Clinical and cytogenetic features of nonsecretory multiple myeloma (NSMM) in the era of novel agent induction therapy: The Mayo Clinic experience.

person Bharat Nandakumar Division of Hematology,Mayo Clinic, Rochester, MN info_outline Bharat Nandakumar, Wilson I. Gonsalves, Francis Buadi, Angela Dispenzieri, David Dingli, Martha Lacy, Prashant Kapoor, Yi Lin, Taxiarchis Kourelis, Eli Muchtar, Ronald S. Go, Rahma M. Warsame, Suzanne R. Hayman, Nelson Leung, Lisa Hwa, Amie L. Fonder, Robert A. Kyle, Morie A. Gertz, S. Vincent Rajkumar, Shaji Kumar

Authors person Bharat Nandakumar Division of Hematology,Mayo Clinic, Rochester, MN info_outline Bharat Nandakumar, Wilson I. Gonsalves, Francis Buadi, Angela Dispenzieri, David Dingli, Martha Lacy, Prashant Kapoor, Yi Lin, Taxiarchis Kourelis, Eli Muchtar, Ronald S. Go, Rahma M. Warsame, Suzanne R. Hayman, Nelson Leung, Lisa Hwa, Amie L. Fonder, Robert A. Kyle, Morie A. Gertz, S. Vincent Rajkumar, Shaji Kumar Organizations Division of Hematology,Mayo Clinic, Rochester, MN, Division of Hematology, Mayo Clinic, Rochester, MN, Mayo Clinic, Rochester, MN, Mayo Clinic, Division of Hematology, Rochester, MN Abstract Disclosures Research Funding U.S. National Institutes of Health Background: NSMM is a rare subtype of myeloma that has not been well characterized in the era of novel agent induction therapy. Thus, we evaluated the clinical and cytogenetic features of patients with newly diagnosed NSMM evaluated at our institution. Methods: We evaluated all NSMM patients seen at the Mayo Clinic, Rochester from 2008-2017 based on the absence of a detectable monoclonal protein in their serum and urine electrophoresis and having a concurrent involved serum immunoglobulin light chain of less than 5 mg/dL. Survival analysis was performed by the Kaplan-Meier method and clinical and cytogenetic features were reported descriptively. Results: This cohort consisted of 30 consecutive patients with NSMM with a median age of 62 years (40-79) of which 16 (53%) were male. The median bone marrow plasma cell involvement was 70% (Range: 0 – 100). There were 3/25 (12%) patients who presented with a creatinine of 2 mg/dL or greater and 6/23 (26%) patients who presented with hypercalcemia (11 mg/dL or greater). The ISS classification of this cohort is as follows: Stage 1- 8 (36%) patients, Stage 2- 3 (14%) patients and Stage 3- 11 (50%) patients. There were 6 (21%) out of 28 patients with high risk cytogenetics (either del 17p, t(4;14), t(14;16) or t(14;20). The distribution of primary cytogenetic abnormalities among this cohort was as follows: t(11;14) – 16 (57%), t(4;14) – 1 (4%), trisomies – 6 (21%) and other - 5 (13%). The median overall survival (OS) for patients in this cohort was 59 months (95% CI: 34 – 64). In comparison to a control cohort of newly diagnosed secretory myeloma patients matched for age, gender and year of diagnosis in a 1:2 ratio, the median OS was worse for the NSMM cohort but this was not statistically significant (59 vs. 92 months, p = 0.257). Conclusions: Patients diagnosed with NSMM had a predisposition towards having a t(11;14) primary cytogenetic abnormality. In the era of novel agent induction therapy, they may have a survival outcome that may be worse than newly diagnosed secretory myeloma patients.