We prospectively obtained 192 BM samples from 166 PCM patients at Asan Medical Center, Seoul, Korea, between May 2016 and May 2017; four samples were excluded because of lack of sample volume or patient information, and 188 samples from 162 PCM patients were included. The BM samples of PCM patients included 81 samples obtained at diagnosis and 107 obtained at follow-up. The mean value of the follow-up period after initial diagnosis was 31.8 ± 36.5 months and that after stem cell transplantation (SCT) was 23.3 ± 30.5 months. PCM disease stage and treatment response were determined, according to the Revised International Staging System (R-ISS) developed by the International Myeloma Working Group in 2014 [5]. We assessed patient characteristics and medical history by chart review and performed laboratory investigations, including free light chain, M-peak, FISH, and karyotyping, as routine practice for PCM work-up. Fifty-three patients with available albumin, lactate dehydrogenase, karyotype, FISH, and β-2-microglobulin test results at diagnosis were classified using R-ISS index criteria; three were at R-ISS stage I; 34, at stage II; and 15, at stage III. Follow-up patients were divided into two groups: those treated with chemotherapy (CTx; N= 51) and those receiving autologous SCT (N= 56) (Table 1). Cytogenetic abnormalities were categorized as standard-, intermediateand high-risk using the Mayo stratification for myeloma and risk-adapted therapy classification (mSMART) [6].

Patient characteristics

Abbreviations: CTx, chemotherapy; CR, complete remission; RD, residual disease; SCT, stem cell transplantation; VTD, vincristine/thalidomide/dexamethasone; TD, thalidomide/dexamethasone; VMP, vincristine/melphalan/prednisolone; HD-Dexa, high-dose dexamethasone; TCD, thalidomide/cycolophosphamide/dexamethasone; R-ISS, revised international staging system; CTx-CR, with complete remission after chemotherapy; CTx-RD, with residual disease after chemotherapy; SCT-CR, with complete remission after stem cell transplantation; SCT-RD, with residual disease after stem cell transplantation; BM, bone marrow; t, translocation; del, deletion.

Control BM samples were collected from 32 patients who had undergone a BM study owing to cytopenia or fever of unknown origin, had no hematologic malignancy of the BM, and were reported as having normo/hypo/hypercellular marrow.

This study was approved by the Institutional Review Board of Asan Medical Center (Approval Number: 20161087); the subjects’ informed consent to participate in research was waived. Written informed consent was obtained from all patients for the BM biopsy procedures and genetic testing, and the study was performed in accordance with the Declaration of Helsinki.

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