Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group. - PubMed - NCBI
Blood. 2016 Jun 16;127(24):2955-62. doi: 10.1182/blood-2016-01-631200. Epub 2016 Mar 21.
Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group.
Sonneveld P1,
Avet-Loiseau H2,
Lonial S3,
Usmani S4,
Siegel D5,
Anderson KC6,
Chng WJ7,
Moreau P8,
Attal M9,
Kyle RA10,
Caers J11,
Hillengass J12,
San Miguel J13,
van de Donk NW14,
Einsele H15,
Bladé J16,
Durie BG17,
Goldschmidt H18,
Mateos MV19,
Palumbo A20,
Orlowski R21.
Abstract
The International Myeloma Working Group consensus updates the definition for high-risk (HR) multiple myeloma based on cytogenetics Several cytogenetic abnormalities such as t(4;14), del(17/17p), t(14;16), t(14;20), nonhyperdiploidy, and gain(1q) were identified that confer poor prognosis. The prognosis of patients showing these abnormalities may vary with the choice of therapy. Treatment strategies have shown promise for HR cytogenetic diseases, such as proteasome inhibition in combination with lenalidomide/pomalidomide, double autologous stem cell transplant plus bortezomib, or combination of immunotherapy with lenalidomide or pomalidomide. Careful analysis of cytogenetic subgroups in trials comparing different treatments remains an important goal. Cross-trial comparisons may provide insight into the effect of new drugs in patients with cytogenetic abnormalities. However, to achieve this, consensus on definitions of analytical techniques, proportion of abnormal cells, and treatment regimens is needed. Based on data available today, bortezomib and carfilzomib treatment appear to improve complete response, progression-free survival, and overall survival in t(4;14) and del(17/17p), whereas lenalidomide may be associated with improved progression-free survival in t(4;14) and del(17/17p). Patients with multiple adverse cytogenetic abnormalities do not benefit from these agents. FISH data are implemented in the revised International Staging System for risk stratification. © 2016 by The American Society of Hematology.
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