Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group
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.
Pieter Sonneveld, Herve Avet-Loiseau, Sagar Lonial, Saad Usmani, David Siegel, Kenneth C. Anderson, Wee-Joo Chng, Philippe Moreau, Michel Attal, Robert A. Kyle,Jo Caers, Jens Hillengass, Jesus San Miguel, Niels W. C. J. van de Donk, Hermann Einsele, Joan Blade, Brian G. M. Durie, Hartmut Goldschmidt, Maria-VictoriaMateos, Antonio Palumbo, Robert Orlowski
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