[Edna]

Mixed iFISH, unsure of best decision now

by Edna on Mon Mar 23, 2015 7:14 pm

I had an iFISH Profile at diagnosis, before induction treatment, of which the most significant results were:

Loss of one opy of CDKN2C (loss of 1p32.3) (22% cells) and loss of one copy of both CDNK2C and CKS1B (1q21) loci (12% cells) indicating monosomy of chromosome 1.
Loss of one copy of both the DLEU (13q14) and 13q34 loci indicative of monosomy of chromosome 13.

3-4 copies of Chromosomes 5,9,11,15and 17 - hyperdiploidy.

I am at the point, one year post starting initial treatment (VGPR within 2 cycles stable until now), of being considered for ASCT. Initial treatment included Bortezomib based triplet including steroid. The treatment was non intensive and reduced over time due to peripheral neuropathy development. I had infections including pneumonia during treatment, but aside from multiple bone lesions and problems thereof feel OK now.

My concern now is with the published research on chromosome 1 deletions / 13 deletions suggesting an adverse prognostic profile, where ASCT may not confer PFS or OS benefit than a less intensive appproach. It also suggests a very short survival for these deletions.

If no ACST then which combination of drugs (evidence from research please if possible) might be appropriate in my case. Treating multiple myeloma is an art not a science at present so making decisions is a mind game for us all.

I am unclear as to whether ASCT and the further reduced quality of life is worth it if the survival, (ISS stage 3 multiple myeloma), is likely to be short. Does being hyperdiploid negate the adverse profile? Is there published evidence? I do not really understand if I am high, intermediate or standard risk according to the Mayo classification ( I do have renal issues, not necessarily multiple myeloma related up until now).

Thoughts would be very much appreciated.