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. 2025 Sep;25(9):676-683.e11.
doi: 10.1016/j.clml.2025.03.011. Epub 2025 Mar 29.

Clinicians' Perspectives and Methodological Application of Fluorescence in situ Hybridization (FISH) to Define Cytogenetic Risk in Multiple Myeloma: An Italian, Real-World, Survey-Based Report From the European Myeloma Network (EMN) Italy

Lorenzo Cani  1 , Maria Teresa Petrucci  2 , Katia Mancuso  3 , Renato Zambello  4 , Laura Paris  5 , Sara Aquino  6 , Flavia Lotti  7 , Francesco Vassallo  8 , Norbert Pescosta  9 , Micol Quaresima  10 , Patrizia Tosi  11 , Iolanda Donatella Vincelli  12 , Sonia Ronconi  13 , Nicola Giuliani  14 , Francesco Pisani  15 , Mario Luppi  16 , Rita Rizzi  17 , Rita Mazza  18 , Delia Rota-Scalabrini  19 , Claudia Cellini  20 , Silvia Mangiacavalli  21 , Giuseppe Pietrantuono  22 , Maria Luisa Pioltelli  23 , Antonietta Pia Falcone  24 , Elisabetta Antonioli  25 , Angelo Belotti  26 , Sonia Morè  27 , Benedetto Bruno  1 , Mario Boccadoro  28 , Mattia D'Agostino  29
Affiliations
Free article

Clinicians' Perspectives and Methodological Application of Fluorescence in situ Hybridization (FISH) to Define Cytogenetic Risk in Multiple Myeloma: An Italian, Real-World, Survey-Based Report From the European Myeloma Network (EMN) Italy

Lorenzo Cani et al. Clin Lymphoma Myeloma Leuk. 2025 Sep.
Free article

Abstract

Background: Fluorescence in situ hybridization (FISH) is the standard technique for the prognostic detection of cytogenetic abnormalities (CA) in multiple myeloma (MM). In Italy, the application of practical guidelines for FISH testing in clinical studies and the degree of standardization of laboratory techniques are largely unknown.

Methods: We conducted a survey from April to July 2023 among 70 MM-treating centers associated with the European Myeloma Network Italy and geographically well distributed across Italy. We aimed to record laboratory and clinicians' perspectives about FISH application in Italy, with a focus on 1q alterations.

Results: FISH was widely accessible across the country, with 71% of centers performing it locally, while the remaining centers (predominantly those with <30 newly diagnosed MM cases/year) sent samples to external laboratories. Variability in laboratory techniques, such as CD138+ cell purification and CA detection thresholds, was observed among centers. The centers analyzed del(17p) (100%), t(4;14) (100%), t(14;16) (98%), 1q+ (96%, with 70% distinguishing between gain and amplification), t(11;14) (90%), del(1p32) (88%), del(13q) (68%), and hyperdiploidy (52%). FISH emerged as a crucial prognostic technique, since 94% of centers used the Revised International Staging System (R-ISS) at diagnosis, and 69% implemented the recent R2-ISS. Most centers performed FISH at diagnosis in all patients, while others did not routinely perform FISH in some categories of patients (e.g., aged >80 years). At relapse, 53% of centers routinely repeated FISH testing, 9% did not, while others repeated it selectively.

Conclusions: This overview of FISH use in Italy provides a basis for future standardization efforts.

Keywords: Clinical decision-making; Cytogenetic abnormalities; Laboratory practices; Real-life data; Risk stratification.

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Conflict of interest statement

Disclosure MTP has received honoraria from and served on the advisory boards for Johnson & Johnson, Bristol Myers Squibb, Amgen, Sanofi, GlaxoSmithKline, Takeda, Oncopeptides, Pfizer, Menarini, and AbbVie. KM has received honoraria from Sanofi, Amgen, Janssen, GlaxoSmithKline, Celgene, and Oncopeptides. RZ has served on the advisory boards for Amgen, GlaxoSmithKline, Sanofi, Janssen, Oncopeptides, and Menarini. LP has received honoraria from Takeda, Amgen, Bristol Myers Squibb, Sanofi, and Janssen; has served on the advisory boards for Bristol Myers Squibb, Amgen, Sanofi, and Janssen; has received consultancy fees from Janssen. SA has served on the advisory boards for Menarini Stemline Italia S.r.l. MQ has served on the advisory boards for Novartis. NG has received research funding from Pfizer; has served on the advisory boards for Takeda, Pfizer, Stemline (Menarini); has received speaker fees from Amgen and Sanofi. ML has served on the advisory boards for and has received honoraria for participation in meetings from AbbVie, Jazz Pharma, Novartis, Grifols, Sanofi, Incyte, Istituto Gentili, Roche, and AstraZeneca. RM ​has served on advisory boards and has provided training and scientific consultancy for Sanofi, Johnson & Johnson, Menarini Stemline, and Takeda. CC has served on the advisory boards for Janssen and Amgen; has provided consultancy for Menarini, Sanofi, and Takeda. SM has received honoraria from Sanofi, Janssen, Bristol Myers Squibb, Pfizer, Menarini Stemline, GlaxoSmithKline, and Takeda; has served on the advisory boards for Janssen, GlaxoSmithKline, Pfizer, and Menarini Stemline. EA has received honoraria from Sanofi; has served on the advisory boards for GlaxoSmithKline, Pfizer, and Menarini Stemline. AB has served on the advisory boards for Amgen, Janssen, GlaxoSmithKline, and Menarini Stemline. SM has received honoraria from GlaxoSmithKline, Janssen, Menarini, and Pfizer. MB has received honoraria from Sanofi, Celgene, Amgen, Janssen, Novartis, Bristol Myers Squibb, and AbbVie; has served on the advisory boards for Janssen and GlaxoSmithKline; has received research funding from Sanofi, Celgene, Amgen, Janssen, Novartis, Bristol Myers Squibb, and Mundipharma. MD has received honoraria from GlaxoSmithKline, Sanofi, and Janssen; has served on the advisory boards for GlaxoSmithKline, Sanofi, Bristol Myers Squibb, and Adaptive Biotechnologies; has received research support from Janssen. The other authors declare no competing financial interests.