Mutational Spectrum, Copy Number Changes, and Outcome: Results of a Sequencing Study of Patients With Newly Diagnosed Myeloma
Open accessAbstract
Purpose: At the molecular level, myeloma is characterized by copy number abnormalities and recurrent translocations into the immunoglobulin heavy chain locus. Novel methods, such as massively parallel sequencing, have begun to describe the pattern of tumor-acquired mutations, but their clinical relevance has yet to be established. Methods: We performed whole-exome sequencing for 463 patients who presented with myeloma and were enrolled onto the National Cancer Research Institute Myeloma XI trial, for whom complete molecular cytogenetic and clinical outcome data were available. Results: We identified 15 significantly mutated genes: IRF4, KRAS, NRAS, MAX, HIST1H1E, RB1, EGR1, TP53, TRAF3, FAM46C, DIS3, BRAF, LTB, CYLD, and FGFR3. The mutational spectrum is dominated by mutations in the RAS (43%) and nuclear factor-κB (17%) pathways, but although they are prognostically neutral, they could be targeted therapeutically. Mutations in CCND1 and DNA repair pathway alterations (TP53, ATM, ATR, and ZNFHX4 mutations) are associated with a negative impact on survival. In contrast, those in IRF4 and EGR1 are associated with a favorable overall survival. We combined these novel mutation risk factors with the recurrent molecular adverse features and international staging system to generate an international staging system mutation score that can identify a high-risk population of patients who experience relapse and die prematurely. Conclusion: We have refined our understanding of genetic events in myeloma and identified clinically relevant mutations that may be used to better stratify patients at presentation.
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KRAS and NRAS mutations induce activation of ERK and are common in MM, present in 23-54% at new diagnosis and increasing to 45-81% in RRMM patients.
“The mutations of KRAS and NRAS induce the activation of ERK are common in MM, and these mutations present in 23-54% with a new diagnosis, but it increases to 45-81% in RRMM patients [90–92].”
From Multiple myeloma: signaling pathways and targeted therapy (2024) · cites this paper as [90]
The Results (‘Significantly mutated genes and altered pathways’; page unavailable) report KRAS mutations in 21.2% and NRAS mutations in 19.4% of patients with newly diagnosed myeloma, supporting that these mutations are common and fall within the cited newly diagnosed range. The paper links them to RAS/MAPK pathway deregulation, but does not specifically report ERK activation or the claimed 45–81% frequency in relapsed or refractory myeloma; its Methods (‘Patient Samples’; page unavailable) describe a newly diagnosed cohort. (LLM, conf=0.88)
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- Authors
- Walker, B. A., Boyle, E. M., Wardell, C. P., Murison, A., Begum, D. B., Dahir, N. M., Proszek, P. Z., Johnson, D. C., Kaiser, M. F., Melchor, L., Aronson, L. I., Scales, M., Pawlyn, C., Mirabella, F., Jones, J. R., Brioli, A., Mikulasova, A., Cairns, D. A., Gregory, W. M., Quartilho, A., Drayson, M. T., Russell, N., Cook, G., Jackson, G. H., Leleu, X., Davies, F. E., & Morgan, G. J.
- Affiliations
- University of Leeds (GB)
- Brian A. Walker, Eileen M. Boyle, Christopher P. Wardell, Alex Murison, Dil B. Begum, Nasrin M. Dahir, Paula Z. Proszek, David C. Johnson, Martin F. Kaiser, Lorenzo Melchor, Lauren I. Aronson, Charlotte Pawlyn, Fabio Mirabella, John R. Jones, Annamaria Brioli, Faith E. Davies, and Gareth J. Morgan, The Institute of Cancer Research, London; Matthew Scales, The Institute of Cancer Research, Surrey; David A. Cairns, Walter M. Gregory, and Ana Quartilho, University of Leeds; Gordon Cook, St James's...
- ORCID
- Walker, Brian A.
- Boyle, Eileen M.
- Wardell, Christopher P.
- Proszek, Paula Z.
- Johnson, David C.
- Kaiser, Martin F.
- Melchor, Lorenzo
- Aronson, Lauren I.
- Pawlyn, Charlotte
- Mirabella, Fabio
- Jones, John R.
- Brioli, Annamaria
- Cairns, David A.
- Gregory, Walter M.
- Quartilho, Ana
- Drayson, Mark T.
- Russell, Nigel
- Cook, Gordon
- Jackson, Graham H.
- Leleu, Xavier
- Davies, Faith E.
- Morgan, Gareth J.
- Venue
- Journal of Clinical Oncology
- Published
- 2015-11-20
- Volume
- 33
- Issue
- 33
- Pages
- 3911-3920
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC6485456
- OpenAlex
- W2169846247
- Semantic Scholar
- a23d5e88c245fa590b738b5bd0ba3ab9403f8887
- Cited by
- 567
- References
- 53
- Citations by year
- 2026: 13 · 2025: 36 · 2024: 43 · 2023: 38 · 2022: 69 · 2021: 73 · 2020: 62 · 2019: 63 · 2018: 63 · 2017: 62 · 2016: 37 · 2015: 4
- FWCI
- 43.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Cancer Research Institute
- National Cancer Research Institute
- Cancer Research UK (C2470/A17761, C2470/A14261, C2470/A12136)
- University of Leeds
- University of Nottingham
- Medical Research Council (MR/L01629X/1)
- Topics
- Health Sciences › Medicine › Hematology › Multiple Myeloma Research and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphoma Diagnosis and Treatment
- Health Sciences › Medicine › Genetics › Chronic Lymphocytic Leukemia Research
- Keywords
- multiple myeloma, mutation spectrum, copy number alterations, prognostic factors, RAS mutations, NF-κB signaling, TP53 mutation, CCND1, IRF4, EGR1, relapse risk, overall survival, therapeutic target
- MeSH terms
- Adult, DNA Mutational Analysis, Female, United Kingdom, Humans, Male, Middle Aged, Multiple Myeloma, Prospective Studies, Multivariate Analysis, Proportional Hazards Models, Survival Analysis, ras Proteins, Genetic Predisposition to Disease, Young Adult, DNA Copy Number Variations, High-Throughput Nucleotide Sequencing
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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