Figure 1.

Genetic events from initiation to progression in multiple myeloma pathogenesis. Chromosomal aberrations involving immunoglobulin heavy chain (IGH) at the 14q32 region and the hyperdiploid are considered primary translocations as they are mutually exclusive and present in asymptomatic stages. Secondary aberrations follow primary events contributing to tumor progression and relapse. Secondary events cooperate with primary events to produce the malignant PC phenotype. The progression from MGUS-SMM to MM is associated with RAS mutation, MYC overexpression, and amplification of 1q21. Incidence of MYC translocation, deletion of 17p, and recurrent mutations increased as disease progressed. The initiation of aberrant clones at the onset of the disease is indicated in yellow. Red indicates the accumulation of malignant clones during disease progression. Percentage is indicated at new diagnosis. Asterisk indicates P53 mutation.