title: Impact of gene expression profiling-based risk stratification in patients with myeloma receiving initial therapy with lenalidomide and dexamethasone.
abstract: Detection of specific chromosomal abnormalities by FISH and metaphase cytogenetics allows risk stratification in multiple myeloma; however, gene expression profiling (GEP) based signatures may enable more specific risk categorization. We examined the utility of 2 GEP-based risk stratification systems among patients undergoing initial therapy with lenalidomide in the context of a phase 3 trial. Among 45 patients studied at baseline, 7 (16%) and 10 (22%), respectively, were high-risk using the GEP70 and GEP15 signatures. The median overall survival for the GEP70 high-risk group was 19 months versus not reached for the rest (hazard ratio = 14.1). Although the medians were not reached, the GEP15 also predicted a poor outcome among the high-risk patients. The C-statistic for the GEP70, GEP15, and FISH based risk stratification systems was 0.74, 0.7, and 0.7, respectively. Here we demonstrate the prognostic value for GEP risk stratification in a group of patients primarily treated with novel agents. This trial was registered at www.clinicaltrials.gov as #NCT00098475.
authors.affiliation: Division of Hematology, Mayo Clinic Rochester, Rochester, MN 55905, USA. kumar.shaji@mayo.edu
authors.forename: Shaji K
authors.initials: SK
authors.lastname: Kumar
authors.forename: Hajime
authors.initials: H
authors.lastname: Uno
authors.forename: Susanna J
authors.initials: SJ
authors.lastname: Jacobus
authors.forename: Scott A
authors.initials: SA
authors.lastname: Van Wier
authors.forename: Greg J
authors.initials: GJ
authors.lastname: Ahmann
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Henderson
authors.forename: Natalie S
authors.initials: NS
authors.lastname: Callander
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Haug
authors.forename: David S
authors.initials: DS
authors.lastname: Siegel
authors.forename: Philip R
authors.initials: PR
authors.lastname: Greipp
authors.forename: Rafael
authors.initials: R
authors.lastname: Fonseca
authors.forename: S Vincent
authors.initials: SV
authors.lastname: Rajkumar
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002869:Chromosome Aberrations; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D020869:Gene Expression Profiling; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000235:genetics*; D016019:Survival Analysis; D013792:Thalidomide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D013792:Thalidomide; D003907:Dexamethasone; D000077269:Lenalidomide