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Jung SH, Koh Y, Kim MK, Kim JS, Moon JH, Min CK, Yoon DH, Yoon SS, Lee JJ, Hong CM, Kang KW, Kwon J, Kim KH, Kim DS, Kim SY, Kim SH, Kim YR, Do YR, Mun YC, Park SS, Park YH, Shin HJ, Eom HS, Yoon SE, Hwang SM, Lee WS, Lee MW, Yi JH, Lee JY, Lee JH, Lee HS, Lim SN, Lim J, Yhim HY, Chang YH, Jo JC, Cho J, Cho H, Choi YS, Cho HJ, Ahn A, Choi JH, Kim HJ, Kim K. Evidence-based Korean guidelines for the clinical management of multiple myeloma: addressing 12 key clinical questions. Blood Res 2025; 60:9. [PMID: 39903326 PMCID: PMC11794900 DOI: 10.1007/s44313-025-00055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 01/10/2025] [Indexed: 02/06/2025] Open
Abstract
Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM. In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treatment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, therapeutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.
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Affiliation(s)
- Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Youngil Koh
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Kyoung Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Joon Ho Moon
- Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chang-Ki Min
- Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Soo Yoon
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Republic of Korea
| | - Chae Moon Hong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ka-Won Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jihyun Kwon
- Department of Internal Medicine, Hematology and Oncology, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Kyoung Ha Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Dae Sik Kim
- Division of Oncology & Hematology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Sung Yong Kim
- Hematology & Oncology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung-Hyun Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Yu Ri Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Young Rok Do
- Division of Hematology-Oncology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Yeung-Chul Mun
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Sung-Soo Park
- Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Hoon Park
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Ho Jin Shin
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Hyeon-Seok Eom
- Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang, Republic of Korea
| | - Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, Republic of Korea
| | - Sang Mee Hwang
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Won Sik Lee
- Department of Internal Medicine, Hematology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Myung-Won Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jun Ho Yi
- Division of Hematology-Oncology, Department of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Ji Yun Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ji Hyun Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Ho Sup Lee
- Department of Internal Medicine, Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Sung-Nam Lim
- Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jihyang Lim
- Department of Laboratory Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho-Young Yhim
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Yoon Hwan Chang
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jinhyun Cho
- Division of Hematology-Oncology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hyungwoo Cho
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoon Seok Choi
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Jeong Cho
- Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ari Ahn
- Department of Laboratory Medicine, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Han Choi
- Department of Endocrine and Metabolism Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hyun Jung Kim
- Institute for Evidence-Based Medicine, Cochrane Korea College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, Republic of Korea.
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Dong X, Wang R, Ying X, Xu J, Yan J, Xu P, Peng Y, Chen B. Construction and validation of an 18F-FDG-PET/CT-based prognostic model to predict progression-free survival in newly diagnosed multiple myeloma patients. Hematology 2024; 29:2329029. [PMID: 38488443 DOI: 10.1080/16078454.2024.2329029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/06/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE To investigate the relationship between 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) related parameters and the prognosis of multiple myeloma and to establish and validate a prediction model regarding the progression-free survival (PFS) of multiple myeloma. METHODS A retrospective analysis of 126 newly diagnosed multiple myeloma patients who attended Nanjing Drum Tower Hospital from 2014-2021. All patients underwent PET/CT before treatment and were divided into a training cohort (n = 75) and a validation cohort (n = 51). Multivariate Cox proportional hazard regression analysis incorporated PET/CT-related parameters and clinical indicators. A nomogram was established to individually predict PFS in MM patients. The model was evaluated by calculating the C-index and calibration curve. RESULTS Here, 4.2 was used as the cut-off value of SUVmax to divide patients into high and low groups. PFS significantly differed between patients in the high-SUVmax group and low-SUVmax group, and SUVmax was an independent predictor of PFS in newly diagnosed multiple myeloma (NDMM) patients. Univariate and multivariate cox regression analysis suggested that lactate dehydrogenase (LDH), bone marrow plasma cell (BMPC), and SUVmax affected PFS. These factors were incorporated to construct a nomogram model for predicting PFS at 1 and 2 years in NDMM patients. The C-index and calibration curves of the nomogram exhibited good accuracy and consistency, and the DCA curves suggested that the model had good clinical utility. CONCLUSION The PET/CT parameter SUVmax is closely related to the prognosis of myeloma patients. The nomogram constructed in this study based on PET/CT-related parameters and clinical indicators individually predicts the PFS rate of NDMM patients and enables further risk stratification of NDMM patients.
