Understanding the role of hyperdiploidy in myeloma prognosis: which trisomies really matter?
A partir de données portant sur 965 patients atteints d'un myélome multiple, cette étude française identifie une association entre une trisomie du chromosome 3 ou du chromosome 5 et un pronostic favorable, ainsi qu'une association entre une trisomie du chromosome 21 et un pronostic défavorable
The prognosis of multiple myeloma is mainly dependent upon chromosomal changes. The two major abnormalities driving poor outcome are the del(17p) and the t(4;14). However, the outcome of these high-risk patients is not absolutely uniform, some patients presenting long survival. We hypothesized that these better outcomes might be related to concomitant "good risk" chromosomal changes exploring hyperdiploidy. We analyzed a large series of 965 myeloma patients including 168 patients with t(4;14) and 126 patients with del(17p) using high throughput SNP arrays after plasma cell sorting. As expected, trisomic chromosomes were highly associated. Using the LASSO model, we found that only chromosome 3 when trisomic was associated with a longer progression free survival and that three trisomies modulated overall survival (OS) in myeloma patients: Trisomies 3 and 5 significantly improved OS, and trisomy 21 worsened OS. Especially in patients with t(4;14), trisomies 3 and/or 5 seemed to overcome the poor prognosis. For the first time, using a specific modelling approach, we show that not all trisomies display the same prognostic impact. This finding could be important for routine assessment of prognosis in myeloma, some high-risk patients with a traditional evaluation could be in fact standard risk.
Blood , résumé, 2014