Deletion 17p predicts poor outcomes in newly diagnosed myeloma regardless of induction, ASCT

Issue: December 10, 2015

NEW YORK — Patients with newly diagnosed myeloma who have deletion 17p have a particularly poor prognosis regardless of induction treatment and receipt of autologous stem cell transplantation, according to study results presented at Lymphoma & Myeloma 2015.

However, among the subgroup of patients with t(4;14) translocation, those who received a bortezomib (Velcade; Takeda, Millennium)-based induction regimen demonstrated significantly longer PFS, results showed.

Juliana Bastos, MD, of Hospital Sao-Joao in Portugal, and colleagues retrospectively analyzed a series of patients from their center with newly diagnosed multiple myeloma. All patients underwent cytogenetic characterization with fluorescence in situ hybridization.

The researchers documented several factors, including sex, age at diagnosis, staging, lactate dehydrogenase (LDH) levels, type of induction regimen, attained response, receipt of autologous stem cell transplantation (ASCT) and type of maintenance.

Bastos and colleagues performed univariate and multivariate analyses accounting for these variables to assess OS and PFS.

The analysis included 105 patients (53% female). Median patient age was 66 years (range, 40-86).

The majority (56%) of patients had International Staging System stage III disease and 25% had extramedullary disease. About one-third (32%) had elevated LDH levels at diagnosis.

Analysis of cytogenetic abnormalities showed 41.9% had deletion 13q; 17.1% had t(4;14) translocation; 16.2% had IGH rearrangement; 13.3% had deletion 17p; 6.7% had monoallelic deletion of 5’IGH; 3.8% had t(11;14) translocation; and 1.9% had t(14;16) translocation. Slightly less than half (45.7%) demonstrated numerical changes.

More than one-third (39%) of patients underwent ASCT, and they underwent a variety of induction regimens.

In the entire cohort, researchers reported median OS of 24 months and median PFS of 20 months.

At 2 years, 52% of patients were alive and 41% were progression free; at 3 years, 39% of patients were alive and 23% were progression free.

Results of univariate analysis revealed statistically significant associations between survival and International Staging System stage (OS, P = .013; PFS, P = .038); deletion 17p (OS, P = .002; PFS, P < .001); ASCT (OS, P = .001; PFS, P = .014); type of induction regimen (OS, P = .009; PFS, P = .001); and response achieved after induction (P = .001 for both OS and PFS).

Bastos and colleagues observed no association between survival and other cytogenetic abnormalities.

When researchers performed a subanalysis that accounted for induction treatments and cytogenetic features, they found patients with t(4;14) translocation treated with bortezomib-based regimens were significantly more likely to be progression free at 1 year (79.4% vs. 33.3%; P = .001). This difference remained statistically significant after multivariate analysis with ASCT (P = .034).

The investigators observed no improvement in outcome among patients with deletion 17p based on induction treatment.

Results of multivariate analysis showed only deletion 17p and ASCT retained their prognostic value for PFS and OS (P < .001 for both PFS and OS in both subgroups).

Bastos and colleagues also analyzed the subgroup of patients with deletion 17p according to receipt of ASCT. Results showed deletion 17p remained an adverse prognostic factor in both groups.

However, results showed “a clear tendency” for improved survival among those who did undergo ASCT, Bastos and colleagues wrote. In the subgroup with deletion 17p, median PFS (17 months vs. 5 months) and median OS (21 months vs. 9 months) was considerably higher among those who underwent ASCT. – by Mark Leiser

Reference:

Bastos J, et al. Abstract P6. Presented at: Lymphoma & Myeloma 2015: An International Congress on Hematologic Malignancies; Oct. 22-24, 2015; New York.

Disclosure: Healio.com was unable to confirm the researchers’ relevant financial disclosures.