Arzoumanian V, Hoering A, Sawyer J, van Rhee F, Bailey C, Gurley J, Shaughnessy J D, Anaissie E, Crowley J, Barlogie B
Myeloma Institute for Research and Therapy, Arkansas Cancer Research Center, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Leukemia. 2008 Apr;22(4):850-5. doi: 10.1038/sj.leu.2405091. Epub 2008 Jan 17.
Cytogenetic studies were performed as part of all diagnostic and surveillance bone marrow examinations in 956 newly diagnosed patients with multiple myeloma (MM) receiving total therapy (TT) protocols and in 1085 previously treated patients enrolled in non-TT protocols. In both groups, cytogenetic abnormalities (CA) were present in one-third at baseline and persisted in 14% prior to first and 10% prior to second transplant (TT, 5%; non-TT, 15%); post-transplant detection rates increased progressively with time, from 7% within 6 months to 21% within 24 months to 28% at relapse. According to multivariate analyses, overall survival was adversely affected by the presence of CA at baseline (hazard ratio (HR)=7.20, P<0.001) and the development of CA both prior to (HR=3.28, P<0.001) and after first transplant (HR=6.24, P<0.001), whereas suppression of CA pretransplant was favorable (HR=0.38, P<0.001). The presence of CA at relapse further distinguished patients with a short median post-relapse survival of only 11 versus 47 months in those without CA (P<0.0001). Post-relapse survival was independently adversely affected by the detection of CA both at baseline (HR=1.35, P=0.044) and relapse (HR=2.47, P<0.001). Collectively, these results underscore the importance of monitoring for CA and attest to the favorable prognostic consequences of CA suppression with effective therapy.
细胞遗传学研究作为所有诊断和监测性骨髓检查的一部分，在956例接受全疗程（TT）方案的新诊断多发性骨髓瘤（MM）患者以及1085例参加非TT方案的既往治疗患者中进行。在两组中，细胞遗传学异常（CA）在基线时三分之一的患者中存在，在首次移植前持续存在于14%的患者中，在第二次移植前持续存在于10%的患者中（TT组为5%；非TT组为15%）；移植后检测率随时间逐渐增加，从6个月内的7%增加到24个月内的21%，在复发时达到28%。根据多变量分析，基线时存在CA（风险比（HR）=7.20，P<0.001）以及首次移植前（HR=3.28，P<0.001）和首次移植后（HR=6.24，P<0.001）CA的出现均对总生存产生不利影响，而移植前CA的抑制是有利的（HR=0.38，P<0.001）。复发时CA的存在进一步区分了患者，有CA的患者复发后中位生存期仅为11个月，而无CA的患者为47个月（P<0.0001）。复发后的生存独立地受到基线时（HR=1.35，P=0.044）和复发时（HR=2.47，P<0.001）CA检测的不利影响。总体而言，这些结果强调了监测CA的重要性，并证明了有效治疗抑制CA对预后的有利影响。
