In multiple myeloma, which molecular event defines 'high-risk' cytogenetics that predicts poor prognosis regardless of treatment?
- A t(4;14), t(14;16), del(17p), and gain(1q21) ✓
- B t(11;14) translocation
- C Hyperdiploidy alone
- D del(13q) as detected by FISH alone
Correct answer: A. t(4;14), t(14;16), del(17p), and gain(1q21)
Explanation
High-risk cytogenetic features in myeloma by IMWG criteria include: t(4;14) — FGFR3/MMSET translocation, t(14;16) — MAF translocation, del(17p) — TP53 deletion, and gain(1q21). These predict shorter PFS and OS even with novel agents. t(11;14) is associated with standard risk and bcl-2 overexpression (venetoclax sensitivity). Hyperdiploidy (odd-numbered trisomies) is a favourable-risk feature. Del(13q) alone (by FISH) does not independently confer high risk — it matters in combination with IgH translocations.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.