A 65-year-old woman with multiple myeloma undergoes bone marrow biopsy. Cytogenetics reveals t(4;14)(p16;q32). This translocation juxtaposes the IGH gene with FGFR3/MMSET, and is significant because it predicts:
- A Favorable prognosis and excellent response to standard bortezomib-based therapy
- B Intermediate prognosis with hyperdiploid karyotype
- C High-risk disease with inferior outcome despite novel therapy ✓
- D Loss of chromosome 13 as the primary event
Correct answer: C. High-risk disease with inferior outcome despite novel therapy
Explanation
t(4;14) is classified as high-risk cytogenetics in multiple myeloma along with t(14;16), t(14;20), del(17p13), and del(1p32). It results in overexpression of FGFR3 and MMSET histone methyltransferase, conferring aggressive disease biology. Despite the use of bortezomib-based regimens (which partly overcome the t(4;14) risk), outcomes remain inferior compared to hyperdiploid myeloma (which carries favorable prognosis). Risk stratification guides transplant eligibility and maintenance decisions.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.