On Location
American Society of Hematology’s
MEETING ON HEMATOLOGIC MALIGNANCIES
t this year’s ASH Meeting on Hematologic
Malignancies, which took place September
16-17 in Chicago, speakers and attendees
gathered to discuss important research and
clinical updates in malignant hematology. Here, we share
some of the highlights of the meeting, including the
under-representation of youger patients in clinical trials
and the prognostic significance of TP53 mutations in
myelodysplastic syndromes.
ASH Clinical News was on site in Chicago to speak with
presenters at the meeting. See all of our video interviews at ashclinicalnews.org/mhmvideos.
Improving Risk Stratification in Standar d-Risk
Myeloma Patients: Age, Bone Marrow Involvement
Independently Predict Survival
Though the field of multiple myeloma
TABLE 1. Factors Associated With Poor Overall Survival at Three Years
(MM) has seen many advances in treatParameter
Value
Odds Ratio
p Value
ment in the past two years – including
ISS stage
I, II, III
1.85
0.001
three new drug approvals – patients who
(95% CI 1.29-2.66)
have so-called standard-risk cytogenetAge
<65 years, 65-75 years, >75 years
1.81
0.001
ics often have poor survival outcomes.
(95% CI 1.28-2.56)
These poor outcomes indicate that there
Plasma cells
<20% in bone marrow
2.64
0.010
is still a need for better risk-stratification
(95% CI 1.26-5.54)
methods, according to Moritz Binder,
Karyotype
Normal, hyperdiploid, other
2.8
<0.001
MD, MPH, of the Department of Internal
(95% CI 2.09-3.74)
Medicine at the Mayo Clinic in Rochester,
Thrombocytopenia
<150x109/L
2.74
0.001
Minnesota, who presented results of a
(95% CI 1.47-5.09)
new risk prediction model using fluoISS = International Staging System
rescence in situ hybridization (FISH) at
the 2016 ASH Meeting on Hematologic
Bone marrow aspirates were evaluated for dele- with lower rates of three-year OS included
Malignancies.
tions, monosomies, trisomies, and tetrasomies
With this study, Dr. Binder and colleagues
disease stage, older age, greater extent of bone
using chromosome- or centromere-specific
sought to identify demographic, clinical, and
marrow involvement, karyotype, and lower
FISH probes.
cytogenetic characteristics that would predisplatelet count at the time of diagnosis (TABLE 1).
The median patient age was 65 years (range
pose MM patients with standard-risk cytoge“The model had excellent discrimination,” Dr.
= 31-95 years), and 60 percent were male
netics to poor three-year overall survival (OS).
Binder and colleagues noted, “and correctly clas(n=270). Median OS was longest in the group
The study included 449 patients diagnosed
sified 83 percent of the patients, with 56 percent
of patients who survived at least three years
with MM between July 2004 and July 2014 at
sensitivity and 92 percent specificity.” This trans(n=332; 74%), compared with the entire patient lated to a positive predictive value of 71 percent,
the Mayo Clinic. Patients were included if they
cohort (n=449) and those who did not achieve
underwent FISH evaluation within six months
and a negative predictive value of 86 percent.
three-year OS (n=117; 26%):
of diagnosis and received treatment with an
“One-fourth of the patients are experiencimmunomodulator, proteasome inhibitor, or a
ing less than three years of overall survival after
• 8.0 years for the entire patient cohort
combination of both.
diagnosis,” Dr. Binder and colleagues conclud(range = 6.4-8.6 years)
Patients were excluded from the study if they:
ed. “These findings emphasize the importance
of further risk stratification and the need for
• 10.5 years for those who survived at least 3 reliable predictors of poor clinical outcomes in
• had high-risk cytogenetics, which was
years (range = 8.3 years - not reached)
defined as del(17p), t(14;16), and t(14;20)
this patient population.”
• had intermediate-risk cytogenetics, which
was defined as t(4;14) and gain(1q)
• were lost to follow-up within three years
24
ASH Clinical News
• 1.4 years for those who did not survive at
least 3 years (range = 1.1-1.6 years)
Other risk factors independently associated
REFERENCE
Binder M, Rajkumar SV, Ketterling RP, et al. Predicting poor overall survival in
patients with newly diagnosed multiple myeloma and standard-risk cytogenetics
treated with novel agents. Abstract #89267. Presented at the ASH Meeting on
Hematologic Malignancies, September 16-17, 2016; Chicago, IL.
October 2016