267 Outcome of Patients with Multiple Myeloma with t(4;14) after Autologous Hematopoietic Stem Cell Transplantation

Track: Poster Abstracts
Wednesday, February 11, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Koji Sasaki, MD , Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
Rima Saliba, PhD , Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
Gary Lu, MD , Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
Nina Shah, MD , Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
Qaiser Bashir, MD , Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
Krina Patel, MD , Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
Fabian Bock, MD , Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
Simrit Parmar, MD , Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
Chitra Hosing, MD , Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
Uday R. Popat, MD , Stem Cell Transplantation and Cellular Therapy, UT MD Anderson Cancer Center, Houston, TX
Ruby Delgado , Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
Gabriela Rondon, MD , Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
Richard E. Champlin, MD , Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
Muzaffar H. Qazilbash, MD , Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX
Presentation recording not available for download or distribution as requested by the presenting author.

Background:

The cytogenetic abnormality  t(4;14)(p16;q32) results in the fusion of immunoglobulin heavy chain (IgH) gene on chromosome 14q32 with the fibroblast growth factor 3 (FGFR3) gene on chromosome 4p16 in patients with multiple myeloma (MM), and is associated with shorter progression-free survival (PFS) and overall survival (OS). Recent studies indicate that treatment with proteasome inhibitors (PI) may overcome the adverse prognostic features.  The aim of this study is to assess the outcome of patients with t(4;14) after high-dose chemotherapy and autologous hematopoietic stem cell transplant (Auto-HCT).

Methods:

We identified 23 patients with MM who had t(4;14) on conventional cytogenetic or fluorescent in situ hybridization (FISH) studies prior to auto-HCT at our institution between 2008 and 2013. We compared their outcomes to a matched control group (n=92) without t(4;14) prior to HCT who were treated during the same time period. Matching was based on age and response to the last therapy prior to HCT.

Results:

Patient characteristics are summarized in Table 1. Median follow-up intervals were 41 months and 23 months in the t(4;14) and control groups, respectively. PFS at 2 years was 18% (95% confidence interval [CI], 6-37) in the t(4;14) and 65% (95% CI, 53-75) in the control group (Fig. 1),  (p<.001; hazard ratio [HR], 5.2; 95% CI, 3.1-11.0). OS at 2 years was 43% (95% CI, 22-62) in the t(4;14) and 81% (95% CI, 70-89) in the control group (Fig. 2),  (p<.001; HR, 5.2; 95% CI, 2.4-11.0). On multivariate analysis for PFS, t(4;14) (p <.004; HR, 4.6; 95% CI, 2.5-8.4) emerged as the only significant adverse prognostic factor. Relapsed disease at auto-HCT was associated with a trend for lower PFS (p= .06; HR, 1.7; 95% CI, 0.97).  On multivariate analysis for OS, t(4;14) (p <.001; HR, 4.2; 95% CI, 1.9-9.2) and relapsed disease at auto-HCT (p =.014; HR, 2.7; 95% CI, 1.2-6.2) emerged as adverse prognostic factors.

Conclusion:

Patients with t(4;14) have a significantly shorter  PFS and OS even after an auto-SCT. Use of novel approaches like post-transplant consolidation, maintenance, and immune-based therapies should be explored in these high-risk patients.

Disclosures:
Nothing To Disclose
See more of: Poster Session 1: Lymphoma/Multiple Myeloma
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