More Precise Prognostic Index in Myeloma Relies Heavily on Cytogenetics
Posted: Tuesday, September 3, 2019
Based on data from more than 1,600 patients, work that could further facilitate the development of treatment strategies for multiple myeloma based on risk assessment has been published in the Journal of Clinical Oncology. “The current definition of high-risk profile is restrictive and oversimplified,” cautioned the authors, noting that a better definition of cytogenic risk classification for this disease is essential because “the wide heterogeneity in outcome is driven mainly by cytogenetic abnormalities.”
Aurore Perrot, MD, PhD, of Centre Hospitalier Régional Universitaire Nancy in Nancy, France, and colleagues identified six cytogenetic abnormalities as clinically relevant in 1,635 newly diagnosed patients who had been enrolled in four trials run by the Intergroupe Francophone du Myélome: del(17p); t(4;14); del(1p32); 1q21 gain; and trisomies 5 and 21. The researchers then computed, for all patients, a prognostic index based on the parameter estimates of the multivariable Cox model.
“A higher prognostic index was consistently associated with a poor survival outcome,” noted Dr. Perrot and co-investigators. “Hazard ratios for patients in the high-risk category for death were between 6 and 15 times higher than those of patients in the low-risk category.” The prognostic index performed well in discriminating between patients who died and those who survived (ie, Harrell’s concordance index greater than 70%). The team is confident that—in part because it is based on a weighted score—their cytogenetic prognostic index may more effectively classify the risk associated with a patient’s particular disease than the classifications currently used for newly diagnosed multiple myeloma.
Disclosure: The study authors’ disclosure information may be found at ascopubs.org.