Prognostic Value Of "Multiple-hits" In Patients With Multiple Myeloma In Xinjiang

Objective: To understand the distribution and prognostic value of "multiple-hits" in patients with multiple myeloma(MM)in Xinjiang,as well as the difference of clinical efficacy between different treatment regimens in patients with "multiple-hits" MM.Methods:(1)A total of 245 newly diagnosed MM(NDMM)patients with complete clinical data and cytogenetic abnormalities after CD138 magnetic bead sorting combined with FISH detection who were admitted to the Department of Hematology of Xinjiang Uygur Autonomous Region People’s Hospital from June 2014 to February 2020 were collected as research subjects.(2)According to the results of FISH and the diagnostic criteria of multiple-hits defined by m SMART 3.0,the distribution of "multiple-hits" in MM patients was understood.(3)All MM patients were grouped according to whether they had high risk cytogenetic abnormality(HRCA).The prognosis of patients in the high-risk group and the non-high-risk group was compared,and the prognosis of patients with "multiple-hits" and "non-multiple-hits" in the high-risk group was compared.(4)The prognostic difference between "multiple-hits" and "non-multiple-hits" MM patients with different R-ISS stages and the effect of different HRCA combinations on the prognosis of "multiple-hits" MM patients were compared.(5)To preliminarily understand the clinical efficacy and the occurrence of adverse reactions of different treatment regimens in "multiple-hits" MM patients.Results:(1)The incidence of "multiple-hits" in NDMM patients with genetic abnormalities in Xinjiang was21.6%.,including double-hit in 18.7% of patients and triple-hit in 2.9% of patients.(2)The median progression-free survival(PFS)and median overall survival(OS)of MM patients with HRCA(high-risk)were shorter than those without HRCA(not high-risk)(P<0.05).Moreover,among high-risk patients,the median PFS time of "multiple-hits" patients was shorter than that of "non-multiple-hits" patients(P<0.05),and the median OS time of "multiple-hits" patients was also shorter than that of "non-multiple-hits" patients(P< 0.05).(3)In patients with R-ISS stage II and R-ISS stage III MM,the median PFS time,the median OS time and duration of response(DOR)time of "multiple-hits" patients were all shorter than those without HRCA and those with one type of HRCA(P < 0.05),while the TTR(time to response)was significantly prolonged(P < 0.05).Patients with a combination of 1q21+ and Del(17p)had the worst prognosis among "multiple-hits" MM patients.(4)The efficacy of different treatment regimens in "multiple-hits" MM patients was compared.The deep response rate and overall response rate of VRD group were significantly higher than PDD and PCD group(P<0.05),and the median PFS time and median OS time were longer(P<0.05).However,there was no significant difference between PDD and PCD in the treatment effect of "multiple-hits" MM patients.Conclusion:Among MM patients with HRCA,patients with "multiple-hits" MM had the worst prognosis.R-ISS staging combined with "multiple-hits" will provide a more accurate prognosis assessment for MM patients.Moreover,patients with different combinations of HRCA in "multiple-hits" had different outcomes.For patients with "multiple-hits" MM,the VRD regimen can improve deep response rate and overall response rate,prolongs PFS and OS,and improves prognosis.