The prognostic significance of 1q21 gain/amplification in newly diagnosed multiple myeloma： a single‑center real world retrospective study of China

Abstract

The gain or amplification 1q21(1q21+) is the most common abnormality in multiple myeloma, but their prognostic impact remains under debate in the era of novel agents. In addition, the prognosis of the 1q21 copy number is controversial. In this retrospective study, cytogenetic abnormalities detected by fluorescence in situ hybridization (FISH) and clinical outcomes of 375 newly diagnosed MM patients were analyzed. 1q21 + was detected in 164 (43.7%) patients, including 103 (27.5%) with 3 copies and 61(16.3%) with ≥4 copies. Patients with 1q21 were more likely to be accompanied by anemia and hypercalcemia and were also associated with the accompaniment of other high-risk cytogenetics abnormalities (HRCAs) such as t (4;14), t(14;16) (p༜0.001; p = 0.002 ). The median progression-free survival (PFS) of 1q21-, 1q21 gain, and 1q21 amp was not reached (NR), 35 months and 21 months, respectively (p < 0.001), and the median overall survival (OS) was NR, 56 months and NR, respectively (p = 0.049). And compared with 1q21gain, 1q21 amp has shorter PFS (p = 0.007), but not the OS (p = 0.258). Meanwhile, there was no difference outcome of survival between patients with 1q21gain alone,1q21amp alone, and FISH-. When accompanied by different HRCAs, 1q21 showed earlier disease progression than 1q21 + alone and FISH-. Combined application of proteasome inhibitors (PIs) and immunomodulators (IMiDs) could improve the poor prognosis of 1q21 partly, and autologous stem cell transplantation (ASCT) could prolong the survival of 1q21 + patients (p༜0.001). Hence, when coexisted with other cytogenetics abnormalities (CAs), 1q21 showed a relatively poor prognosis, especially 1q21amp.