myeloma patients treated with high-dose therapy Clinical implications of t(11;14)(q13;q32), t(4;14)(p16.3;q32), and -17p13 in

Abstract Fluorescent in situ hybridization (FISH) is more sensitive than conventional cytogenetics for recognizing chromosomal changes. Several FISH-detected abnormalities have been associated with inferior prognosis, including deletion of chromosomes 17 and 13 (∆13) and t(4;14)(p16.3;q32). We analyzed the prognostic value of FISH testing in 238 patients who received high-dose therapy between January 1990 and September 2001. All patients had pretransplant cytoplasmic immunoglobulin FISH done on cytospin slides from bone marrow aspirates for t(11;14), t(4;14), and −17(p13.1) ( p53 ). Time to progression and overall survival were significantly shorter for patients with t(4;14) and those with −17(p13.1) but were not affected by t(11;14). Overall survival was significantly shorter for patients with both t(4;14) and ∆13 abnormalities than for those with ∆13 alone (26.8 vs 18.8 months). In a multivariable analysis of the effect of ∆13 and t(4;14), the risk ratio for t(4;14) was greater than for ∆13 (2.6 vs 1.5). For high-dose therapy patients, −17(p13) and t(4;14) have clinical importance for estimating time to progression and overall survival. The presence of t(4;14) identifies a subset of patients whose time to progression is only 8.2 months. These patients receive minimal benefit from autologous stem cell transplantation and are candidates for novel therapeutic approaches. Key words: chromosome 14 abnormalities; cyclin D1; immunoglobulin heavy chain gene; multiple myeloma; stem cell transplantation From bloodjournal.hematologylibrary.org by guest on June 2, 2013. For personal use only.