A 70-year-old man is diagnosed with multiple myeloma with CRAB features. ISS stage III based on β2-microglobulin 6.2 mg/L and albumin 2.8 g/dL. FISH reveals deletion 17p. Which statement about this patient's risk stratification and treatment approach is correct?
- A Del 17p has neutral prognostic impact when ISS staging is applied
- B Del 17p confers high cytogenetic risk; bortezomib-containing triplet (VRd or VCd) is preferred as bortezomib partially overcomes del 17p adverse prognosis ✓
- C Thalidomide-dexamethasone doublet is preferred to avoid bortezomib neuropathy in elderly
- D Del 17p indicates the tumour will not respond to proteasome inhibitors
Correct answer: B. Del 17p confers high cytogenetic risk; bortezomib-containing triplet (VRd or VCd) is preferred as bortezomib partially overcomes del 17p adverse prognosis
Explanation
Deletion 17p (affecting TP53) is one of the highest-risk cytogenetic abnormalities in myeloma by R-ISS staging, associated with median OS under 2 years. Bortezomib-containing regimens (VRd — bortezomib, lenalidomide, dexamethasone or VCd) are guideline-preferred because bortezomib partially overcomes the poor prognosis conferred by del 17p through TP53-independent apoptotic pathways. IMiD doublets without PI are inferior in high-risk cytogenetics. Bortezomib neurotoxicity is managed by subcutaneous administration and weekly dosing in elderly patients.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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