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Affiliation(s)
- Xiaoqing Dong
- Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Ruoyi Wang
- Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Xiuhua Ying
- Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Jiaxuan Xu
- Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Jie Yan
- Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Peipei Xu
- Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Yue Peng
- Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Bing Chen
- Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
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Pellegrino S, Origlia D, Di Donna E, Lamagna M, Della Pepa R, Pane F, Del Vecchio S, Fonti R. Coefficient of variation and texture analysis of 18F-FDG PET/CT images for the prediction of outcome in patients with multiple myeloma. Ann Hematol 2024; 103:3713-3721. [PMID: 39046513 PMCID: PMC11358233 DOI: 10.1007/s00277-024-05905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/18/2024] [Indexed: 07/25/2024]
Abstract
In multiple myeloma (MM) bone marrow infiltration by monoclonal plasma cells can occur in both focal and diffuse manner, making staging and prognosis rather difficult. The aim of our study was to test whether texture analysis of 18 F-2-deoxy-d-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) images can predict survival in MM patients. Forty-six patients underwent 18 F-FDG-PET/CT before treatment. We used an automated contouring program for segmenting the hottest focal lesion (FL) and a lumbar vertebra for assessing diffuse bone marrow involvement (DI). Maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean) and texture features such as Coefficient of variation (CoV), were obtained from 46 FL and 46 DI. After a mean follow-up of 51 months, 24 patients died of myeloma and were compared to the 22 survivors. At univariate analysis, FL SUVmax (p = 0.0453), FL SUVmean (p = 0.0463), FL CoV (p = 0.0211) and DI SUVmax (p = 0.0538) predicted overall survival (OS). At multivariate analysis only FL CoV and DI SUVmax were retained in the model (p = 0.0154). By Kaplan-Meier method and log-rank testing, patients with FL CoV below the cut-off had significantly better OS than those with FL CoV above the cut-off (p = 0.0003), as well as patients with DI SUVmax below the threshold versus those with DI SUVmax above the threshold (p = 0.0006). Combining FL CoV and DI SUVmax by using their respective cut-off values, a statistically significant difference was found between the resulting four survival curves (p = 0.0001). Indeed, patients with both FL CoV and DI SUVmax below their respective cut-off values showed the best prognosis. Conventional and texture parameters derived from 18F-FDG PET/CT analysis can predict survival in MM patients by assessing the heterogeneity and aggressiveness of both focal and diffuse infiltration.
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Affiliation(s)
- Sara Pellegrino
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
| | - Davide Origlia
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
| | - Erica Di Donna
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
| | - Martina Lamagna
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Roberta Della Pepa
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Silvana Del Vecchio
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
| | - Rosa Fonti
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini 5, Naples, 80131, Italy.
