A gain in chromosome 1q (+1q) was associated with several clinical characteristics among patients with multiple myeloma including high tumor burden and advanced disease stage, according to a new Mayo Clinic study.
+1q is a common cytogenetic abnormality among patients with multiple myeloma. Prior studies have suggested that it is associated with inferior outcomes, but none have confirmed if it is an independent adverse prognostic factor.
The Mayo Clinic study included 1376 patients diagnosed with myeloma between 2005 and 2018; 28% had a +1q mutation. A gain in 1q was associated with anemia, hypercalcemia, high tumor burden, International Staging System stage 3, high-risk translocations, and chromosome 13 abnormalities.
There was no difference in response rate to induction chemotherapy for immunomodulatory drugs, proteasome inhibitors, or the combination of both for patients with +1q and those without. Similarly there was no difference in very good partial response or better for these treatments.
Patients with +1q did have a shorter time to next treatment compared with those without +1q (19.9 vs 27.7 months; P <.001).
“This is also consistent with results from previous studies, where decreased progression-free survival is seen in patients with +1q, despite similar responses to various novel treatment-based induction regimens and to transplantation,” the researchers noted.
On univariate analysis, a gain in 1 q was associated with an increased risk of death (risk ratio, 1.9; P <.001). On multivariate analysis adjusting for other high-risk cytogenetic abnormalities, ISS stage 3, and age 70 or older, +1q was associated with decreased overall survival (RR, 1.5; P <.001).
“Inferior outcomes are not mitigated by currently available treatment options, including transplantation,” the researchers wrote. “Therefore, patients with +1q should be considered to have high-risk disease at diagnosis, and future efforts should be geared toward identification of more effective therapies for patients harboring this abnormality.”
Abdallah N, Greipp P, Kapoor P, et al. Clinical characteristics and treatment outcomes of newly diagnosed multiple myeloma with chromosome 1q abnormalities. Blood Advances. Published online August 4, 2020. doi:10.1182/bloodadvances.2020002218