M.D. 1. Hematology Unit, San Bortolo hospital, Vicenza, Italy, Italy
Introduction: The pathogenesis of Multiple Myeloma (MM) is settled by primary or secondary genetic abnormalities. According to Revised International Staging System (R-ISS) t(4;14), t(14;16) and del17p are considered high risk (HR) aberrations, while all other abnormalities are considered standard risk (SR). However, recent evidence suggests that t(14;16) translocation could not be associated with dismal outcome in the novel agents era. The aim of this study was to evaluate the prognostic impact of t(14;16) translocation in the real-life setting and to compare the outcome of this subgroup with a cohort of SR patients.
Methods: The study cohort included 47 active MM patients with t(14;16) translocation diagnosed from 2004 to 2022. Patients’ characteristics including clinical and biological features at diagnosis, type of treatment and OS were collected. These cases were compared with 227 SR patients according to R-ISS.
Results: Median age of the cohort was 65 years. Baseline clinical features included ISS III and R-ISS III in 19/40 (47.5%) cases and high LDH levels in 16/38 (42%) cases. Considering additional cytogenetic abnormalities, del17p has been detected in 16/47 (34%) of patients while +1q abnormalities in 36/47 (76.6%) cases (gain1q in 20 cases and amp1q in 16 cases). Considering the treatment received, almost all patients were treated with a proteasome inhibitor (45/47, 95.7%) and most received an IMID (35/47, 74.5%), while 22/47 (46.8%) patients received an anti-CD38 monoclonal antibody and 21/47 (41.68%) at least one autologous stem cell transplantation. Median OS of the entire cohort of was 75 months. T(14;16) patients harboring del17p showed reduced survival as compared to patients without del17p (32 months vs not reached, p=0.0395), while +1q abnormalities (either amp1q or gain1q) did not significantly affect the outcome (p=0.8204). We then compared the outcome of the t(14;16) subgroup with a cohort of 227 SR patients, including 78 t(11;14) cases and 81 hyperdiploid (HRD) cases. Overall, t(14;16) patients showed a reduced, although non statistically significant, OS as compared to SR patients (75 vs 105 months, p=0.1104); however, after the exclusion of del17p cases, the outcome of the two subgroups was superimposable (not reached vs 105 months, p=0.9948). Of notice, t(14;16) alone cases displayed reduced OS with respect of SR cases without +1q abnormalities (38.5 vs 105 months, p=0.0231). The t(14;16) alone dismal outcome was maintained when compared with defined cytogenetic subgroups of patients, notably t(11;14) alone patients (p=0.0875) and HRD alone patients (p=0.0016).
Conclusions: The data herein presented showed that within t(14;16) patients, the presence of del17p conferred inferior survival while +1q abnormalities did not affect the outcome. Of notice t(14;16) alone patients showed reduced survival with respect to SR patients overall and in cytogenetically defined subsets, thus confirming the negative prognostic impact of this alteration.
