title: Cytogenetic and clinical risk factors for assessment of ultra high-risk multiple myeloma.
abstract: BACKGROUND
  Cytogenetic assessments can improve conventional clinical risk assessment for ultra-high risk (UHR) multiple myeloma (MM) patients.
  
  
  OBJECTIVE
  Cytogenetic and clinical risk factors were examined in UHR MM patients.
  
  
  METHODS
  Consecutive MM patients (n = 168) were retrospectively screened for untreated, symptomatic MM between July 2008 and March 2011, including UHR (n = 35) and control (n = 60) patients with ≤ 12 or >12 month survival, respectively. Treatment outcomes; clinical, radiological, histological factors; and fluorescence in situ hybridization (FISH)-indicated cytogenetic abnormalities (CAs) were compared.
  
  
  RESULTS
  Included UHR patients exhibited lower median overall survival (OS) (5 vs. >24 months); overall response rates (ORRs) (31.4% vs. 83.3%); complete response (CR), near CR (nCR), or very good partial response (VGPR) (8.6% vs. 51.7%) (all P<0.001); and partial response (PR) (22.9% vs. 31.7%, P = 0.358). UHR patients exhibited more renal failure (54.3% vs. 28.3%), hypercalcemia (11.4% vs. 0), elevated lactate dehydrogenase (LDH) (25.7% vs. 5%), secondary plasma cell leukemia (14.3% vs. 0), International Staging System (ISS) stage III (77.1% vs. 45%), and 1q21+ and 17p- (42.9% vs. 18.3%; 17.1% vs. 3.3%) (all P<0.05). ≥ 3 CAs indicated poor survival (36.7% vs. 16.1%, P = 0.035). Multivariate analysis showed ISS stage and LDH correlated with UHR (P = 0.05 and P =0.01, respectively), and 1q21+ and 17p- were increased but non-significantly correlated with UHR (P = 0.15 and P = 0.2, respectively).
  
  
  CONCLUSIONS
  Combined clinical and cytogenetic assessments optimally indicate UHR MM patients' prognosis, allowing earlier risk-adapted interventions.
authors.affiliation: Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: zhuangjunling@hotmail.com.
authors.forename: Junling
authors.initials: J
authors.lastname: Zhuang
authors.affiliation: Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: da_yi@sina.com.
authors.forename: Yi
authors.initials: Y
authors.lastname: Da
authors.affiliation: Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: lh10205@sina.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: hanbing_li@sina.com.
authors.forename: Bing
authors.initials: B
authors.lastname: Han
authors.affiliation: Department of Epidermiology, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730 China. Electronic address: wanxiasnake@163.com.
authors.forename: Xia
authors.initials: X
authors.lastname: Wan
authors.affiliation: Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: tienanzhu@gmail.com.
authors.forename: Tienan
authors.initials: T
authors.lastname: Zhu
authors.affiliation: Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: zhenyucmpal@sina.com.
authors.forename: Miao
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: mhduan@sina.com.
authors.forename: Minghui
authors.initials: M
authors.lastname: Duan
authors.affiliation: Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: xy901@tom.com.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: pumchzhaoyq@aliyun.com.
authors.forename: Yongqiang
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: shent@pumch.cn.
authors.forename: Ti
authors.initials: T
authors.lastname: Shen
authors.affiliation: Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: emmyzhuang@sina.com.
authors.forename: Yongji
authors.initials: Y
authors.lastname: Wua
authors.affiliation: Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China. Electronic address: daobinzhou@yahoo.com.
authors.forename: Daobin
authors.initials: D
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D020732:Cytogenetic Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis
keywords: Cytogenetic; Lactate dehydrogenase; Multiple myeloma; Prognosis; Risk factors; Ultra high-risk