A 65-year-old man has lytic bone lesions, serum M-spike of 4.2 g/dL, and plasma cells comprising 35% of bone marrow. Serum free light chain assay shows kappa:lambda ratio of 180. Which chromosome translocation most commonly seen in multiple myeloma confers the worst prognosis?
- A t(11;14) — CCND1/IGH
- B del(17p) involving TP53 ✓
- C t(4;14) — FGFR3/IGH and MMSET
- D t(14;16) — MAF/IGH
Correct answer: B. del(17p) involving TP53
Explanation
Deletion of 17p13.1 (involving TP53) confers the worst prognosis in multiple myeloma, associated with aggressive disease, resistance to therapy, and shortened survival. t(4;14) is a high-risk translocation activating FGFR3 and MMSET, while t(14;16) involving MAF is also adverse. t(11;14) with cyclin D1 overexpression is associated with standard or favorable risk and characteristically shows lymphoplasmacytic morphology.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.