000291411 001__ 291411 000291411 005__ 20241111130035.0 000291411 0247_ $$2doi$$a10.3390/ijms25126431 000291411 0247_ $$2pmid$$apmid:38928138 000291411 0247_ $$2pmc$$apmc:PMC11204152 000291411 0247_ $$2ISSN$$a1422-0067 000291411 0247_ $$2ISSN$$a1661-6596 000291411 037__ $$aDKFZ-2024-01385 000291411 041__ $$aEnglish 000291411 082__ $$a540 000291411 1001_ $$00000-0002-2771-712X$$aSeckinger, Anja$$b0 000291411 245__ $$aMolecular Long-Term Analysis of the GMMG-HD4 Trial in Multiple Myeloma-Patterns of Association of Chromosomal Aberrations with Response and Proliferation Determining Survival in Selecting Treatments in View of Limited Resources in Low- and Middle-Income Countries. 000291411 260__ $$aBasel$$bMolecular Diversity Preservation International$$c2024 000291411 3367_ $$2DRIVER$$aarticle 000291411 3367_ $$2DataCite$$aOutput Types/Journal article 000291411 3367_ $$0PUB:(DE-HGF)16$$2PUB:(DE-HGF)$$aJournal Article$$bjournal$$mjournal$$s1719836769_5817 000291411 3367_ $$2BibTeX$$aARTICLE 000291411 3367_ $$2ORCID$$aJOURNAL_ARTICLE 000291411 3367_ $$00$$2EndNote$$aJournal Article 000291411 520__ $$aBased on the lack of differences in progression-free and overall survival after a median follow-up of 93 months in our HOVON-65/GMMG-HD4 trial (German part; n = 395) randomizing VAD induction (vincristin/adriamycin/dexamthasone)/tandem-transplantation/thalidomide-maintenance vs. PAD induction (bortezomib/adriamycin/dexamethasone)/tandem transplantation/bortezomib maintenance, we discern how chromosomal aberrations determine long-term prognosis by different patterns of association with proliferation and treatment-dependent response, whether responses achieved by different regimens are equal regarding prognosis, and whether subpopulations of patients could be defined as treatable without upfront 'novel agents' in cases of limited resources, e.g., in low- or middle-income countries. Serum parameters and risk factors were assessed in 395 patients. CD138-purified plasma cells were subjected to fluorescence in situ hybridization (n = 354) and gene expression profiling (n = 204). We found chromosomal aberrations to be associated in four patterns with survival, proliferation, and response: deletion (del) del17p13, del8p21, del13q14, (gain) 1q21+, and translocation t(4;14) (all adverse) associate with higher proliferation. Of these, del17p is associated with an adverse response (pattern 1), and 1q21+, t(4;14), and del13q14 with a treatment-dependent better response (pattern 2). Hyperdiploidy associates with lower proliferation without impacting response or survival (pattern 3). Translocation t(11;14) has no association with survival but a treatment-dependent adverse response (pattern 4). Significantly fewer patients reach a near-complete response or better with 'conventional' (VAD) vs. bortezomib-based treatment after induction or high-dose melphalan. These patients, however, show significantly better median progression-free and overall survival. Molecularly, patients responding to the two regimens differ in gene expression, indicating distinct biological properties of the responding myeloma cells. Patients with normal renal function (89.4%), low cytogenetic risk (72.5%), or low proliferation rate (37.9%) neither benefit in progression-free nor overall survival from bortezomib-based upfront treatment. We conclude that response