Prediction of high- and low-risk multiple myeloma based on gene expression and the International Staging System
A partir de données portant sur un total de 4 750 patients atteints d'un myélome multiple, cette étude met en évidence, sur la base d'une combinaison entre des critères cliniques de l'International Staging System et des marqueurs moléculaires (EMC92), l'intérêt d'une classification en 4 groupes pour le pronostic de la maladie
Combination of ISS and the EMC92 gene classifier is a novel clinically applicable risk classification for survival in multiple myeloma.ISS has clear independent additive prognostic value in combination with GEP classifiers or FISH markers. Patients with multiple myeloma have variable survival, and require reliable prognostic and predictive scoring systems. Currently, clinical and biological risk markers are used independently. Here, ISS, FISH markers and gene expression (GEP) classifiers were combined to identify novel risk classifications in a discovery/validation setting. We used the datasets of HOVON-65/GMMG-HD4, UAMS-TT2, UAMS-TT3, MRC-IX, APEX and IFM-G (total number of patients: 4750). A total of 20 risk markers were evaluated including t(4;14) and deletion of 17p (FISH), EMC92 and UAMS70 (GEP classifiers) and ISS. The novel risk classifications demonstrated that ISS is a valuable partner to GEP classifiers and FISH. Ranking all novel as well as existing risk classifications showed that the EMC92-ISS combination is the strongest predictor for overall survival, resulting in a four group risk classification. The median survival was 24 months for the highest risk group, 47 and 61 months for the intermediate risk groups and median not reached after 96 months for the lowest risk group. The EMC92-ISS classification is a novel prognostic tool, based on biological and clinical parameters, which is superior to current markers and offers a robust clinically relevant 4-group model.
Blood , résumé, 2014