Vol. 4, Issue 1, Part A (2024)

Background: Multiple myeloma is a cancer originates from plasma cell usually from bone marrow, divided into two subtypes: active or symptomatic multiple myeloma and smoldering multiple myeloma. The aim of this work was to study the role of translocation t(4:14), translocation t(14:16) and deletions (17p) by fluorescence in situ hybridization technique for risk stratification of newly diagnosed multiple myeloma patients, their correlation with clinico-laboratory features, and to explore their predictive value of disease response to triplet standard combination therapy.
Methods: 50 adults with newly diagnosed multiple myeloma and a performance status more than 2 were involved in this prospective study. Stages I and II were considered normal risk, stage III was considered high risk with a single hit, and super high risk with two or three hits was considered super high risk in the revised international staging system (R-ISS) with molecular risk stratification. Randomization of patients to VRD or VCD procedures was based on their degree of renal impairment, and they all received triplet conventional combination medicine. Patients in stages 3 and 4 started VCD treatments. Afterwards, the response was assessed in accordance with the IMWG Standard Answer Criteria. 
Results: 7 patients (4: 14) had positive translocation t, 2 had positive t (14: 16), and 3 had positive del 17p. Two patients had 4:14 hit t and del 17p, one had 14:16. Serum IgG and IgA levels were significantly greater in the very high-risk group compared to high and normal risk groups (p<0.001). With substantial differences (p= 0.0014), the very high-risk group got Bortezomib, cyclophosphamide, and dexamethasone (VCD), whereas the high-risk and standard risk groups received VCD and VRD, respectively Most ultra-high-risk patients had stable disease (SD), more high-risk patients had partial response (PD), and practically all standard risk patients achieved CR or very strong partial response.
Conclusion: Comparing the ISS and R-ISS systems may misallocate a patient group with inferior response at the lower ISS stage. Multiple myeloma prognoses have improved with protease inhibitors and immunomodulators. However, extremely high- and high-risk patients responded less to traditional triplet combination therapy than normal risk patients.