Alterations in chromosome 1q in multiple myeloma randomized clinical trials: a systematic review

• Published in: Blood cancer journal (New York) Vol. 14; no. 1; pp. 20 - 8
• Main Authors: Neupane, Karun, Fortuna, Gliceida Galarza, Dahal, Riyasha, Schmidt, Timothy, Fonseca, Rafael, Chakraborty, Rajshekhar, Koehn, Kelly Ann, Mohan, Meera, Mian, Hira, Costa, Luciano J., Sborov, Douglas, Mohyuddin, Ghulam Rehman
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 25.01.2024; Springer Nature B.V; Nature Publishing Group
• Subjects: 692/420/2489/68/2486; 692/699/67/395; Antineoplastic Combined Chemotherapy Protocols; Biomedical and Life Sciences; Biomedicine; Bortezomib - therapeutic use; Cancer Research; Chromosome Aberrations; Chromosomes, Human, Pair 1 - genetics; Hematology; Humans; Lenalidomide - therapeutic use; Multiple myeloma; Multiple Myeloma - drug therapy; Multiple Myeloma - genetics; Oncology; Prognosis; Randomized Controlled Trials as Topic; Systematic review
• ISSN: 2044-5385; 2044-5385
• DOI: 10.1038/s41408-024-00985-0

Extra copies of chromosome 1q21 (+1q: gain = 3 copies, amp >= 4 copies) are associated with worse outcomes in multiple myeloma (MM). This systematic review assesses the current reporting trends of +1q, the efficacy of existing regimens on +1q, and its prognostic implications in MM randomized controlled trials (RCTs). Pubmed, Embase and Cochrane Registry of RCTs were searched from January 2012 to December 2022. Only MM RCTs were included. A total of 124 RCTs were included, of which 29 (23%) studies reported on +1q. Among them, 10% defined thresholds for +1q, 14% reported survival data separately for gain and amp, and 79% considered +1q a high-risk cytogenetic abnormality. Amongst RCTs that met the primary endpoint showing improvement in progression free survival (PFS), lenalidomide maintenance (Myeloma XI), selinexor (BOSTON), and isatuximab (IKEMA and ICARIA) were shown to improve PFS for patients with evidence of +1q. Some additional RCT’s such as Myeloma XI+ (carfilzomib), ELOQUENT-3 (elotuzumab), and HOVON-65/GMMG-HD4 (bortezomib) met their endpoint showing improvement in PFS and also showed improvement in PFS in the +1q cohort, although the confidence interval crossed 1. All six studies that reported HR for +1q patients vs. without (across both arms) showed worse OS and PFS for +1q. There is considerable heterogeneity in the reporting of +1q. All interventions that have shown to be successful in RCTs and have clearly reported on the +1q subgroup have shown concordant direction of results and benefit of the applied intervention. A more standardized approach to reporting this abnormality is needed.