| Background and objective: Multiple myeloma(MM)is a heterogenous plasma cell malignancy that is becoming more common in today's ageing population.Cytogenetics abnormalities(CA)is one of the most important prognostic factors of MM.Several clinical studies have reported 1q21 amplification,playing a significant role in prognosis evaluation,is among the most frequent high-risk chromosomal alterations.However,it has not been included in the risk stratification of MM by International Myeloma Working Group(IMWG)and the prognosis of 1q21 amplification is not completely consistent.The prognostic value of various copy numbers of 1q is still controversial.Moreover,with the advent of new drugs and new treatment paradigms,the rate and the degree of disease remission have been significantly improved.Nevertheless,they cannot improve the outcome of the patients with 1q21 amplification.The purpose of the present study was to explore the clinical features,prognosis and treatment response of newly diagnosed multiple myeloma with 1q21 amplification or copy number variations.Methods: We retrospectively analyzed the clinical data of 180 cases newly diagnosed multiple myeloma collected from November 2009 to August 2016 in cancer center of The First Hospital of Jilin University and compared the clinical features,Btz/ASCT-treatment response and prognosis between the patients with or without 1q21 amplification.Results:1.In 180 patients,92 patients(51.1%)carrying 1q21 amplification,bone marrow plasma cells(BMPCs)and cytogenetics abnormalities(CA)(such as 17p-,IGH translocation)have significant statistical difference when compared with those without 1q21(P=0.033,0.049,0.017).2.In 174 patients with regular medical follow-up,OS and PFS was significantly low in patients with 1q21 amplification(P=0.038,0.029).Meanwhile,67 patients have the results of 1q copy number changes and the patients with 3copie s seemd to have no statistical significance difference when compared with those >3copies(P>0.05).3.We evaluated the short-term and long-term therapeutic effect of the bortezomib-based regimen in patients with 1q21 amplification.The short-term therapeutic effect,including the overall response rate and the rate of achieving at least VGPR,has a significant statistical difference between the patients with or without bortezomib-based regimen(P=0.032),especially in patients who received at least four cycles bortezomib-based regimen(P=0.023,0.030).4.We separated 66 patients with 1q21 amplification who received bortezomibbased regimen into two groups according whether or not receiving autologous stem cell transplantation(9 cases vs 57 cases).PFS was significantly low in patients without autologous stem cell transplantation(P=0.048),but OS seemed to have no significant statistical difference when compared with those who received autologous stem cell transplantation(P>0.05).5.28 patients with 17p-were divided into two groups according to the condition of 1q21 amplification(11 cases vs 7 cases).OS was significantly low in patients in combination with 1q21 amplification(P=0.035),but PFS seemed to have no significant statistical difference(P>0.05).105 patients with IGH translocation were divided into two groups according to the condition of 1q21 amplification again(62 cases vs 43 cases).However,neither OS nor PFS seemed to have a significant statistical difference between the two groups(P>0.05).6.Multivariate analysis of 127 patients have demonstrated that 1q21 amplification and Hb<100g/l are independent prognostic factors for the overall survival and progression free survival(P=0.029,0.020;P=0.020,0.015).While,ISS-? and ?2-MG?5.5mmol/l are only independent prognostic factors for the overall survival(P=0.034,0.032).Conclusions: 1.1q21 amplification is one of the most frequent high-risk chromosomal alterations,being the independent poor prognostic factors for both overall survival and progression free survival.However,there is no significant difference in survival between patients with different copy numbers in the 1q21 amplification group.2.1q21 amplification is always associated with other cytogenetics alterations,including 17p-,IGH translocation.Patients with del(17p)and 1q21 amplification have the shoter overall survival and poor prognosis.3.Patients who received bortezomib-based regimen can get a best of the short-term therapeutic effectiveness.4.Bortezomib combined with ASCT was able to prolong the progression free survival of patients with 1q21 amplification,indicating the possibility of improving the long-term prognosis. |
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