Multiple myelomda kromozomal aberasyonlar: klinik sonuçlar ve bortezomib’ e yanıt

Amaç:Multiple myelom heterojen bir hastalık olup, en etkin tedavinin planlanlanabilmesi için kromozomal aberasyonların prognostic ve prediktif değerlerinin anlaşılması önemlidir. Bu çalışmada kurumumuzda tanı almış hastaların kromozomal aberasyonlarının sıklığını ve tedavi seçenekleri ile arasındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntem:Ocak 2010 ve Aralık 2015 tarihleri arasında kurumumuzda tanı almış multiple myelomlu hastalarda, interfaz-floresan in situ hibridizasyon yöntemi ile del(17p13), del(13q14), t(11;14), and t(4;14) kromozomal aberasyonlarının sıklığını araştırdık. Bu sonuçların, konvansiyonel kemoterapi alan hastalar ile bortezomib tabanlı kemoterapi alan hastalardaki yanıtlarını karşılaştırdık. Bulgular:Seksen hastada (%72.7) en az bir adet kromozomal aberasyon saptandı. En sık saptanan aberasyon del(17p13) (%48.2) idi. Bunu sırasıyla del(13q14) (%40.9), t(11;14) (%16.4), ve t(4;14) (%11.8) takip etmekteydi. Klinik bulgularına ulaşılabilen 67 hastalık grupta, Bortezomib tabanlı kemoterapi alan 36 hastanın tedaviye yanıt oranı (%55.6) konvansiyonel kemoterapi alan gruba oranla (%48.4) daha yüksek idi. Kromozomal aberasyonlar ile karşılaştırıldığında; del (17p13) saptanan hastaların Bortezomib tabanlı kemoterapiye yanıtları (%63.2), konvansiyonel kemoterapi alanlardan (%50) daha yüksek saptandı. Benzer şonuç; del (13q14) saptanan  hastalarda da gözlendi (Bortezomib alanlarda %61.5, konvansiyonel kemoterapi alanlarda %50). Sonuç: Bortezomib içeren tedaviler özellikle del (17p13) ve del (13q14) aberayonu saptanan hastalarda daha iyi sonuç vermektedir.

Chromosomal aberrations in multiple myeloma: clinical outcome and response to bortezomib.

Purpose: Multiple myeloma is a heterogeneous disease, for which an understanding of the prognostic and predictive value of chromosomal aberrations is necessary to prescribe the most appropriate therapy. We aimed to document the frequencies of chromosomal aberrations in our institute and searched the relationships between therapy regimens and chromosomal aberrations. Materials and methods: We analyzed the frequency of del(17p13), del(13q14), t(11;14), and t(4;14) in patients with MM by interphase-fluorescent in situ hybridization who were diagnosed between January 2010 and December 2015 in our institute. We researched the relationship between response to conventional chemotherapy and Bortezomib based chemotherapy.Results: Eighty patients (72.7%) had at least one chromosomal aberration. The most frequently observed aberration was del(17p13) (48.2%), followed by del(13q14) (40.9%), t(11;14) (16.4%), and t(4;14) (11.8%). In clinically analyzed subgroup (n=67), 36 patients who received Bortezomib based chemotherapy showed a higher response rate (55.6%) than conventional chemotherapy group (48.4%). With respect to chromosomal aberrations, response rates were higher in Bortezomib based therapy group (63.2%) than conventional chemotherapy group  (50%) in del (17p13) positive patients as well as in del (13q14) positive patients (61.5% in Bortezomib based, 50% in conventional chemotherapy group). Conclusion: Bortezomib-containing regimens may have beneficial effects on the clinical outcome of patients with del (17p13) and del (13q14). 

Kaynakça

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