Luo Tiancheng, Qiang Wanting, Lu Jing, He Haiyan, Liu Jin, Li Lu, Jiang Hua, Fu Weijun, Du Juan
Department of Hematology, Myeloma & Lymphoma Center, Shanghai Changzheng Hospital, The Second Military Medical University, Shanghai, China.
Blood Sci. 2020 Jul 29;3(3):78-86. doi: 10.1097/BS9.0000000000000077. eCollection 2021 Jul.
Fluorescence in situ hybridization (FISH) evaluation is essential for initial risk stratification in multiple myeloma (MM). The presence of specific cytogenetic abnormalities (CA) confers a heterogeneity impact on prognosis. However, the cutoff values among different centers are not uniform. Therefore, we conduct this study to better predict the prognosis of newly diagnosed MM patients based on FISH results. The Kaps method was used to calculate the chromosomal abnormal cutoff values. A total of 533 participants were included in the study. The best cutoff value of overall survival were as follows: 17p- 20.1%, 13q- 85%, 1q21+ 39%, t(11;14) 55.5%, t(14;16) 87%, and t(4;14) 53.5%. The survival analysis showed that 17p- and 1q21+ were the independent factors affecting both OS and progress free survival (PFS) among CA. The analysis based on the cutoff value obtained by Kaps suggested that 13q-, t(14;16), 17p-, and 1q21+ were independent factors affecting OS among CA; t(14;16), 17p-, and 1q21+ were independent factors affecting PFS among CA. The prognostic model was constructed by the Kaps method with the Harrell concordance index (c-index) at 0.719 (95% CI, 0.683-0.756; corrected 0.707), which was higher than that calculated by the European Myeloma Network criteria (0.714; 95% CI, 0.678-0.751; corrected 0.696). In conclusion, chromosomal abnormalities in different proportions and combinations can affect the prognosis of MM patients. Therefore, effective criteria should be formulated to evaluate the prognosis of MM patients better.
荧光原位杂交（FISH）评估对于多发性骨髓瘤（MM）的初始风险分层至关重要。特定细胞遗传学异常（CA）的存在对预后具有异质性影响。然而，不同中心的临界值并不统一。因此，我们开展本研究以基于FISH结果更好地预测新诊断MM患者的预后。采用Kaps方法计算染色体异常临界值。本研究共纳入533名参与者。总生存的最佳临界值如下：17p-为20.1%，13q-为85%，1q21+为39%，t(11;14)为55.5%，t(14;16)为87%，以及t(4;14)为53.5%。生存分析表明，在CA中，17p-和1q21+是影响总生存（OS）和无进展生存（PFS）的独立因素。基于Kaps获得的临界值进行的分析表明，在CA中，13q-、t(14;16)、17p-和1q21+是影响OS的独立因素；t(14;16)、17p-和1q21+是影响PFS的独立因素。采用Kaps方法构建的预后模型，其Harrell一致性指数（c指数）为0.719（95%CI，0.683 - 0.756；校正后为0.707），高于欧洲骨髓瘤网络标准计算的值（0.714；95%CI，0.678 - 0.751；校正后为0.696）。总之，不同比例和组合的染色体异常可影响MM患者的预后。因此，应制定有效的标准以更好地评估MM患者的预后。
