© F e r r a t a S t o r t i F o u n d a t i o n © F e r r a t a S t o r t i F o u n d a t i o nto better define SMM patients with different clinical outcomes.
Design and Methods
PatientsA total of 123 HR-SMM patients were randomized to receive nine Len-Dex cycles plus maintenance (intervention arm) versus no treatment (abstention arm). 15,16 HR-SMM were defined by the presence of more than 10% PCs in BM and an MC of IgG more than 3 g/dL, IgA more than 2 g/dL, or Bence Jones proteinuria more than 1 g/24 h together with the absence of CRAB.2 Patients meeting either, but not both, of these two criteria were also included in the study if they met the additional criterion of having 95% or more phenotypically aberrant PCs from the total BMPC compartment (aPC/BMPC) plus immunoparesis. 11 The study was approved by the research ethics committees of all participating centers and written informed consent was obtained from all patients in accordance with the Declaration of Helsinki.
Sample preparationBM samples were collected at the time of inclusion, at symptomatic progression and after nine months of either treatment or abstention. In all the BM samples, CD138-positive PC selection (purity >95%) was carried out using the AutoMACs separation system (Miltenyi-Biotec, Auburn, CA, USA). PCs were frozen in RLT buffer (Quiagen, Valencia, CA, USA) and nucleic acids were then extracted using commercially available kits (Allprepkit, Qiagen, Valencia, CA, USA) according to the manufacturer's instructions. RNA and DNA quality and quantity were determined using 2100 Bioanalyzer (Agilent, Palo Alto, CA, USA) and ND-1000 Spectrophotometer (Nano-Drop Technologies, Wilmington, DE, USA), respectively.
Interphase fluorescence in situ hybridization analysisFluorescence in situ hybridization (FISH) analysis was performed in all samples at diagnosis and in 11 samples at symptomatic progression. The systematic screening for genomic aberrations in our institution includes FISH studies for detecting IGH rearrangements t(11;14)(q13;q32), t(4;14)(p16;q32) and t(14;16)(q32;q23) with the corresponding dual-color, dual-fusion translocation probes (Abbott Molecular/Vysis), 13q (LSI 13, RB1 13q14) and 17p deletions (LSI p53, 17p13.1) (Abbott Molecular/Vysis), and 1q gains (on 1q21/SRD 1p36, Kreatech Diagnostics, Amsterdam).17 FISH results of 80% of the patients included in the present study have been reported previously.
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Gene expression profiling and SNP-array studiesThe gene expression profiling (GEP) was investigated using Human Gene 1.0 ST (Affymetrix, Santa Clara, CA, USA) in 33 samples at the time of inclusion and 6 at the time of progression. Differentially expressed genes were identified using Significant Analysis of Microarrays (SAM). Genome-wide detection of copy number abnormalities and loss of heterozygosity (LOH) was also performed in 20 samples at diagnosis using the Genome-Wide Human SNP Array 6.0 assay protocol (Affymetrix, Santa Clara, CA, USA). The complete dataset was analyzed by visual inspection using the Genotyping Cons...