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Deprecated: Implicit conversion from float 267.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Haematologica 2015 ; 100 (9): 1214-21 Nephropedia Template TP
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Four genes predict high risk of progression from smoldering to symptomatic multiple myeloma (SWOG S0120) #MMPMID26022710
Khan R; Dhodapkar M; Rosenthal A; Heuck C; Papanikolaou X; Qu P; van Rhee F; Zangari M; Jethava Y; Epstein J; Yaccoby S; Hoering A; Crowley J; Petty N; Bailey C; Morgan G; Barlogie B
Haematologica 2015[Sep]; 100 (9): 1214-21 PMID26022710show ga
Multiple myeloma is preceded by an asymptomatic phase, comprising monoclonal gammopathy of uncertain significance and smoldering myeloma. Compared to the former, smoldering myeloma has a higher and non-uniform rate of progression to clinical myeloma, reflecting a subset of patients with higher risk. We evaluated the gene expression profile of smoldering myeloma plasma cells among 105 patients enrolled in a prospective observational trial at our institution, with a view to identifying a high-risk signature. Baseline clinical, bone marrow, cytogenetic and radiologic data were evaluated for their potential to predict time to therapy for symptomatic myeloma. A gene signature derived from four genes, at an optimal binary cut-point of 9.28, identified 14 patients (13%) with a 2-year therapy risk of 85.7%. Conversely, a low four-gene score (<9.28) combined with baseline monoclonal protein <3 g/dL and albumin ?3.5 g/dL identified 61 patients with low-risk smoldering myeloma with a 5.0% chance of progression at 2 years. The top 40 probe sets showed concordance with indices of chromosome instability. These data demonstrate high discriminatory power of a gene-based assay and suggest a role for dysregulation of mitotic checkpoints in the context of genomic instability as a hallmark of high-risk smoldering myeloma.