Centrosome amplification is common in myeloma and may be involved in disease pathogenesis. We have previously derived a gene expression-based centrosome index (CI) that correlated with centrosome amplification and was an independent prognostic factor in a small cohort of heterogeneously treated patients. In this study, we validated the prognostic significance of the CI in 2 large cohorts of patients entered into clinical trials and showed that a high CI is a powerful independent prognostic factor in both newly diagnosed and relapsed patients, whether treated by intensive therapy (total therapy II) or novel agents (bortezomib). Tumors with high CI overexpressed genes coding for proteins involved in cell cycle, proliferation, DNA damage, and G 2 -M checkpoints, and associated with the centrosome and kinetochore/ microtubules. In particular, aurora kinases are significantly overexpressed in patients with high CI, with concordant increase in protein expression. Human myeloma cell lines with higher CI are more responsive to treatment with a novel aurora kinase inhibitor. Aurora kinase may represent novel therapeutic targets in these patients with very poor prognosis.
IntroductionCentrosomes are cellular microtubule-organizing centers whose normal function is crucial for chromosome segregation and cytokinesis during mitosis. 1 Centrosome amplification has been detected in a broad range of solid tumors 2-7 and more recently in leukemia 8,9 and lymphoma. 10-12 Previously, we and others have shown that centrosome amplification is common in multiple myeloma (MM) and is already present in monoclonal gammopathy of undetermined significance (MGUS), suggesting an early role in myelomagenesis. 13,14 In addition, we derived a gene expression-based centrosome index (CI) that correlated closely with centrosome amplification detected by immunofluorescence. We also showed in a heterogeneously treated and relatively small cohort of patients that the CI is an independent prognostic factor. 13 In the current study, we wanted to validate the prognostic importance of the CI in large cohorts of homogenously treated patients entered into clinical trials and study the differences in the gene expression profiles (GEP) of patients with high and low CI in order to understand the underlying biological difference and possibly identify therapeutic targets.
Methods
PatientsGroup 1: University of Arkansas (UAMS) patients treated with total therapy II. These are newly diagnosed patients entered into total therapy II studies (n ϭ 351). These patients have GEP performed on CD138 ϩ selected plasma cells (PCs) from pretreatment bone marrows (BMs) using the Affymetrix U133plus 2.0 chip (Affymetrix, Santa Clara, CA). The GEP data of these patients have been published. 15 (These data are available from the National Institutes of Health Gene Expression Omnibus, http:// www.ncbi.nlm.nih.gov/geo/, under accession #GSE2658.) These patients were assigned Translocations and Cyclin (TC) class, a gene expressionbased proliferation index (PI), and a recently pu...