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 Blood, 25 June 2009, Vol. 113, No. 26, pp. 6572-6575.
Prepublished online as a Blood First Edition Paper on April 23, 2009; DOI 10.1182/blood-2009-02-207803.

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CLINICAL TRIALS AND OBSERVATIONS

Brief report

Gene expression profiling of plasma cells at myeloma relapse from tandem transplantation trial Total Therapy 2 predicts subsequent survival

Bijay Nair1, John D. Shaughnessy, Jr1, Yiming Zhou1, Marie Astrid-Cartron1, Pingping Qu2, Frits van Rhee1, Elias Anaissie1, Yazan Alsayed1, Sarah Waheed1, Klaus Hollmig1, Jackie Szymonifka2, Nathan Petty1, Antje Hoering2, and Bart Barlogie1

1 Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock; and 2 Cancer Research and Biostatistics, Seattle, WA

We report on prognostic implications for postrelapse survival (PRS) of a gene expression profiling (GEP)–defined risk score at relapse available in 120 myeloma patients previously enrolled in tandem transplantation trial Total Therapy 2. Among the 71 patients with additional GEP baseline information, 3-year PRS was 71% in 40 patients with low risk present both at baseline and relapse contrasting with only 17% in 28 patients with high risk at relapse, 12 of whom with baseline low-risk status fared better than the remainder (P = .08). On multivariate analysis of relapse parameters available in 104 patients, high risk conferred short PRS (hazard ratio = 4.00, P < .001, R2 = 33%), whereas relapse hyperdiploidy predicted long PRS (hazard ratio = 0.37, P = .022, cumulative R2 = 41%). In case the initial partial response lasted less than 2 years, relapse low-risk identified 26 patients with superior 3-year PRS of 61% versus 9% among 32 with relapse high-risk (P < .001). Based on its PRS predictive power, GEP analysis should be an integral part of new agent trials in search of better therapy for high-risk myeloma.


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