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Shen M, Yang G, Li X, Geng C, Huang Z, Chen W. At least two high-risk cytogenetic abnormalities indicate the inferior outcomes for newly diagnosed multiple myeloma patients: a real-world study in China. Leuk Lymphoma 2021; 62:2992-3001. [PMID: 34219587 DOI: 10.1080/10428194.2021.1948032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We retrospectively studied the impact of cytogenetic abnormalities in 328 consecutive newly diagnosed multiple myeloma (MM) patients. High-risk cytogenetic abnormalities (HRCAs) included del (17p), amp/gain (1q21), t(4;14), and t(14;16). We defined a standard-risk group by the absence of HRCA, an intermediate-risk group with one HRCA, and a high-risk (HiR) group with at least two HRCAs. The HiR group constituted 14.3% of patients and was associated with a median overall survival (OS) of 28.6 months and progression-free survival (PFS) of 14.0 months. Moreover, the HiR group predicted poor outcomes for OS and PFS in multivariate analyses, and bortezomib prolongation to nine cycles could not bring additional benefit to this entity, suggesting the necessity of more effective therapies for these patients. Furthermore, we confirmed the independent prognostic impact of amp 1q21 in this real-world study.
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Affiliation(s)
- Man Shen
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Guangzhong Yang
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xin Li
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chuanying Geng
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhongxia Huang
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wenming Chen
- Department of Hematology, Multiple Myeloma Medical Center of Beijing, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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The combination of C-Myc rearrangement and 1q21 gain is associated with poor prognosis in multiple myeloma. Ann Hematol 2021; 100:1251-1260. [PMID: 33686491 DOI: 10.1007/s00277-021-04475-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/22/2021] [Indexed: 02/05/2023]
Abstract
The prognostic value of chromosomal 1q21 gain in newly diagnosed multiple myeloma (NDMM) remains controversial. Add-on Myc aberrations may further worsen the outcome. To investigate whether specific genes located at the 1q21 region, such as myeloid cell leukemia 1 (Mcl-1), are involved in NDMM progression, we examined bone marrow cytogenetic abnormalities in 153 patients with NDMM by fluorescence in situ hybridization. Their response to treatment and survival was also analyzed. C-Myc and Mcl-1 expressions in bone marrow samples were analyzed by RT-PCR. The expression of Mcl-1 was evaluated in bone marrow sections by immunohistochemistry. MM cell lines were transfected with Mcl-1 siRNA. 1q21 gain was present in 55/153 (35.9%) patients and strongly associated with Myc rearrangement (31/153, 20.3%, P = 0.004). A positive correlation was observed between Myc and Mcl-1 mRNA levels in bone marrow cells from 47 patients (r = 0.57, P < 0.001). The combination of 1q21 gain and Myc rearrangement was associated with poorer overall survival than Myc rearrangement alone (16.8 vs. 27.9 months, P = 0.077) or 1q21 gain alone (16.8 vs. 60.7 months, P < 0.01). High Mcl-1 protein expression in bone marrow plasma cells was associated with Myc rearrangement. Mcl-1 silencing by siRNA inhibited Myc protein expression in three myeloma cell lines. Treatment with the small-molecule Mcl-1 inhibitor, UMI-77, produced similar results. Overall, the combination of Myc rearrangement and 1q21 gain was associated with particularly poor prognosis in patients with MM. Furthermore, our data are consistent with Mcl-1-dependent Myc protein activation.
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Double-Hit Primary Plasma Cell Leukemia with IGH/MYC and IGH/CCND1 Translocations. Case Rep Hematol 2021; 2020:8811114. [PMID: 33381329 PMCID: PMC7762630 DOI: 10.1155/2020/8811114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 11/18/2022] Open
Abstract
Primary plasma cell leukemia (pPCL) is an aggressive variant of multiple myeloma (MM). Immunoglobulin heavy chain (IgH) translocations are found in a majority of pPCL cases, supporting a central relation to pathogenesis of pPCL. However, two independent IgH translocations are barely detected at the onset of pPCL, and their significance is yet to be elucidated. Here, we report a case of an aggressive pPCL with simultaneous IGH/MYC and IGH/CCND1 translocations. A 73-year-old man was referred to our hospital with back pain and diagnosed as having pPCL with more than 50% circulating plasma cells. Cytogenetic analysis revealed 47, Y, t (X; 8;14) (q24; q24; q32), t (11; 14) (q13; q32), and +18. IGH/MYC and IGH/CCND1 translocations were confirmed by fluorescence in situ hybridization analysis. Bortezomib and dexamethasone treatment achieved rapid elimination of peripheral malignant plasma cells, and the patient maintained a partial response for 18 months. After biological relapse, he received salvage therapy with ixazomib, lenalidomide, and dexamethasone, followed by pomalidomide and dexamethasone, and exhibited stable disease for an additional 14 months. Although IGH/MYC translocation in association with dysregulation of antiapoptotic pathway leads to worse prognosis in lymphomas, the novel agent-based regimen showed good efficacy, suggesting that IGH/MYC plays a different role in the pathogenesis of MM. IGH/CCND1 and IGH/MYC translocations may have contributed to abrupt onset of pPCL in this case.
