To molecularly define high-risk disease, we performed microarray analysis on tumor cells from 532 newly diagnosed patients with multiple myeloma (MM) treated on 2 separate protocols. Using log-rank tests of expression quartiles, 70 genes, 30% mapping to chromosome 1 (P < .001), were linked to early disease-related death. Importantly, most up-regulated genes mapped to chromosome 1q, and downregulated genes mapped to chromosome 1p. The ratio of mean expression levels of up-regulated to down-regulated genes defined a high-risk score present in 13% of patients with shorter durations of complete remission, event-free survival, and overall survival (training set: hazard ratio [HR], 5.16; P < .001; test cohort: HR, 4.75; P < .001). The high-risk score also was an independent predictor of outcome endpoints in multivariate analysis (P < .001) that included the International Staging System and high-risk translocations. In a comparison of paired baseline and relapse samples, the high-risk score frequency rose to 76% at relapse and predicted short postrelapse survival (P < .05). Multivariate discriminant analysis revealed that a 17-gene subset could predict outcome as well as the 70-gene model. Our data suggest that altered transcriptional regulation of genes mapping to chromosome 1 may contribute to disease progression, and that expression profiling can be used to identify high-risk disease and guide therapeutic interventions. (Blood.

When incorporated into high-dose therapy for myeloma, thalidomide increased the frequency of complete responses and extended event-free survival at the expense of added adverse effects without improving overall survival. (ClinicalTrials.gov number, NCT00083551.).

Objectives The epidemiological trends contributing to increasing acute pancreatitis (AP) hospitalizations remain unknown. We sought to analyze etiological factors and outcomes of increasing AP-hospitalizations. Methods Utilizing the Nationwide Inpatient Sample, retrospective analyses of adult (≥18 years) inpatient admissions with a primary diagnosis of AP (total N: 2,016,045) were performed. Patient hospitalizations from 2009–2012 were compared to those from 2002–2005. Results Compared to 2002–2005, there was a 13.2% (p<0.001) increase in AP-admissions in 2009–2012. Multivariate analysis adjusted for “time-period”, patient and hospital demographics, AP-etiologies, and disease associations, demonstrated an increase in the odds of associated-chronic pancreatitis (CP) (2002–2005: odds ratio [OR] 32.04, 95% confidence interval [CI] 30.51–33.64; 2009–2012: OR 35.02, 95% CI 33.94–36.14); while associated odds of gallstones (2002–2005: OR 36.37, 95% CI 35.32–37.46; 2009–2012: OR 29.85, 95% CI 29.09–30.64) decreased. Compared to 2002–2005, the AP-related mortality decreased in 2009–2012 (1.62% to 0.79%, p<0.001) and was lower in AP with associated-CP (0.65% to 0.26%; p<0.001) compared to AP without-CP. Conclusion In the preceding decade, AP-hospitalizations are increasing but associated mortality is declining. Associated-CP has emerged as a leading contributor for AP-related hospitalizations. Further research is needed to identify novel interventions to prevent disease progression of AP.

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