level, the treatment by which it is achieved, and molecular background determine long-term prognosis. Chromosomal aberrations are associated in four patterns with proliferation and treatment-dependent responses. Associations with faster and deeper responses can be deceptive in the case of prognostically adverse aberrations 1q21+ and t(4;14). Far from advocating a return to 'outdated' treatments, if resources do not permit state-of-the-art-treatment, normal renal function and/or molecular profiling identifies patient subpopulations doing well without upfront 'novel agents'. 000291411 536__ $$0G:(DE-HGF)POF4-313$$a313 - Krebsrisikofaktoren und Prävention (POF4-313)$$cPOF4-313$$fPOF IV$$x0 000291411 588__ $$aDataset connected to CrossRef, PubMed, , Journals: inrepo02.dkfz.de 000291411 650_7 $$2Other$$aLMIC 000291411 650_7 $$2Other$$amolecular profiling 000291411 650_7 $$2Other$$amultiple myeloma 000291411 650_7 $$2Other$$aproliferation 000291411 650_7 $$2Other$$aresponse 000291411 650_7 $$2Other$$asurvival 000291411 650_7 $$07S5I7G3JQL$$2NLM Chemicals$$aDexamethasone 000291411 650_7 $$069G8BD63PP$$2NLM Chemicals$$aBortezomib 000291411 650_7 $$04Z8R6ORS6L$$2NLM Chemicals$$aThalidomide 000291411 650_2 $$2MeSH$$aHumans 000291411 650_2 $$2MeSH$$aMultiple Myeloma: genetics 000291411 650_2 $$2MeSH$$aMultiple Myeloma: drug therapy 000291411 650_2 $$2MeSH$$aMultiple Myeloma: mortality 000291411 650_2 $$2MeSH$$aMultiple Myeloma: pathology 000291411 650_2 $$2MeSH$$aChromosome Aberrations 000291411 650_2 $$2MeSH$$aFemale 000291411 650_2 $$2MeSH$$aMale 000291411 650_2 $$2MeSH$$aMiddle Aged 000291411 650_2 $$2MeSH$$aAged 000291411 650_2 $$2MeSH$$aAntineoplastic Combined Chemotherapy Protocols: therapeutic use 000291411 650_2 $$2MeSH$$aCell Proliferation: drug effects 000291411 650_2 $$2MeSH$$aPrognosis 000291411 650_2 $$2MeSH$$aAdult 000291411 650_2 $$2MeSH$$aDeveloping Countries 000291411 650_2 $$2MeSH$$aDexamethasone: therapeutic use 000291411 650_2 $$2MeSH$$aDexamethasone: pharmacology 000291411 650_2 $$2MeSH$$aBortezomib: therapeutic use 000291411 650_2 $$2MeSH$$aBortezomib: pharmacology 000291411 650_2 $$2MeSH$$aThalidomide: therapeutic use 000291411 7001_ $$aSalwender, Hans$$b1 000291411 7001_ $$aMartin, Hans$$b2 000291411 7001_ $$00009-0007-6539-226X$$aScheid, Christof$$b3 000291411 7001_ $$0P:(DE-He78)743a4a82daab55306a2c88b9f6bf8c2f$$aHielscher, Thomas$$b4$$udkfz 000291411 7001_ $$00000-0001-5584-3951$$aBertsch, Uta$$b5 000291411 7001_ $$0P:(DE-He78)fae4f3c76bbbd2fc21dd920b46945d42$$aHummel, Manuela$$b6 000291411 7001_ $$aJauch, Anna$$b7 000291411 7001_ $$aKnauf, Wolfgang$$b8 000291411 7001_ $$aEmde-Rajaratnam, Martina$$b9 000291411 7001_ $$aBeck, Susanne$$b10 000291411 7001_ $$00000-0003-1311-8107$$aNeben, Kai$$b11 000291411 7001_ $$aDührig, Jan$$b12 000291411 7001_ $$aLindemann, Walter$$b13 000291411 7001_ $$00000-0002-5655-0867$$aSchmidt-Wolf, Ingo G H$$b14 000291411 7001_ $$aHänel, Mathias$$b15 000291411 7001_ $$aBlau, Igor W$$b16 000291411 7001_ $$aWeisel, Katja$$b17 000291411 7001_ $$aWeinhold, Niels$$b18 000291411 7001_ $$aRaab, Marc S$$b19 000291411 7001_ $$aGoldschmidt, Hartmut$$b20 000291411 7001_ $$aChoon-Quinones, Mimi$$b21 000291411 7001_ $$aHose, Dirk$$b22 000291411 773__ $$0PERI:(DE-600)2019364-6$$a10.3390/ijms25126431$$gVol. 25, no. 12, p. 6431 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