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Fang Y, Hou J. [Multiple-Hit myeloma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 40:620-622. [PMID: 32397033 PMCID: PMC7364890 DOI: 10.3760/cma.j.issn.0253-2727.2019.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Y Fang
- Department of Hematology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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Concepts of Double Hit and Triple Hit Disease in Multiple Myeloma, Entity and Prognostic Significance. Sci Rep 2020; 10:5991. [PMID: 32249811 PMCID: PMC7136246 DOI: 10.1038/s41598-020-62885-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/18/2020] [Indexed: 02/06/2023] Open
Abstract
Risk assessment in newly diagnosed multiple myeloma patients (NDMM) is the first and the most crucial determinant of treatment. With the utilization of FISH analysis as a part of routine practice, high risk Multiple Myeloma (MM) is defined as having at least one of the mutations related with poor prognosis including; t(4;14) t(14;16), t(14;20), del 17p, p53 mutation, gain 1q and del 1p. M-Smart MM risk stratification guideline by Mayo Clinic has proposed a concept similar to high grade lymphomas. Having two of the high risk genetic abnormalities were defined as double hit MM and having any three as triple hit MM. Based on these definitions which may bring a much more clinically relatable understanding in MM prognosis, we aimed to assess our database regarding these two concepts and their probable significance in terms of outcome and prognosis. We retrospectively evaluated 159 newly diagnosed multiple myeloma patients and their clinical course. Among these patients; twenty-four patients have one high risk determinant and also seven and two patients were classified as double hit MM and triple hit MM respectively. Overall survival (OS) of the patients with double hit MM was 6 months, 32.0 months for patients with single high risk abnormality and 57.0 months for patients with no high risk abnormality. Univariate analysis showed that Double Hit and Triple Hit MM is a predictive of low OS. Hazard Ratio of patients with one high risk abnormality was 1.42, double-hit MM patients was 5.55, and triple-hit MM patients was 7.3. Despite the development of novel drugs and their effects of prolonging survival, the treatment has not been individualized. Understanding the biology of each patient as a unique process will be the success of the treatment. As it is known that some MM patients harbor high risk genetic abnormalities according to FISH analysis, we can continue the argument that some patients bring an even higher risk and that can be defined as double or triple hit MM.
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Luo TC, Wu LL, Wu H, Lu M, Fu WJ, Du J. [Clinical prognosis analysis of patients with "double hit" multiple myeloma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:918-923. [PMID: 31856440 PMCID: PMC7342371 DOI: 10.3760/cma.j.issn.0253-2727.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Indexed: 11/17/2022]
Abstract
Objective: To analyze and explore the clinical characteristics and prognosis of patients with "double hit" multiple myeloma (MM) . Methods: We retrospectively analyzed 89 MM patients in our department of Shanghai Changzheng Hospital from 2010-2016. All patients were assayed by fluorescence in situ hybridization (FISH) and TP53 gene sequencing, based on Dr. Walker BA proposed the "double hit" MM concept, and then the clinical features and prognosis were evaluated. Results: In the results, 15 (16.85%) cases harbored "double hit" showed the median PFS of 8.4 months and the median OS 22.2 months, which was significantly lower than non-"double hit" patients with median PFS 14.2 months and the median OS 39.2 months, respectively (P<0.05) . Multivariate analysis displayed that the "double hit" was an independent poor prognostic factor on PFS (HR=2.171, 95%CI 1.206-3.907, P=0.010) and OS (HR=4.106, 95%CI 2.116-7.969, P<0.001) . Moreover, "double hit" MM patients had the higher adverse prognosis risk, which showed the shorter median OS and PFS than stage III of R-ISS patients (PFS 8.4 vs 11.8 months; OS 22.2 vs 24.3 months, P<0.05, respectively) . Conclusion: Patients with "double hit" MM have a very poor clinical prognosis. Prospective clinical studies are urgently needed to improve these extra high risk patients.
