Consensus recommendations for risk stratification in multiple myeloma: report of the International Myeloma Workshop Consensus Panel 2

Abstract

A panel of members of the 2009 International Myeloma Workshop developed guidelines for risk stratification in multiple myeloma. The purpose of risk stratification is not to decide time of therapy but to prognosticate. There is general consensus that risk stratification is applicable to newly diagnosed patients; however, some genetic abnormalities characteristic of poor outcome at diagnosis may suggest poor outcome if only detected at the time of relapse. Thus, in good-risk patients, it is necessary to evaluate for high-risk features at relapse. Although detection of any cytogenetic abnormality is considered to suggest higher-risk disease, the specific abnormalities considered as poor risk are cytogenetically detected chromosomal 13 or 13q deletion, t(4;14) and del17p, and detection by fluorescence in situ hybridization of t(4;14), t(14;16), and del17p. Detection of 13q deletion by fluorescence in situ hybridization only, in absence of other abnormalities, is not considered a high-risk feature. High serum β(2)-microglobulin level and International Staging System stages II and III, incorporating high β(2)-microglobulin and low albumin, are considered to predict higher risk disease. There was a consensus that the high-risk features will change in the future, with introduction of other new agents or possibly new combinations.

Chromosome 1q21 gains confer inferior outcomes in multiple myeloma treated with bortezomib but copy number variation and percentage of plasma cells involved have no additional prognostic value

“…17 There are some reports that 1q21 gains may have clinical significance as a poor-risk feature; however, 1q21 has not yet made its way into routine FISH markers to predict prognosis. 18 This study has focused on the chromosome 1q21 gains in MM patients and analyzed the poor outcomes of newly diagnosed MM patients with 1q21 gains by FISH despite novel agent-based therapy.…”

“…18 A long-term analysis of the IFM99 trials for myeloma established that cytogenetic abnormalities 1q21 gains play a major role in defining long-term survival. 19 However, the Mayo Clinic showed that this parameter was not retained in multivariate analyses and that its prognostic value disappeared when combined with other classical biological and genetic prognostic factors.…”

Diffuse pattern of bone marrow involvement on magnetic resonance imaging is associated with high risk cytogenetics and poor outcome in newly diagnosed, symptomatic patients with multiple myeloma: A single center experience on 228 patients

“…4). Discussion MRI pattern of marrow involvement and specific cytogenetic abnormalities have been associated with prognosis in newly diagnosed patients with symptomatic myeloma [4][5][6][7][8][9]. However, there are very limited data in the literature for the correlation between MRI patterns and cytogenetic aberrations in myeloma patients.…”

“…To date, the definition of high risk myeloma is based mainly on stage, according to the International Staging System (ISS) and on cytogenetic abnormalities. The International Myeloma Working Group has recently suggested that the cytogenetically detected chromosomal 13 or 13q deletion, translocation t(4;14) and deletion 17p, and detection by fluorescence in situ hybridization (FISH) of t(4;14), t (14;16), and del17p are considered as poor risk features [6]. Other cytogenetic aberrations, such as the add1q21 and the hypodiploidy have also correlated with poor prognosis [7][8][9].…”

Amplification of 1q21 and Other Abnormalities in Multiple Myeloma Patients from a Tertiary Hospital in Singapore

“…The [18][19][20]. Most recently, the International Myeloma Workshop issued a consensus recommendation for high risk stratification of newly diagnosed multiple myeloma to include the above and added that patients in good-risk who show these abnormalities at relapse are considered having a high risk [21].…”