Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Prognostic Value of Baseline 18F-Fluorodeoxyglucose PET/CT in Patients with Multiple Myeloma: A Multicenter Cohort Study

  • Moon, Seung Hwan (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Woo Hee (Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yoo, Ie Ryung (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Lee, Soo Jin (Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Paeng, Jin Chul (Department of Nuclear Medicine, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Jeong, Shin Young (Department of Nuclear Medicine, Kyungpook National University Medical Center, Kyungpook National University School of Medicine) ;
  • Lee, Sang-Woo (Department of Nuclear Medicine, Kyungpook National University Medical Center, Kyungpook National University School of Medicine) ;
  • Kim, Kihyun (Department of Medicine, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Joon Young (Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2017.05.31
  • Accepted : 2017.10.18
  • Published : 2018.06.01
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Abstract

Objective: We investigated the prognostic value of $^{18}F$-fluorodeoxyglucose positron emission tomography/computed tomography ($^{18}F$-FDG PET/CT) in patients with multiple myeloma (MM). Materials and Methods: Subjects were 76 patients with newly diagnosed myeloma and pretreatment with$^{18}F$-FDG PET/CT from four hospitals. The PET/CT features were evaluated and the clinical characteristics were reviewed. Prognostic factors related to poor progression-free survival (PFS) and overall survival (OS) were identified using a Cox proportional hazards regression model and a prediction scale was developed based on the identified factors. Results: Multivariate analysis showed that the presence of $^{18}F$-FDG-avid focal bone lesions (${\geq}3$) was a significant and independent predictor of PFS (hazard ratio [HR] = 3.28, p = 0.007) and OS (HR = 11.78, p = 0.001). The presence of extramedullary disease on PET/CT scan was also a significant predictor of poor PFS (HR = 2.79, p = 0.006) and OS (HR = 3.89, p = 0.003). A prognostic scale was developed using these two predictors. An increase in score on the scale corresponded to a significantly increased risk of poor OS (p = 0.005). In addition, Kaplan-Meier analysis demonstrated that patient survival varied significantly according to the scale (p < 0.001 for OS and p = 0.001 for PFS). Conclusion: $^{18}F$-FDG-avid focal lesions and the presence of extramedullary disease on PET/CT scan are significantly associated with poor OS in MM patients. The scale developed according to these predictors represents a potential prognostic tool for evaluation of patients with MM.