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Affiliation(s)
- T C Luo
- Department of Hematology, Changzheng Hospital, the Second Military Medical University, The Myeloma and Lymphoma Center, Shanghai 200003, China
| | - L L Wu
- Shanghai Institute of Hematology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine 200090, China
| | - H Wu
- Department of Hematology, Changzheng Hospital, the Second Military Medical University, The Myeloma and Lymphoma Center, Shanghai 200003, China
| | - M Lu
- Shanghai Institute of Hematology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine 200090, China
| | - W J Fu
- Department of Hematology, Changzheng Hospital, the Second Military Medical University, The Myeloma and Lymphoma Center, Shanghai 200003, China
| | - J Du
- Department of Hematology, Changzheng Hospital, the Second Military Medical University, The Myeloma and Lymphoma Center, Shanghai 200003, China
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Misyurina AE, Kravchenko SK, Kovrigina AM, Magomedova AU, Plastinina LV, Obukhova TN, Misyurin AV, Misyurin VA, Grebenuk LA, Babaeva FE, Baryakh EA, Vorobiev AI. [The role of translocations involving c-MYC/8q24, BCL2/18q21 and/or BCL6/3q27 genes in patients with follicular lymphoma. Retrospective analysis of single - centre data]. TERAPEVT ARKH 2019; 91:52-62. [PMID: 32598736 DOI: 10.26442/00403660.2019.07.000070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
Aim of the issue was to compare clinical characteristics and treatment results of patients with follicular lymphoma (FL) with translocations involving loci of c-MYC/8q24, BCL2/18q21 and/or BCL6/3q27 genes and patients with high - grade B-cell lymphoma [High - grade B-cell lymphoma (HGBL), double - hit (DH)]. Materials and methods. Since 2004 to 2017 years in National Research Center for Hematology 12 patients with high - grade B-cell lymphoma double - hit (HGBL DH) and 6 FL patients with translocations involving c-MYC and BCL2 and/or BCL6 had been treated. We performed a comparative analysis of clinical characterisctics in both groups. As primary endpoints was assessed frequency of complete remission (CR) or progressive disease (PD); as secondary endpoints - overall (OS) and event - free survival (EFS). Results. 5 patients with HGBL DH had c-MYC/BCL6, 7 - c-MYC/BCL2 rearrangements; 2 patients with FL had c-MYC/BCL2, 3 - c-MYC/BCL6, 1 - c-MYC/BCL2/BCL6 rearrangements. FL was represented by grade 3A in 2, grade 3B - in 4 cases, 3 of them had large - cell transformation. In HGBL DH and FL patients had no significant differences in clinical characteristics. The majority of patients had a widespread tumour, increased LDH activity, high frequency of extranodal and bone marrow involvement. Ki-67 expression level was lower in patients with FL (p.
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Kalff A, Khong T, Wall M, Gorniak M, Mithraprabhu S, Campbell LJ, Spencer A. A rare case of IGH/MYC and IGH/BCL2 double hit primary plasma cell leukemia. Haematologica 2014; 100:e60-2. [PMID: 25381133 DOI: 10.3324/haematol.2014.111385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Anna Kalff
- Alfred Hospital, Myeloma Research Group, Australian Centre for Blood Diseases, Monash University, Melbourne
| | - Tiffany Khong
- Alfred Hospital, Myeloma Research Group, Australian Centre for Blood Diseases, Monash University, Melbourne
| | - Meaghan Wall
- Victorian Cancer Cytogenetics Service, St Vincent's Hospital, Melbourne Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Malgorzata Gorniak
- Department of Laboratory Haematology, Alfred Hospital, Melbourne, Australia
| | - Sridurga Mithraprabhu
- Alfred Hospital, Myeloma Research Group, Australian Centre for Blood Diseases, Monash University, Melbourne
| | - Lynda J Campbell
- Victorian Cancer Cytogenetics Service, St Vincent's Hospital, Melbourne Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Andrew Spencer
- Alfred Hospital, Myeloma Research Group, Australian Centre for Blood Diseases, Monash University, Melbourne
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