The Clinical Features And Prognosis Analysis Of Newly Diagnosed Multiple Myeloma With 1q21 Amplification

Background and objective:Multiple myeloma(MM) is a malignant plasma cell disease, especially in the elderly, which is highly heterogeneous. A variety of factors can affect the efficacy of treatment and prognosis, while cytogenetic alterations are the most important prognostic factor for MM, including 1 、 13 、 17 、 14 chromosome abnormality. Among them amplification of 1q21 is one of the most common cytogenetics in MM, which has been detected in 40% of newly diagnosed MM and 70% of relapsed or refractory MM. Although a series of reports considered 1q21 amplification as a significant and independent poor prognostic factor, it has not been included among the high-risk genetic abnormalities listed by the International Myeloma Working Group(IMWG). New drugs immunomodulatory drugs and proteasome inhibitors have changed the management of myeloma and extended overall survival, while for patients with 1q21 amplification, the current treatment response is poor. The amplified region contains a variety of pathogenic and drug resistance genes, such as CKS1 B, MCL1 and PSMD4.In the present study, we evaluated the clinical features and prognostic value of 1q21 amplification in newly diagnosed MM. Methods:Clinical data of 115 cases newly diagnosed MM were collected from November 2009 to November 2015, including the basic information of the patients, serum biochemical parameters, the percentage of bone marrow plasma cells and 1q21 amplification detected by FISH. We retrospectively analyzed the relationship between 1q21 amplification and the clinical features, treatment outcome and prognosis of patients. Results:1. Of the 115 patients, 53 patients(46.1%) carrying 1q21 amplification, clinical charecteristics(such as gender, age, serum albumin, hemoglobin, β2-microglobulin, calcium, lactate dehydrogenase, serum creatinine, percentage of plasma cells in bone marrow) seemd to have no statistical significance when compared with those without 1q21(P>0.05). The PFS was significantly low in patients with 1q21 amplification(P=0.011), but the OS was not.2. 53 patients with 1q21 amplification were divided into 1q21 amplification alone(13 cases) and in combination with other genetic abnormalities(40 cases), the PFS or OS was not significant difference between the two groups(P>0.05).3. We investigated the clinical efficacy of patients with 1q21 amplification after at least four cycles of treatment with or without bortezomib-based regimen. The complete response and the overall response rate had no significant difference between the two groups(P>0.05), while achievement of at least VGPR, the two groups(57.6% vs 25%) were significant difference(P=0.026). The PFS or the OS was not significant difference between the two groups(P>0.05).4. 33 patients with 1q21 amplification who were treatment with bortezomib-based regimens were investigated. The patients who could not reached the VGPR after induction therapy resulted in significantly shorter PFS(the median PFS 19 m vs 8m)(P=0.044), while the OS was not significant difference between the two groups(P>0.05). Conclusions:1. The PFS was significantly low in newly diagnosed MM patients with 1q21 amplification.2. Newly diagnosed MM patients with 1q21 amplification could improve the depth remission rate with bortezomib-based regimens, but could not prolong the PFS and OS.3. Newly diagnosed MM patients with 1q21 amplification, if they could not reached the VGPR after induction with bortezomib-based regimens have shorter PFS.