Subclonal TP53 copy number is associated with prognosis in multiple myeloma

Vallari Shah, David C. Johnson, Amy L. Sherborne, Sidra Ellis, Frances M. Aldridge, Julie Howard-Reeves, Farzana Begum, Amy Price, Jack Kendall, Laura Chiecchio, Suvi Savola, Matthew W. Jenner, Mark T. Drayson, Roger G. Owen, Walter M. Gregory, Gareth J. Morgan, Faith E. Davies, Richard S. Houlston, Gordon Cook, David A. Cairns, Graham Jackson and Martin F. Kaiser on behalf of the National Cancer Research Institute Haematology Clinical Studies Group

Key Points

  • TP53 deletion of minor tumor subclones is independently prognostic in newly diagnosed multiple myeloma.

  • Assessment of subclonal TP53 deletions by MLPA is readily applicable in standard diagnostics, enabling stratified patient management.


Multiple myeloma (MM) is a genetically heterogeneous cancer of bone marrow plasma cells with variable outcome. To assess the prognostic relevance of clonal heterogeneity of TP53 copy number, we profiled tumors from 1777 newly diagnosed Myeloma XI trial patients with multiplex ligation-dependent probe amplification (MLPA). Subclonal TP53 deletions were independently associated with shorter overall survival, with a hazard ratio of 1.8 (95% confidence interval, 1.2-2.8; P = .01). Clonal, but not subclonal, TP53 deletions were associated with clinical markers of advanced disease, specifically lower platelet counts (P < .001) and increased lactate dehydrogenase (P < .001), as well as a higher frequency of features indicative of genomic instability, del(13q) (P = .002) or del(1p) (P = .006). Biallelic TP53 loss-of-function by mutation and deletion was rare (2.4%) and associated with advanced disease. We present a framework for identifying subclonal TP53 deletions by MLPA, to improve patient stratification in MM and tailor therapy, enabling management strategies.

  • Submitted June 12, 2018.
  • Accepted October 3, 2018.
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