There is a new study out from researchers at the Mayo Clinic that looks at how the chromosomal abnormalities in multiple myeloma patients change over time. I thought I would post information about the study and then we all could look at it and figure out what we think are the most important implications.
I've read the abstract and skimmed the rest of the study, and, based on that, here is a quick list of some key findings:
- The chromosomal abnormalities that matter the most, in terms of patient's prognosis, are those present at the time of diagnosis
- Patients who develop no new chromosomal abnormalities within 3 years after diagnosis, or whose abnormalities go away, have a better prognosis than patients who develop additional abnormalities
- The abnormality t(11;14) is associated with a lower chance of changes in chromosomal abnormalities over time
- Having at least one trisomy or tetrasomy at diagnosis is associated with a higher risk of additional chromosomal abnormalities developing over time
I don't think this is a perfect study since patients in the study didn't have FISH testing done right at the time of diagnosis, and they were not followed in a uniform way. But it does provide some insights into an issue that comes up often here in the forum.
Here is the reference for the article, which can be read in full online with no charge:
M Binder et al, "Occurrence and prognostic significance of cytogenetic evolution in patients with multiple myeloma," Blood Cancer Journal, March 2016 (full text of article)
And here is the abstract:
Cytogenetic evaluation at the time of diagnosis is essential for risk stratification in multiple myeloma, however little is known about the occurrence and prognostic significance of cytogenetic evolution during follow-up. We studied 989 patients with multiple myeloma, including 304 patients with at least two cytogenetic evaluations. Multivariable-adjusted regression models were used to assess the associations between the parameters of interest and cytogenetic evolution as well as overall survival. The prognostic significance of baseline cytogenetic abnormalities was most pronounced at the time of diagnosis and attenuated over time. In the patients with serial cytogenetic evaluations, the presence of t(11;14) at the time of diagnosis was associated with decreased odds of cytogenetic evolution during follow-up (odds ratio (OR)=0.22, 95% confidence interval (CI)=0.09–0.56, P=0.001), while the presence of at least one trisomy or tetrasomy was associated with increased odds (OR=2.96, 95% CI=1.37–6.42, P=0.006). The development of additional abnormalities during the 3 years following diagnosis was associated with increased subsequent mortality (hazard ratio=3.31, 95% CI=1.73–6.30, P<0.001). These findings emphasize the importance of the underlying clonal disease process for risk assessment and suggest that selected patients may benefit from repeated risk stratification.
