Cytogenetic Prognostic Index for Survival in Multiple Myeloma


Key Points

  • A prognostic index was developed using the cytogenetic abnormalities of del(17p), t(4;14), del(1p32), 1q21 gain, and trisomies 5 and 21.
  • In three validation sets, the HR for death was 6 to 15 times higher in the high-risk vs low-risk categories.

In a study reported in the Journal of Clinical Oncology, Perrot et al identified a cytogenetic prognostic index predictive of survival in patients with newly diagnosed multiple myeloma.

Study Details

The study involved data from 1,635 patients in four trials conducted by the Intergroupe Francophone du Myélome. Older data were used for model development and internal validation. For external validation, two newer data sets were used to assess model performance in patients treated with more current regimens. The final prognostic index model defined low-, intermediate-, and high-risk groups incorporating six cytogenetic abnormalities: del(17p), t(4;14), del(1p32), 1q21 gain, and trisomies 5 and 21.

Prognostic Performance

In all data sets, a higher prognostic index was associated with poorer survival outcome. Hazard ratios for death for the high-risk vs low-risk groups were 11.44 (P < .001) in the internal validation cohort, 15.22 (P < .001) in one external validation cohort, and 8.13 (P < .001) in the second external validation cohort.  In analysis pooling all three validation sets, patients with t(4;14) or del(17p) in the high-risk category had worse survival than those in the intermediate-risk category. The prognostic index showed good discrimination between patients who died and those who survived, with C-indices of 0.71 for the internal validation cohort and 0.76 and 0.71 for the two external validation data sets.

The investigators concluded, “The cytogenetic prognostic index improves the classification of newly diagnosed patients with [multiple myeloma] in the high-risk group compared with current classifications. These findings may facilitate the development of risk-adapted treatment strategies.”

Hervé Avet-Loiseau, MD, PhD, of the Unit for Genomics in Myeloma, Institut Universitaire du Cancer de Toulouse-Oncopole, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by National Cancer Institute grants and the Cancer Pharmacology of Toulouse and Region program. For full disclosures of the study authors, visit

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