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Poor prognosis in multiple myeloma is associated only with partial or
complete deletions of chromosome 13 or abnormalities involving 11q and not
with other karyotype abnormalities
G Tricot, B Barlogie, S Jagannath, D Bracy, S Mattox, DH Vesole, S Naucke and JR Sawyer
Division of Hematology/Oncology, University of Arkansas for Medical
Sciences, Little Rock 72205, USA.
Chromosomal abnormalities have major biologic and prognostic implications
in leukemias. Cytogenetic information in typically hypoproliferative
multiple myeloma (MM) is limited because of difficulties in obtaining
analyzable metaphases. In this study, karyotypes and other known prognostic
factors were analyzed in 155 newly diagnosed MM patients, entered on an
intensive treatment program with two autotransplants. Complete remission
(CR), event-free (EFS) and overall survival (OS) were analyzed using
standard statistical methods. Abnormal cytogenetics were found in 39% of
patients and were associated with a significantly lower CR rate (27% v 48%;
P = .008). EFS and OS were inferior in patients with either partial or
complete deletion of chromosome 13 or 11q abnormalities ("unfavorable"
karyotype) when compared with the remaining patients (P < .001) who, as
a group, had a similar prognosis irrespective of cytogenetic findings, ie,
inevaluable, normal, or abnormal but without an "unfavorable" karyotype.
The patients with abnormalities of both chromosomes 11 and 13 had a dismal
prognosis with median EFS and OS of only 11 and 12 months, respectively.
Significant associations were noted between an "unfavorable" karyotype and
IgA isotype, elevated levels of beta-2 microglobulin (B2M, > or = 3
mg/L) and age > 60 years. On multivariate regression analysis, the
absence of an "unfavorable" karyotype was the most significant variable
associated with prolonged EFS and OS (P = .0001 and .0002, respectively).
Other independent favorable variables were age less than 60 years,
C-reactive protein (CRP) < or = 0.4 mg/dL and bone marrow plasmacytosis
< or = 50% before treatment. On a multivariate analysis without
cytogenetics, these same three standard parameters were identified as the
only favorable variables. Patients not having all three standard favorable
variables had a significantly lower CR rate (P = .03), EFS (P = .0001), and
OS (P = .002) if an unfavorable karyotype was detected. We conclude that,
in this program of uniformly treated MM patients, a poor prognosis was
associated predominantly with abnormalities of chromosomes 11 and 13.
Volume 86,
Issue 11,
pp. 4250-4256,
12/01/1995
Copyright © 1995 by The American Society of Hematology
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