Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Clin Cancer Res. 2019 Nov 15;25(22):6781-6787. doi: 10.1158/1078-0432.CCR-19-0706. Epub 2019 Sep 3.
Patients with multiple myeloma with t(11;14) have been considered to have standard-risk disease. However, several recent reports have shown contradictory results. We identified 95 patients with multiple myeloma with t(11;14) on FISH studies, who underwent upfront autologous hematopoietic stem cell transplant (auto-HCT) at our center. We compared their outcome with a group of standard-risk patients with multiple myeloma who had diploid cytogenetics by both conventional cytogenetics (CC) and FISH ( = 287).
To reduce the bias between the groups, we performed a 1:1 propensity score matching technique for analysis. A total of 160 patients, 80 in each group, were identified. Patients in the 2 groups were matched for age, International staging system stage at diagnosis, serum creatinine at presentation, disease status at auto-HCT, type of preparative regimens, dose of melphalan used for conditioning, and induction and maintenance regimens.
Patients in t(11;14) group had a post auto-HCT overall response rate (ORR) of 97.5% (78/80), compared with 100% (80/80) in the standard-risk control group ( = 0.50). Complete response rate in the t(11;14) group was 35% (28/80), compared with 45% (36/80) in the standard-risk control group ( = 0.26). The 4-year PFS rates were 40.8% (95% CI, 29.6%-56.1%) and 51.1% (95% CI, 39.4%-66.3%) in the t(11;14) and standard-risk control groups, respectively ( = 0.14). The 4-year OS rates were 74.9% (95% CI, 63.3%-88.7%) and 88.3% (95% CI, 80.4%-97.0%) in the t(11;14) and standard-risk control groups, respectively ( = 0.17). Also, patients with t(11;14) with concurrent cytogenetics had significantly poor PFS and OS compared with a propensity matched standard-risk control group.
Our study confirms that t(11;14) multiple myeloma undergoing upfront autologous transplantation had similar outcomes as patients with multiple myeloma with normal cytogenetic and FISH studies. Existence of additional genomic aberrations by CC or FISH was associated with a worse outcome.
带有 t(11;14)的多发性骨髓瘤患者被认为是标准风险疾病。然而，最近有几项报告显示出了矛盾的结果。我们在我们的中心通过 FISH 研究鉴定了 95 例多发性骨髓瘤伴 t(11;14)的患者，他们接受了一线自体造血干细胞移植(auto-HCT)。我们将他们的结果与一组通过常规细胞遗传学 (CC) 和 FISH 具有二倍体细胞遗传学的标准风险多发性骨髓瘤患者进行了比较（= 287）。
为了减少两组之间的偏差，我们进行了 1:1 倾向评分匹配技术分析。共鉴定了 160 例患者，每组 80 例。两组患者在年龄、诊断时国际分期系统分期、就诊时血肌酐、auto-HCT 时疾病状态、预处理方案类型、用于调理的美法仑剂量以及诱导和维持方案方面进行了匹配。
t(11;14)组患者在 auto-HCT 后的总缓解率 (ORR) 为 97.5%（78/80），而标准风险对照组为 100%（80/80）（= 0.50）。t(11;14)组完全缓解率为 35%（28/80），而标准风险对照组为 45%（36/80）（= 0.26）。t(11;14)组和标准风险对照组的 4 年 PFS 率分别为 40.8%（95%CI，29.6%-56.1%）和 51.1%（95%CI，39.4%-66.3%）（= 0.14）。t(11;14)组和标准风险对照组的 4 年 OS 率分别为 74.9%（95%CI，63.3%-88.7%）和 88.3%（95%CI，80.4%-97.0%）（= 0.17）。此外，伴有并发细胞遗传学的 t(11;14)多发性骨髓瘤患者与经倾向性匹配的标准风险对照组相比，PFS 和 OS 明显较差。
我们的研究证实，接受一线自体移植的 t(11;14)多发性骨髓瘤患者与具有正常细胞遗传学和 FISH 研究的多发性骨髓瘤患者的结果相似。通过 CC 或 FISH 存在其他基因组异常与较差的结果相关。
