诊断与鉴别诊断与分层.ppt

Del(17p) Del(17p)=11% 532 pts EFS OS No del(17p): 474 pts Del(17p) +: 58 pts p=1.10-7 No del(17p): 474 pts Del(17p) +: 58 pts p=3.10-7 No del(17p): 494 pts Del(17p) 60%: 38 pts p=5.10-11 No del(17p): 494 pts Del(17p) 60%: 38 pts p=4.10-12 Cytogenetic correlations t(4;14) and del(13) 84% del(13)=0 or 0 ? p=2.10-13 (C2) del(13)75% or 75% ? p=2.10-11 (C2) Tight association del(17p) and del(13) 77% del(13)=0 or 0 ? p=6.10-5 (C2) del(13)75% or 75% ? p=4.10-4 (C2) Tight association del(17p) and t(4;14) 14% p=0.51 Independent parameters Del(13) et t(4;14)/del(17p) p=0.41 p=0.12 Del(13) 0 no t(4;14), no del(17p) EFS OS Multiparametric analysis Independent prognostic parameters EFS: del(17p) t(4;14) b2m3 ou 4 Hb10g/dl OS: del(17p) t(4;14) b2m3 ou 4 Prognostic parameters: del(13), t(4;14), del(17p), 1q gains, b2m3/4 Hb10, albumine30 or 35, platelets130 mSMART 2.0: Classification of Active MM FISH Del 17p t(14;16) t(14;20) GEP High risk signature All others including: Hyperdiploid t(11;14)*** t(6;14) FISH t(4;14)* Cytogenetic Deletion 13 or hypodiploidy PCLI 3% High-Risk 20% Intermediate-Risk 20% Standard-Risk 60% ** * Prognosis is worse when associated with high beta 2 M and anemia ** LDH ULN and beta 2 M 5.5 in standard risk may indicate worse prognosis *** t(11;14) is associated with plasma cell leukemia mSMART 2.0: Classification of Active MM FISH Del 17p t(14;16) t(14;20) GEP High risk signature All others including: Hyperdiploid t(11;14) t(6;14) FISH t(4;14)* Cytogenetic Deletion 13 or hypodiploidy PCLI 3% 3 years 5 years 7-10 years mSMART 2.0: Treatment of Active MM Novel approaches New drugs “TT3 like” approach for p53 deletion ? Regimen which provides a high ORR and which minimizes early toxicity HDM could be delayed in patients achieving CR Lenalidomide maintenance Bortezomib based combination HDM +/- consolidation Lenalidomide maintenance Targeted therapy High-Risk Interm