Keywords

Acknowledgement

Supported by : Korean Society of Nuclear Medicine

References

  1. Palumbo A, Anderson K. Multiple myeloma. N Engl J Med 2011;364:1046-1060 https://doi.org/10.1056/NEJMra1011442
  2. Terpos E, Dimopoulos MA. Myeloma bone disease: pathophysiology and management. Ann Oncol 2005;16:1223-1231 https://doi.org/10.1093/annonc/mdi235
  3. Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, et al. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003;78:21-33 https://doi.org/10.4065/78.1.21
  4. Dimopoulos M, Terpos E, Comenzo RL, Tosi P, Beksac M, Sezer O, et al. International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple myeloma. Leukemia 2009;23:1545-1556 https://doi.org/10.1038/leu.2009.89
  5. Zamagni E, Cavo M. The role of imaging techniques in the management of multiple myeloma. Br J Haematol 2012;159:499-513
  6. Delorme S, Baur-Melnyk A. Imaging in multiple myeloma. Eur J Radiol 2009;70:401-408 https://doi.org/10.1016/j.ejrad.2009.02.005
  7. Adam Z, Bolcak K, Stanicek J, Buchler T, Pour L, Krejci M, et al. Fluorodeoxyglucose positron emission tomography in multiple myeloma, solitary plasmocytoma and monoclonal gammapathy of unknown significance. Neoplasma 2007;54:536-540
  8. Zamagni E, Nanni C, Patriarca F, Englaro E, Castellucci P, Geatti O, et al. A prospective comparison of 18F-fluorodeoxyglucose positron emission tomographycomputed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma. Haematologica 2007;92:50-55 https://doi.org/10.3324/haematol.10554
  9. Agarwal A, Chirindel A, Shah BA, Subramaniam RM. Evolving role of FDG PET/CT in multiple myeloma imaging and management. AJR Am J Roentgenol 2013;200:884-890 https://doi.org/10.2214/AJR.12.9653
  10. Dinter DJ, Neff WK, Klaus J, Bohm C, Hastka J, Weiss C, et al. Comparison of whole-body MR imaging and conventional X-ray examination in patients with multiple myeloma and implications for therapy. Ann Hematol 2009;88:457-464 https://doi.org/10.1007/s00277-008-0621-6
  11. Ghanem N, Uhl M, Brink I, Schafer O, Kelly T, Moser E, et al. Diagnostic value of MRI in comparison to scintigraphy, PET, MS-CT and PET/CT for the detection of metastases of bone. Eur J Radiol 2005;55:41-55 https://doi.org/10.1016/j.ejrad.2005.01.016
  12. Bartel TB, Haessler J, Brown TL, Shaughnessy JD Jr, van Rhee F, Anaissie E, et al. F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma. Blood 2009;114:2068-2076 https://doi.org/10.1182/blood-2009-03-213280
  13. Zamagni E, Patriarca F, Nanni C, Zannetti B, Englaro E, Pezzi A, et al. Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation. Blood 2011;118:5989-5995 https://doi.org/10.1182/blood-2011-06-361386
  14. Dimitrakopoulou-Strauss A, Hoffmann M, Bergner R, Uppenkamp M, Haberkorn U, Strauss LG. Prediction of progression-free survival in patients with multiple myeloma following anthracycline-based chemotherapy based on dynamic FDG-PET. Clin Nucl Med 2009;34:576-584 https://doi.org/10.1097/RLU.0b013e3181b06bc5
  15. Haznedar R, Aki SZ, Akdemir OU, Ozkurt ZN, Ceneli O, Yagci M, et al. Value of 18F-fluorodeoxyglucose uptake in positron emission tomography/computed tomography in predicting survival in multiple myeloma. Eur J Nucl Med Mol Imaging 2011;38:1046-1053 https://doi.org/10.1007/s00259-011-1738-8
  16. Park S, Lee SJ, Chang WJ, Maeng CH, Hong JY, Choi MK, et al. Positive correlation between baseline PET or PET/CT findings and clinical parameters in multiple myeloma patients. Acta Haematol 2014;131:193-199 https://doi.org/10.1159/000354839
  17. Rajan AM, Rajkumar SV. Interpretation of cytogenetic results in multiple myeloma for clinical practice. Blood Cancer J 2015;5:e365 https://doi.org/10.1038/bcj.2015.92
  18. Pour L, Sevcikova S, Greslikova H, Kupska R, Majkova P, Zahradova L, et al. Soft-tissue extramedullary multiple myeloma prognosis is significantly worse in comparison to bone-related extramedullary relapse. Haematologica 2014;99:360-364 https://doi.org/10.3324/haematol.2013.094409
  19. Usmani SZ, Heuck C, Mitchell A, Szymonifka J, Nair B, Hoering A, et al. Extramedullary disease portends poor prognosis in multiple myeloma and is over-represented in high-risk disease even in the era of novel agents. Haematologica 2012;97:1761-1767 https://doi.org/10.3324/haematol.2012.065698
  20. Oriol A. Multiple myeloma with extramedullary disease. Adv Ther 2011;28 Suppl 7:1-6
  21. Varettoni M, Corso A, Pica G, Mangiacavalli S, Pascutto C, Lazzarino M. Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on 1003 consecutive patients. Ann Oncol 2010;21:325-330 https://doi.org/10.1093/annonc/mdp329
  22. Soret M, Bacharach SL, Buvat I. Partial-volume effect in PET tumor imaging. J Nucl Med 2007;48:932-945 https://doi.org/10.2967/jnumed.106.035774
  23. Kim SJ, Yi HK, Lim CH, Cho YS, Choi JY, Choe YS, et al. Intrapatient variability of FDG standardized uptake values in mediastinal blood pool, liver, and myocardium during R-CHOP chemotherapy in patients with diffuse large B-cell lymphoma. Nucl Med Mol Imaging 2016;50:300-307 https://doi.org/10.1007/s13139-016-0432-y
  24. Kumar SK, Rajkumar SV, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood 2008;111:2516-2520 https://doi.org/10.1182/blood-2007-10-116129
  25. Rajkumar SV, Gahrton G, Bergsagel PL. Approach to the treatment of multiple myeloma: a clash of philosophies. Blood 2011;118:3205-3211 https://doi.org/10.1182/blood-2011-06-297853
  26. Rajkumar SV. Treatment of myeloma: cure vs control. Mayo Clin Proc 2008;83:1142-1145 https://doi.org/10.4065/83.10.1142

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