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WHEN PERFORMANCE OF CYTOGENETICS MATTERS: A POPULATION-BASED STUDY IN THE NETHERLANDS ON NEWLY DIAGNOSED MULTIPLE MYELOMA PATIENTS
Author(s): ,
Mirian Brink
Affiliations:
Department of Research,Comprehensive Cancer Center the Netherlands,Utrecht,Netherlands
,
Otto Visser
Affiliations:
Department of Research,Comprehensive Cancer Center the Netherlands,Utrecht,Netherlands
,
Monique C. Minnema
Affiliations:
Department of Hematology,University Medical Center Utrecht,Utrecht,Netherlands
,
Sonja Zweegman
Affiliations:
Department of Hematology,VUmc,Amsterdam,Netherlands
,
Pieter Sonneveld
Affiliations:
Department of Hematology,Erasmus MC Cancer Institute,Rotterdam,Netherlands
Avinash G. Dinmohamed
Affiliations:
Department of Research,Comprehensive Cancer Center the Netherlands,Utrecht,Netherlands;Department of Hematology,Erasmus MC Cancer Institute,Rotterdam,Netherlands;Department of Public Health,Erasmus University Medical Center,Rotterdam,Netherlands
(Abstract release date: 05/18/17) EHA Library. Brink M. 06/24/17; 181973; P686
Dr. Mirian Brink
Dr. Mirian Brink
Contributions
Abstract

Abstract: P686

Type: Poster Presentation

Presentation during EHA22: On Saturday, June 24, 2017 from 17:30 - 19:00

Location: Poster area (Hall 7)

Background
It was recently shown in both clinical and population-based series that unperformed cytogenetics (UPCs) in intensively treated patients with acute myeloid leukemia was independently associated with poor prognosis, as compared to patients with performed cytogenetics.

Aims

Therefore, we set out to assess whether UPCs is associated with poor outcome in young patients with symptomatic multiple myeloma (MM) who have received induction chemotherapy. 

Methods

We identified 358 newly diagnosed patients with MM <66 years in 2014 from the nationwide population-based Netherlands Cancer Registry (NCR). UPCs was used to indicate that no sample was sent in for cytogenetic analysis. Performed cytogenetics were grouped by Revised International Staging System (R-ISS), i.e. high-risk (presence of translocations (4;14) or (14;16) or deletion 17p) or standard-risk (presence of other aberrations or no aberrations). Only patients treated with induction chemotherapy, defined as treatment with VCD, PAD, BD or TAD +/- subsequent high dose melfalan and autologous stem cell transplantation (ASCT), were included for analyses. In total, 319 (89%, median age 60 years, 62% male) were treated with induction chemotherapy, 39 patients otherwise or had no therapy.
The primary endpoint was progression-free survival (PFS), defined as time from start of first line induction chemotherapy to progression or death, whichever comes first. Patients alive without progression were censored at February 1st, 2016.

Results

In 220/319 (69%) MM patients treated with induction chemotherapy, cytogenetics was performed and 63 of these patients (29%) were cytogenetically high-risk. No statistical significant differences were observed in CRAB criteria or ISS between patients with or without performed cytogenetics. The proportion of patients undergoing ASCT was similar in different cytogenetic groups (standard-risk 85%, high-risk 83% and UPC 77%, p=0.77).
Achieving partial response or better was higher, although not statistically significant, in the standard-risk group as compared to the high-risk and UPC groups (93% vs. 89% vs. 85%, p=0.92). Response outcome was unknown for 9% of the UPC group, 5% in high-risk group and 4% in the standard-risk group.
Median follow-up time was 516 days. PFS for patients in the standard-risk group was highest, as compared to patients in the high-risk or UPCs groups after one year of follow-up (88% vs. 81% vs. 74%, p=0.0003).

Conclusion

Our data show that cytogenetic testing is performed in almost 70% of MM patients <66 years. Although response rates were similar for patients in the UPC, standard- and high-risk groups, PFS was better in the standard-risk group. Patients with unperformed cytogenetics had the poorest outcomes. The reasons are unclear, but a plausible explanation for not performing cytogenetics could be the patients’ worse clinical condition at presentation which requires immediate treatment.   
For the abovementioned outcome measures, data of calendar year 2015 will be added and presented at the European Hematology Association.

Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical

Keyword(s): Multiple Myeloma, Cytogenetics

Abstract: P686

Type: Poster Presentation

Presentation during EHA22: On Saturday, June 24, 2017 from 17:30 - 19:00

Location: Poster area (Hall 7)

Background
It was recently shown in both clinical and population-based series that unperformed cytogenetics (UPCs) in intensively treated patients with acute myeloid leukemia was independently associated with poor prognosis, as compared to patients with performed cytogenetics.

Aims

Therefore, we set out to assess whether UPCs is associated with poor outcome in young patients with symptomatic multiple myeloma (MM) who have received induction chemotherapy. 

Methods

We identified 358 newly diagnosed patients with MM <66 years in 2014 from the nationwide population-based Netherlands Cancer Registry (NCR). UPCs was used to indicate that no sample was sent in for cytogenetic analysis. Performed cytogenetics were grouped by Revised International Staging System (R-ISS), i.e. high-risk (presence of translocations (4;14) or (14;16) or deletion 17p) or standard-risk (presence of other aberrations or no aberrations). Only patients treated with induction chemotherapy, defined as treatment with VCD, PAD, BD or TAD +/- subsequent high dose melfalan and autologous stem cell transplantation (ASCT), were included for analyses. In total, 319 (89%, median age 60 years, 62% male) were treated with induction chemotherapy, 39 patients otherwise or had no therapy.
The primary endpoint was progression-free survival (PFS), defined as time from start of first line induction chemotherapy to progression or death, whichever comes first. Patients alive without progression were censored at February 1st, 2016.

Results

In 220/319 (69%) MM patients treated with induction chemotherapy, cytogenetics was performed and 63 of these patients (29%) were cytogenetically high-risk. No statistical significant differences were observed in CRAB criteria or ISS between patients with or without performed cytogenetics. The proportion of patients undergoing ASCT was similar in different cytogenetic groups (standard-risk 85%, high-risk 83% and UPC 77%, p=0.77).
Achieving partial response or better was higher, although not statistically significant, in the standard-risk group as compared to the high-risk and UPC groups (93% vs. 89% vs. 85%, p=0.92). Response outcome was unknown for 9% of the UPC group, 5% in high-risk group and 4% in the standard-risk group.
Median follow-up time was 516 days. PFS for patients in the standard-risk group was highest, as compared to patients in the high-risk or UPCs groups after one year of follow-up (88% vs. 81% vs. 74%, p=0.0003).

Conclusion

Our data show that cytogenetic testing is performed in almost 70% of MM patients <66 years. Although response rates were similar for patients in the UPC, standard- and high-risk groups, PFS was better in the standard-risk group. Patients with unperformed cytogenetics had the poorest outcomes. The reasons are unclear, but a plausible explanation for not performing cytogenetics could be the patients’ worse clinical condition at presentation which requires immediate treatment.   
For the abovementioned outcome measures, data of calendar year 2015 will be added and presented at the European Hematology Association.

Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical

Keyword(s): Multiple Myeloma, Cytogenetics

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