Clinical and biological features of t(4;14) multiple myeloma: a prospective study

The t(4;14) translocation, found in 15%% of multiple myeloma (MM), indicates a poor prognosis. Clinico-biological features associated with this severe outcome and the impact of novel agents are unknown. We report a series of 102 consecutive patients with t(4;14) MM. The median age was 56 years. The isotype was IgA in 42%%, and the median serum beta beta(2)-microglobulin was 2.3 mg/L. FGFR3 expression was lacking in 20 (19%%) cases. Monoclonal gammopathy of undetermined significance (MGUS) or smoldering MM (sMM) was found in 26 patients (25%%). Seven (27%%) became symptomatic in a median time of 9 months. Fifty-six of 76 patients with symptomatic MM received high-dose therapy (HDT). The overall response rate (ORR) was 93%% (22%% CR, 44%% VGPR), and the median progression-free survival (PFS) was 12 months. Twenty-four (37%%) patients experienced aggressive relapse. Post-second-line ORR was 51%% and the median PFS was 7 months, with a trend for longer PFS in patients treated with a bortezomib-based regimen. Median overall survival after HDT was 31 months. t(4;14) is detected in patients with MGUS/sMM and this does not require immediate chemotherapy. Patients with t(4;14) MM have a high ORR after HDT, contrasting with a short PFS and aggressive relapses, and, despite novel agents, still have a poor prognosis.</.