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Outcome according to cytogenetic abnormalities and DNA ploidy in myeloma patients receiving short induction with weekly bortezomib followed by maintenace

María-Victoria Mateos, Norma C. Gutiérrez, María-Luisa Martín-Ramos, Bruno Paiva, María-Angeles Montalbán, Albert Oriol, Joaquín Martínez-López, Ana-Isabel Teruel, Enrique Bengoechea, Alejandro Martín, Joaquín Díaz-Mediavilla, Felipe de Arriba, Luis Palomera, José-Mariano Hernández, Anna Sureda, Joan Bargay, Francisco-Javier Peñalver, Josep-Maria Ribera, María-Luisa Martín-Mateos, Manuela Fernández, Ramón García-Sanz, María-Belén Vidriales, Joan Bladé, Juan-José Lahuerta and Jesús F. San Miguel

Abstract

Cytogenetic abnormalities (CAs), such as t(4;14), t(14;16) or del(17p) and non-hyperdiploidy, are associated with poor prognosis in Multiple Myeloma. We evaluate the influence of CAs by FISH and DNA ploidy by flow cytometry on response and survival in 231 elderly newly diagnosed myeloma patients receiving an induction with weekly bortezomib followed by maintenance therapy with bortezomib-based combinations. Response was similar in the high-risk and standard-risk CAs groups, both after induction (21% vs. 27% CR) and maintenance (39% vs. 45% CR). However, high-risk patients showed shorter PFS than standard risk, both from first (24m vs. 33m, p=0.04) and second randomization (17m vs. 27m, p=0.01). This also translated into shorter OS for high-risk patients (3-y OS: 55% vs. 77%, p=0.001). This adverse prognosis applied to either t(4;14) or del(17p). Concerning DNA ploidy, hyperdiploid patients showed longer OS than non-hyperdiploid patients (77% vs. 63% at 3 y, p=0.04), and this was more evident in patients treated with bortezomib, thalidomide and prednisone (77% versus 53% at 3 y, p=0.02). The present schema doesn't overcome the negative prognosis of high-risk CAs and non-hyperdiploidy. The trial was registered with ClinicalTrials.gov, number NCT00443235.

  • Submitted April 6, 2011.
  • Accepted August 18, 2011.