| Autor: |
Schavgoulidze A; Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse., Lauwers-Cances V; Centre Hospitalier Universitaire Toulouse, Toulouse., Perrot A; Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse., Cazaubiel T; Centre Hospitalier Universitaire Bordeaux, Bordeaux., Chretien ML; Centre Hospitalier Universitaire Dijon, Dijon., Moreau P; Centre Hospitalier Universitaire Nantes, Nantes., Facon T; Centre Hospitalier Universitaire Lille, Lille., Leleu X; Centre Hospitalier Universitaire Poitiers, Poitiers., Karlin L; Centre Hospitalier Universitaire Lyon, Lyon., Stoppa AM; Institut Paoli Calmettes, Marseille., Decaux O; Centre Hospitalier Universitaire Rennes, Rennes., Belhadj K; Centre Hospitalier Universitaire Creteil, Creteil., Arnulf B; Centre Hospitalier Universitaire, Hopital Saint Louis, Paris., Mohty M; Centre Hospitalier Universitaire, Hopital Saint-Antoine, Paris., Ariette CM; Centre Hospitalier Universitaire Grenoble Alpes, Grenoble., Fohrer-Sonntag C; Centre Hospitalier Universitaire Hautepierre, Strasbourg., Lenain P; Centre de Lutte Contre le Cancer - Centre Henri Becquerel, Rouen., Marolleau JP; Centre Hospitalier Universitaire Amiens, Amiens., Tiab M; Centre Hospitalier Departemental Vendee, La Roche-sur-Yon., Araujo C; Centre Hospitalier de la Cote Basque, Bayonne., Orsini-Piocelle F; Centre Hospitalier Annecy Genevois, Metz-Tessy., Jaccard A; Centre Hospitalier Universitaire Limoges, Limoges., Roussel M; Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse., Benboubker L; Centre Hospitalier Regional Universitaire Tours, Tours., Eveillard JR; Centre Hospitalier Universitaire de Brest, Brest., Dib M; Centre Hospitalier Universitaire Angers, Angers., Divoux M; Centre Hospitalier Regional Universitaire Nancy Vandoeuvre les Nancy, Nancy., Attal M; Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse., Avet-Loiseau H; Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse., Corre J; Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse. corre.jill@iuctoncopole.Fr. |
| Abstrakt: |
In the era of personalized treatment in multiple myeloma, high-risk patients must be accurately identified. The International Myeloma Working Group recommends using the Revised International Staging System (R-ISS) to pick out high-risk patients. The main purpose of our work was to explore the heterogeneity of outcome among R-ISS stage II patients assessing the impact of International Staging System (ISS) stage, chromosomal abnormalities and lactate dehydrogenase level in this subgroup. Data were collected from 1,343 patients up to 65 years old with newly diagnosed myeloma, enrolled in three clinical trials implemented by the Intergroupe Francophone du Myélome. All patients were eligible for intensive treatment. Patients in R-ISS stage II but ISS stage I had 1.6 times higher risk of death than patients in R-ISS stage I (adjusted hazard ratio=1.6; 95% confidence interval: 1.1-2.2; P=0.01) and patients in R-ISS stage II but with ISS stage III had a better overall survival than patients in R-ISS stage III (adjusted hazard ratio=0.7; 95% confidence interval: 0.4-0.9, P=0.02). However, among patients classified in R-ISS II, ISS stage and chromosomal abnormalities (del[17p] and t[4;14]) were still relevant prognostic factors for death. Dividing R-ISS stage II into three subgroups: ISS I with standard-risk chromosomal abnormalities, ISS II or III with standard-risk chromosomal abnormalities and patients with high-risk chromosomal abnormalities, median overall survival times were, respectively, not reached, 112 months and 71 months (P<0.001). In conclusion, stratification of patients in the R-ISS stage II group can be improved by taking into account chromosomal abnormalities and ISS. However, this does not improve predictive performance of survival models. |
