P < .001），其余患者作为一个组，无论细胞遗传学结果如何，预后相似，即不可评估、正常或异常但没有“不利"核型。11号和13号染色体均异常的患者预后差，中位EFS和OS分别仅为11和12个月。“不利"核型与伊加同种型、β 2微球蛋白水平升高（B2 M，大于或等于3 mg/L）和年龄>60岁之间存在显著相关性。在多变量回归分析中，缺乏“不利"核型是与EFS和OS延长相关的最显著变量（分别为P = .0001和.0002）。其他独立有利变量为治疗前年龄小于60岁、C反应蛋白（CRP）小于或等于0.4 mg/dL和骨髓浆细胞增多症小于或等于50%。在没有细胞遗传学的多变量分析中，这三个标准参数被确定为唯一有利的变量。不具有所有三个标准有利变量的患者的CR率显著较低（P = 0.03）。EFS（P = 0.0001）和OS（P = 0.002），如果检测到不利的核型。我们的结论是，在这个统一治疗MM患者的程序中，预后不良主要与染色体11和13的异常有关。(C)1995年，美国血液学会。
Chromosomal abnormalities have major biologic and prognostic implications in leukemias. Cytogenetic information in typically hypoproliferative multiple myeloma (MM) is limited because of difficulties in obtaining analyzable metaphases. In this study, karyotypes and other known prognostic factors were analyzed in 155 newly diagnosed MM patients, entered on an intensive treatment program with two autotransplants. Complete remission (CR), event-free (EFS) and overall survival (OS) were analyzed using standard statistical methods. Abnormal cytogenetics were found in 39% of patients and were associated with a significantly lower CR rate (27% v 48%; P = .008). EFS and OS were inferior in patients with either partial or complete deletion of chromosome 13 or 11q abnormalities (''unfavorable'' karyotype) when compared with the remaining patients (P < .001) who, as a group, had a similar prognosis irrespective of cytogenetic findings, ie, inevaluable, normal, or abnormal but without an ''unfavorable'' karyotype. The patients with abnormalities of both chromosomes 11 and 13 had a dismal prognosis with median EFS and OS of only 11 and 12 months, respectively. Significant associations were noted between an ''unfavorable'' karyotype and IgA isotype, elevated levels of beta-2 microglobulin (B2M, greater than or equal to 3 mg/L) and age >60 years. On multivariate regression analysis, the absence of an ''unfavorable'' karyotype was the most significant variable associated with prolonged EFS and OS (P = .0001 and .0002, respectively). Other independent favorable variables were age less than 60 years, C-reactive protein (CRP) less than or equal to 0.4 mg/dL and bone marrow plasmacytosis less than or equal to 50% before treatment. On a multivariate analysis without cytogenetics, these same three standard parameters were identified as the only favorable variables. Patients not having all three standard favorable variables had a significantly lower CR rate (P = .03). EFS (P = .0001), and OS (P = .002) if an unfavorable karyotype was detected. We conclude that, in this program of uniformly treated MM patients, a poor prognosis was associated predominantly with abnormalities of chromosomes 11 and 13. (C) 1995 by The American Society of Hematology.