Older age is not associated with a higher incidence of adverse genetic abnormalities in multiple myeloma patients

FLAVIA STELLA; ESTELA PEDRAZZINI; DOROTEA BEATRIZ FANTL; GABRIELA BRUNO; OSCAR BALLESTER; IRMA SLAVUTSKY

Atenas

Congreso; ESH International Conference on Multiple Myeloma; 2014

European School of Hematology

Background: Multiple myeloma (MM) is a monoclonal tumor of bone marrow (BM) plasma cells, with highly variable clinical course. Genetic abnormalities and age have shown to be strong prognostic factors. A number of studies have evaluated the association between both parameters with no consistent findings. In this report, we have retrospectively investigated the distribution of genetic alterations and other clinical prognostic indicators in patients older and younger than 65 years. Material and Methods: A total of 258 consecutive MM patients (127 males; mean age: 65.3 years; range: 24-89 years), studied in our Laboratory between 2006 and 2013, were included. The diagnosis was made according to standard criteria. Cytogenetic and FISH analysis using specific probes were performed. The study was approved by the local Ethics Committee and individuals gave informed consent. Results: The analysis of data showed a non significant trend in the percentage of cytogenetic and FISH alterations in patients >65 years compared to those ¡Ü65 years: IGH high risk translocations (66.7% vs 60.7%), deletion 17p13 (66.7% vs 54.8%), 1q21 gain/amplification (CKS1B gene) (58.3% vs 55.6%, respectively). In addition, a similar distribution of complex karyotypes (43.7% vs 33.3%) and structural alteration of chromosome 1 (37.5% vs 35.5%, respectively), was observed. No differences in the number of abnormalities between groups was detected (p=0.751). The analysis of clinical parameters showed higher calcium serum levels in older patients (p=0.028). Cases of ¡Ü65 years had increased percentage of BM plasma cell infiltration (p=0.025) and a tendency to a higher LDH and ¦Â2microglobulin levels. Although no significant differences were observed, older patients showed shorter overall survival (OS) (64.1 months) than younger cases (91.5 months). In addition, we have analyzed our cohort taking into account the recently described score by Moreau et al (J Clin Oncol. 2014; 32: 2173-80) which includes ISS3, elevated LDH and t(4;14) and/or del17p abnormalities. While significant differences in overall survival were noticed in cases with score 0 (154.13 months) and score 1 (50.95 months) with respect to those with score 3 (9.8 months) (p=0.0412 and p=0.0266, respectively), no differences in age distribution among scores were observed. Conclusions: In our limited experience, our findings support that the poor prognosis of older age MM patients is not associated to a higher incidence of high risk genetic abnormalities. In addition, the application of the new score system to our series confirm the importance of biological high-risk disease on clinical outcome.