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A multiple myeloma classification system that associates normal B-cell subset phenotypes with prognosis.

Accepted version
Peer-reviewed

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Type

Article

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Authors

Bødker, Julie Støve 
Brøndum, Rasmus Froberg 
Schmitz, Alexander 
Schönherz, Anna Amanda 
Jespersen, Ditte Starberg 

Abstract

Despite the recent progress in treatment of multiple myeloma (MM), it is still an incurable malignant disease, and we are therefore in need of new risk stratification tools that can help us to understand the disease and optimize therapy. Here we propose a new subtyping of myeloma plasma cells (PCs) from diagnostic samples, assigned by normal B-cell subset associated gene signatures (BAGS). For this purpose, we combined fluorescence-activated cell sorting and gene expression profiles from normal bone marrow (BM) Pre-BI, Pre-BII, immature, naïve, memory, and PC subsets to generate BAGS for assignment of normal BM subtypes in diagnostic samples. The impact of the subtypes was analyzed in 8 available data sets from 1772 patients' myeloma PC samples. The resulting tumor assignments in available clinical data sets exhibited similar BAGS subtype frequencies in 4 cohorts from de novo MM patients across 1296 individual cases. The BAGS subtypes were significantly associated with progression-free and overall survival in a meta-analysis of 916 patients from 3 prospective clinical trials. The major impact was observed within the Pre-BII and memory subtypes, which had a significantly inferior prognosis compared with other subtypes. A multiple Cox proportional hazard analysis documented that BAGS subtypes added significant, independent prognostic information to the translocations and cyclin D classification. BAGS subtype analysis of patient cases identified transcriptional differences, including a number of differentially spliced genes. We identified subtype differences in myeloma at diagnosis, with prognostic impact and predictive potential, supporting an acquired B-cell trait and phenotypic plasticity as a pathogenetic hallmark of MM.

Description

Keywords

B-Lymphocyte Subsets, Biomarkers, Tumor, Gene Expression Profiling, Humans, Immunophenotyping, Multiple Myeloma, Phenotype, Prognosis, Survival Analysis, Transcriptome

Journal Title

Blood Adv

Conference Name

Journal ISSN

2473-9529
2473-9537

Volume Title

2

Publisher

American Society of Hematology

Rights

All rights reserved
Sponsorship
Engineering and Physical Sciences Research Council (EP/N014588/1)
Engineering and Physical Sciences Research Council (EP/P031447/1)
Engineering and Physical Sciences Research Council (EP/J017213/1)