A patient with multiple myeloma undergoes bone marrow biopsy. FISH shows t(4;14)(p16;q32) translocation involving MMSET/FGFR3. Compared to standard-risk myeloma, this translocation confers what prognostic significance and therapeutic implication?
- A Favorable prognosis; thalidomide preferred over bortezomib
- B Standard-risk; no specific therapeutic modification needed
- C High-risk cytogenetics; bortezomib-based regimens partially overcome the adverse prognosis ✓
- D Favorable prognosis due to FGFR3 overexpression enabling targeted therapy
Correct answer: C. High-risk cytogenetics; bortezomib-based regimens partially overcome the adverse prognosis
Explanation
The t(4;14) translocation in multiple myeloma, present in approximately 15% of cases, leads to overexpression of MMSET (NSD2) histone methyltransferase and sometimes FGFR3, representing high-risk cytogenetics associated with shorter survival. Bortezomib-containing regimens can partially abrogate this adverse prognosis, unlike thalidomide. Patients with t(4;14) are typically upfronted with autologous stem cell transplant and bortezomib-based induction. del(17p) involving TP53 is the highest-risk abnormality.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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