Department of Hematology, Jagiellonian University Medical College, Cracow, Poland.
Division of Hematological Malignancies, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
Am J Hematol. 2020 May;95(5):503-509. doi: 10.1002/ajh.25758. Epub 2020 Feb 29.
The t(14;16) translocation, found in 3%-5% of newly diagnosed (ND) multiple myeloma (MM), has been associated with adverse outcomes. However, the studies establishing the characteristics of t(14;16) included solely small cohorts. The goal of the current international, multicenter (n = 25 centers), retrospective study was to describe the characteristics and outcomes of t(14;16) patients in a large, real-world cohort (n = 223). A substantial fraction of patients had renal impairment (24%) and hemoglobin <10 g/dL (56%) on initial presentation. Combined therapy of both immunomodulatory drug and proteasome inhibitor (PI) in the first line was used in 35% of patients. Autologous stem cell transplantation was performed in 42% of patients. With a median follow up of 4.1 years (95% CI 3.7-18.7), the median progression-free survival (PFS) and overall survival (OS) from first line therapy were 2.1 years (95% CI 1.5-2.4) and 4.1 years (95% CI 3.3-5.5), respectively. Worse OS was predicted by age > 60 years (HR = 1.65, 95% CI [1.05-2.58]), as well as revised International Scoring System (R-ISS) 3 (vs R-ISS 2; HR = 2.59, 95% CI [1.59-4.24]). In conclusion, based on the largest reported cohort of t(14;16) patients, quarter of this subset of MM patients initially presents with renal failure, while older age and the R-ISS 3 predict poor survival.
t(14;16)易位在新发多发性骨髓瘤(MM)患者中占 3%-5%,与不良预后相关。然而,确定 t(14;16)特征的研究仅纳入了小队列。本项国际性、多中心(n=25 个中心)回顾性研究的目的在于描述大样本真实世界队列(n=223)中 t(14;16)患者的特征和结局。相当一部分患者在初诊时就存在肾功能不全(24%)和血红蛋白<10g/dL(56%)。一线治疗中 35%的患者采用免疫调节剂联合蛋白酶体抑制剂(PI)的联合治疗。42%的患者接受了自体造血干细胞移植。中位随访 4.1 年(95%CI 3.7-18.7),一线治疗的中位无进展生存(PFS)和总生存(OS)分别为 2.1 年(95%CI 1.5-2.4)和 4.1 年(95%CI 3.3-5.5)。年龄>60 岁(HR=1.65,95%CI [1.05-2.58])和修订后的国际预后评分系统(R-ISS)3 (与 R-ISS 2 相比;HR=2.59,95%CI [1.59-4.24])与 OS 更差相关。总之,根据最大的 t(14;16)患者队列报道,该 MM 亚组患者中有四分之一初诊时就存在肾衰竭,而年龄较大和 R-ISS 3 预测生存不良。