A 72-year-old woman has multiple myeloma with t(4;14) translocation, del(17p) and bone marrow plasma cells 60%. She is ineligible for stem cell transplant. Which cytogenetic finding confers the HIGHEST risk and poorest prognosis?
- A t(11;14)
- B del(17p) (loss of TP53) ✓
- C t(4;14)
- D Hyperdiploidy
Correct answer: B. del(17p) (loss of TP53)
Explanation
Del(17p) involving the TP53 locus is the single most adverse cytogenetic marker in multiple myeloma, associated with the shortest progression-free and overall survival and resistance to conventional therapy. t(4;14) is also high-risk but responds to bortezomib-based therapy. t(11;14) is standard risk and is actually associated with sensitivity to venetoclax. Hyperdiploidy is a favorable cytogenetic finding associated with better outcomes.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.