Clinical and biological features of t(4;14) multiple myeloma: a prospective study.
The t(4;14) translocation, found in 15% of multiple myeloma (MM), indicates a poor prognosis. Clinico-biological features associated with this severe outcome and the impact of novel agents are unknown. We report a series of 102 consecutive patients with t(4;14) MM. The median age was 56 years. The isotype was IgA in 42%, and the median serum β(2)-microglobulin was 2.3 mg/L. FGFR3 expression was lacking in 20 (19%) cases. Monoclonal gammopathy of undetermined significance (MGUS) or smoldering MM (sMM) was found in 26 patients (25%). Seven (27%) became symptomatic in a median time of 9 months. Fifty-six of 76 patients with symptomatic MM received high-dose therapy (HDT). The overall response rate (ORR) was 93% (22% CR, 44% VGPR), and the median progression-free survival (PFS) was 12 months. Twenty-four (37%) patients experienced aggressive relapse. Post-second-line ORR was 51% and the median PFS was 7 months, with a trend for longer PFS in patients treated with a bortezomib-based regimen. Median overall survival after HDT was 31 months. t(4;14) is detected in patients with MGUS/sMM and this does not require immediate chemotherapy. Patients with t(4;14) MM have a high ORR after HDT, contrasting with a short PFS and aggressive relapses, and, despite novel agents, still have a poor prognosis.
Immuno-Hematology, Saint-Louis Hospital, Paris, France.
Lionel
L
Karlin
Jean
J
Soulier
Olivia
O
Chandesris
Sylvain
S
Choquet
Karim
K
Belhadj
Margaret
M
Macro
Didier
D
Bouscary
Raphael
R
Porcher
David
D
Ghez
Marion
M
Malphettes
Bouchra
B
Asli
Jean Claude
JC
Brouet
Jean Christophe
JC
Bories
Olivier
O
Hermine
Jean Paul
JP
Fermand
Bertrand
B
Arnulf
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001897:Boronic Acids / Q000627:therapeutic use; D000069286:Bortezomib; D002883:Chromosomes, Human, Pair 14 / Q000235:genetics*; D002894:Chromosomes, Human, Pair 4 / Q000235:genetics*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D011719:Pyrazines / Q000627:therapeutic use; D051498:Receptor, Fibroblast Growth Factor, Type 3 / Q000378:metabolism; D016879:Salvage Therapy; D015996:Survival Rate; D014178:Translocation, Genetic / Q000235:genetics*
D000970:Antineoplastic Agents; D001897:Boronic Acids; D011719:Pyrazines; D000069286:Bortezomib; C496365:FGFR3 protein, human; D051498:Receptor, Fibroblast Growth Factor, Type 3