UNASSIGNED:1q21增益/扩增(1q21+)是多发性骨髓瘤中常见的异常核型,在中国患者中的比例要高得多。如果将1q21+作为不良预后因素之一,这将大大增加新诊断的多发性髓系(NDMM)患者中高危患者的比例。因此,1q21+的不良预后意义仍存在争议。本研究主要分析临床特点,NDMM患者1q21+的治疗反应和预后意义。
UNASSIGNED:2018年9月1日至2021年8月31日在苏州大学第一附属医院收治的248名NDMM患者,进行回顾性分析。135例(54.4%)通过CD38分选的荧光原位杂交(FISH)检测为1q21+。临床特点,分析一般人群和亚组的治疗反应和预后,其中153例患者通过CytoScan进行了相关基因比较。
UNASSIGNED:与阴性患者相比,1q21+患者更容易有贫血,低蛋白血症,肾功能不全,高乳酸脱氢酶和高比例的R-ISS-III阶段。Cytoscan检测到CKS1B的1q21+患者的复杂核型和异常CNV的比例较高,以及所有由预后指数定义的中风险或高风险组。多因素分析显示,1q21+是独立的不良预后因素(PFSHR=2.358,95CI1.286~4.324,P=0.006;OSHR=2.598,95CI1.050~6.425,P=0.039)。1q21+亚组的预后较差(PFSP=0.0133,OSP=0.0293)。此外,1q21扩增的PFS比1q21扩增的PFS短(24个月vs未达到,P=0.0403),但OS差异无临床意义。1q的比例对预后无影响。此外,主克隆而非亚克隆中的1q21+是影响预后的不利因素(PFSP=0.0172,OSP=0.1260)。自体干细胞移植能有效提高1q21+患者的生存率(P<0.05)。
未经证实:1q21+患者具有临床上显著的终末期器官损伤和较高的肿瘤负荷,更有可能结合13q14-,t(4;14),1p32-等细胞遗传学异常。1q21+是NDMM患者预后不良的独立高危细胞遗传学因素,其中4个或更多拷贝数和主要克隆位置与预后结果显著相关。
UNASSIGNED: 1q21 gain/amplification (1q21+) is a common abnormal karyotype in multiple myeloma, and its proportion in Chinese patients is much higher. If 1q21+ is included as one of the poor prognostic factors, it will greatly increase the proportion of high-risk patients in newly diagnosed multiple myelome (NDMM) patients. Therefore, the poor prognostic significance of 1q21+ is still controversial. This study mainly analyzed the clinical characteristics, treatment response and prognostic significance of 1q21+ in NDMM patients.
UNASSIGNED: 248 NDMM patients admitted in The First Affiliated Hospital of Soochow University from September 01, 2018 to August 31, 2021 of a VRD registration study, were retrospectively analyzed. 135 cases (54.4%) had 1q21+ by CD38-sorted fluorescence in situ hybridization (FISH). The clinical characteristics, treatment response and prognosis of the general population and subgroups were analyzed, among which 153 patients were compared for the involved genes by CytoScan.
UNASSIGNED: Compared with negative patients, 1q21+ patients were more likely to have anemia, hypoalbuminemia, renal insufficiency, high lactate dehydrogenase and high proportion of R-ISS-III stage. The patients with 1q21+ involving CKS1B detected by Cytoscan had a higher proportion of complex karyotypes and abnormal CNVs, and all at middle-risk or high-risk groups defined by Prognostic Index. Multivariate analysis showed that 1q21+ was an independent adverse prognostic factor (PFS HR=2.358, 95%CI 1.286-4.324, P=0.006; OS HR=2.598, 95%CI 1.050-6.425, P=0.039). 1q21+ subgroup had an inferior outcome (PFS P=0.0133, OS P=0.0293). Furthermore 1q21 amplification had a shorter PFS than 1q21 gain (24 months vs not reached, P=0.0403), but the OS difference was not clinically significant. The proportion of 1q had no effects on prognosis. In addition, 1q21+ in main clone rather than subclone was an adverse factor affecting the prognosis (PFS P=0.0172, OS P=0.1260). Autologous stem cell transplantation can effectively improve the survival of 1q21+ patients (P<0.05).
UNASSIGNED: Patients with 1q21+ have clinically significant end-stage organ damage and higher tumor burden, more likely to combine 13q14-, t(4;14), 1p32- and other cytogenetic abnormalities. 1q21+ is an independent high-risk cytogenetic factor for poor prognosis in NDMM patients, of which 4 or more copy numbers and main clone position significantly associated with prognosis results.