title: Combining information regarding chromosomal aberrations t(4;14) and del(17p13) with the International Staging System classification allows stratification of myeloma patients undergoing autologous stem cell transplantation.
abstract: BACKGROUND
  Chromosomal abnormalities have been shown to play a major role in disease evolution of multiple myeloma. Specific changes in interphase cells can be detected by fluorescent in situ hybridization, which overcomes the problem of the lack of dividing cells required for conventional cytogenetics.
  
  
  METHODS
  We analyzed the prognostic value of 12 frequent chromosomal abnormalities detected by fluorescent in situ hybridization in a series of patients (n=315) with newly diagnosed, symptomatic multiple myeloma. All patients underwent frontline autologous stem cell transplantation according to the GMMG-HD3- or GMMG-HD4-trial protocols or analogous protocols.
  
  
  RESULTS
  Univariate statistical analyses revealed that the presence of del(13q14), del(17p13), t(4;14), +1q21 and non-hyperdiploidy was associated with adverse progression-free and overall survival rates independently of the International Staging System (ISS) classification. Multivariate analyses showed that only t(4;14) and del(17p13) retained prognostic value for both progression-free and overall survival. According to the presence or absence of t(4;14) and del(17p13) and the patients' International Staging System classification, the cohort could be stratified into three distinct groups: a group with a favorable prognosis [absence of t(4;14)/del(17p13) and ISS I], a group with a poor prognosis [presence of t(4;14)/del(17p13) and ISS II/III] and a group with an intermediate prognosis (all remaining patients). The probabilities of overall survival at 5 years decreased from 72% in the favorable prognostic group to 62% (hazard ratio 2.4; P=0.01) in the intermediate and 41% (hazard ratio 5.6; P<0.001) in the poor prognostic groups.
  
  
  CONCLUSIONS
  These results have implications for risk-adapted management for patients with multiple myeloma undergoing high-dose chemotherapy followed by autologous stem cell transplantation and suggest that new treatment concepts are urgently needed for patients who belong to the poor prognosis group. As targeted therapies evolve, different treatment options might have variable success, depending on the underlying genetic nature of the clone.
authors.affiliation: Department of Internal Medicine V, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. kai.neben@med.uni-heidelberg.de
authors.forename: Kai
authors.initials: K
authors.lastname: Neben
authors.forename: Anna
authors.initials: A
authors.lastname: Jauch
authors.forename: Uta
authors.initials: U
authors.lastname: Bertsch
authors.forename: Christiane
authors.initials: C
authors.lastname: Heiss
authors.forename: Thomas
authors.initials: T
authors.lastname: Hielscher
authors.forename: Anja
authors.initials: A
authors.lastname: Seckinger
authors.forename: Tina
authors.initials: T
authors.lastname: Mors
authors.forename: Nadine Zoe
authors.initials: NZ
authors.lastname: Müller
authors.forename: Jens
authors.initials: J
authors.lastname: Hillengass
authors.forename: Marc S
authors.initials: MS
authors.lastname: Raab
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Ho
authors.forename: Dirk
authors.initials: D
authors.lastname: Hose
authors.forename: Hartmut
authors.initials: H
authors.lastname: Goldschmidt
mesh_terms: D000328:Adult; D002869:Chromosome Aberrations; D002872:Chromosome Deletion; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality; D009367:Neoplasm Staging; D011379:Prognosis; D018570:Risk Assessment; D014178:Translocation, Genetic; D014182:Transplantation, Autologous