EBMT 2026 | The outcomes of patients with t(4;14) multiple myeloma after autologous transplantation

So in fact upfront autologous hematopoietic cell transplantation still constitutes the standard of care for newly diagnosed multiple myeloma and both single and tandem strategies are used based on the risks of the disease and among those translocation t(4;14) is used to stratify this risk. And it is in fact quite prevalent because approximately 10% of all newly diagnosed multiple myeloma patients are positive for t(4;14). And in our study, we wanted to answer the question, what were the outcomes of those patients? And most importantly, we also wanted to check whether tandem transplantation is associated with any benefit in terms of outcomes. 

We stratified those patients based on the presence or co-occurrence of other cytogenetic abnormalities. So in our group, we did have patients with translocation t(4;14), which was a sole abnormality, we had patients with translocation t(4;14) and additional high-risk cytogenetic abnormalities, and we also had patients with other abnormalities apart from t(4;14). And I think that most importantly, we also performed a separate analysis for patients with t(4;14) and abnormalities of chromosome 1. In this analysis, we included patients who were transplanted between 2016 and 2022, which was important to allow a sufficient follow-up time. And I must say that we had an amazing group of patients of more than 3,000 patients identified in the registry, among whom approximately half did have these additional high-risk mutations. 

And the outcomes, well, I will present them. So, in fact, the three-year PFS for the whole cohort was 42% and the three-year OS was 72%. But most importantly, we looked at those patients based on their co-occurring cytogenetic mutations/abnormalities. And patients who additionally did have other high-risk cytogenetic abnormalities did have the shortest overall survival, the shortest progression-free survival, and those worst outcomes were conferred by a high incidence of relapse. When we looked then at the group of patients with additional high-risk cytogenetic abnormalities, we found that patients who did have the abnormalities of chromosome one did have the worst outcomes. And for them, the three-year PFS was only 35%, and they had a very high relapse rate at three years, which was 61%. 

And then we asked the most important question for us, which was whether tandem transplantation does confer any survival benefit. And in fact, we looked first at the whole group of patients with translocation t(4;14), and we did not find any benefit for this cohort. And then we looked separately at patients with different cytogenetic abnormalities, including patients with translocation t(4;14) and abnormalities of chromosome 1. And also here, we were not able to show any benefit in terms of any of the reported outcomes. 

So our conclusion was that in fact the outcomes of patients with translocation t(4;14), especially with high-risk cytogenetic abnormalities and especially again with abnormalities of chromosome 1, were inferior to those for the general multiple myeloma population. And I think that the most important thing for everyday clinical practice was that in fact, we were not able to show that performing tandem transplantation is beneficial for the patient. So these are the results and we are very happy to share them with a hematological audience.

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