Journal of Clinical Oncology, Vol 15, 2659-2666, Copyright © 1997 by American Society of Clinical Oncology
Unique role of cytogenetics in the prognosis of patients with myeloma receiving high-dose therapy and autotransplants
G Tricot, JR Sawyer, S Jagannath, KR Desikan, D Siegel, S Naucke, S Mattox, D Bracy, N Munshi and B Barlogie
Department of Pathology, Arkansas Cancer Research Center and University of Arkansas for Medical Sciences, Little Rock, USA.
PURPOSE: Although important predictors of survival in myeloma patients have
been identified, it is well recognized that better prognostic factors for
this disease are needed. Because cytogenetics play a dominant role in the
outcome of patients with acute leukemia, their prognostic value was
evaluated in a large group of newly diagnosed and previously treated
myeloma patients receiving autotransplants. METHODS: A total of 427 either
newly diagnosed (26%) or previously treated patients (74%) received tandem
transplants, supported by mobilized peripheral-blood stem cells. Numerous
variables, including cytogenetics, were analyzed for their impact on
complete remission, event-free survival (EFS), and overall survival (OS).
RESULTS: Abnormal karyotypes were detected in 37% of our patients and were
very complex, irrespective of the duration of standard therapy before the
first autotransplant. In addition to previously recognized unfavorable
implications of partial or complete deletion of chromosome 13 and 11q
abnormalities, we now observed that the presence of any translocation
likewise portended poor outcome (unfavorable karyotypes). On multivariate
analysis, the absence of an unfavorable karyotype was the most favorable
variable for both EFS (P = .0001) and OS (P = .0001). Other favorable
factors were duration of standard therapy and a low beta-2 microglobulin
(B2M) level before the first autotransplant. A risk-based classification
system was developed according to the number of these favorable variables
present, showing highly significant differences in event-free and overall
survival. CONCLUSION: Cytogenetics play a dominant role in myeloma and were
independent of previously recognized important prognostic factors, such as
B2M and duration of prior standard therapy.
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