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Chen Z, Yang A, Chen A, Dong J, Lin J, Huang C, Zhang J, Liu H, Zeng Z, Miao W. [ 68Ga]Pentixafor PET/CT for staging and prognostic assessment of newly diagnosed multiple myeloma: comparison to [ 18F]FDG PET/CT. Eur J Nucl Med Mol Imaging 2024; 51:1926-1936. [PMID: 38286937 DOI: 10.1007/s00259-024-06621-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/17/2024] [Indexed: 01/31/2024]
Abstract
PURPOSE To evaluate the prognostic performance of [68Ga]Pentixafor PET/CT at baseline for staging of patients with newly diagnosed multiple myeloma (MM) and to compare it with [18F]FDG PET/CT and the Revised-International Staging System (R-ISS). METHODS Patients who underwent [68Ga]Pentixafor and [18F]FDG PET/CT imaging were retrospectively included. Patient staging was performed according to the Durie-Salmon PLUS staging system based on [68Ga]Pentixafor PET/CT and [18F]FDG PET/CT images, and the R-ISS. Progression-free survival (PFS) at patient follow-up was estimated using the Kaplan-Meier estimator and compared using the log-rank test. Area under the receiver operating characteristic curve (AUC) was calculated to assess predictive performance. RESULTS Fifty-five MM patients were evaluated. Compared with [18F]FDG PET, [68Ga]Pentixafor PET detected 25 patients as the same stage, while 26 patients were upstaged and 4 patients were downstaged (P = 0.001). After considering the low-dose CT data, there was no statistically significant difference in the number of patients classified in each stage using [68Ga]Pentixafor PET/CT and [18F]FDG PET/CT (P = 0.091). [68Ga]Pentixafor PET/CT-based staging discriminated PFS outcomes in patients with different disease stages (stage I vs. stage II, stage I vs. stage III, and stage II vs. stage III; all P < 0.05), whereas for [18F]FDG PET/CT, there was only a difference in median PFS between stage I and III (P = 0.021). When staged by R-ISS, the median PFS for stage III was significantly lower than that for stage I and II (P = 0.008 and 0.035, respectively). When predicting 2-year PFS based on staging, the AUC of [68Ga]Pentixafor PET/CT was significantly higher than that of [68Ga]Pentixafor PET (0.923 vs. 0.821, P = 0.002), [18F]FDG PET (0.923 vs. 0.752 P = 0.002), and R-ISS (0.923 vs. 0.776, P = 0.005). CONCLUSIONS [68Ga]Pentixafor PET/CT-based staging possesses substantial potential to predict disease progression in newly diagnosed MM patients.
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Affiliation(s)
- Zhenying Chen
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Apeng Yang
- Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Aihong Chen
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Jinfeng Dong
- Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Junfang Lin
- Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Chao Huang
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Jiaying Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Huimin Liu
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Zhiyong Zeng
- Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
| | - Weibing Miao
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
- Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
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Murtazaliev S, Rowe SP, Sheikhbahaei S, Werner RA, Sólnes LB. Positron Emission Tomography/Computed Tomography Transformation of Oncology: Multiple Myeloma. PET Clin 2024; 19:249-260. [PMID: 38199914 DOI: 10.1016/j.cpet.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
This article provides a comprehensive review of the role of 2-deoxy-2-[18F]fluoro-d-glucose (18F FDG) positron emission tomography/computed tomography (PET/CT) in multiple myeloma (MM) and related plasma cell disorders. MM is a hematologic malignancy characterized by the neoplastic proliferation of plasma cells. 18F FDG PET/CT integrates metabolic and anatomic information, allowing for accurate localization of metabolically active disease. The article discusses the use of 18F FDG PET/CT in initial diagnosis, staging, prognostication, and assessing treatment response. Additionally, it provides valuable insights into the novel imaging targets including chemokine receptor C-X-C motif 4 and CD38.
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Affiliation(s)
- Salikh Murtazaliev
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science at Johns Hopkins Hospital, 601 North Caroline St., JHOC 3, Baltimore, MD 21287, USA
| | - Steven P Rowe
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science at Johns Hopkins Hospital, 601 North Caroline St., JHOC 3, Baltimore, MD 21287, USA
| | - Sara Sheikhbahaei
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science at Johns Hopkins Hospital, 601 North Caroline St., JHOC 3, Baltimore, MD 21287, USA
| | - Rudolf A Werner
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science at Johns Hopkins Hospital, 601 North Caroline St., JHOC 3, Baltimore, MD 21287, USA; Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Lilja B Sólnes
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science at Johns Hopkins Hospital, 601 North Caroline St., JHOC 3, Baltimore, MD 21287, USA.
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Jamet B, Carlier T, Bailly C, Bodet-Milin C, Monnet A, Frampas E, Touzeau C, Moreau P, Kraeber-Bodere F. Hybrid simultaneous whole-body 2-[ 18F]FDG-PET/MRI imaging in newly diagnosed multiple myeloma: first diagnostic performance and clinical added value results. Eur Radiol 2023; 33:6438-6447. [PMID: 37022439 DOI: 10.1007/s00330-023-09593-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/10/2023] [Accepted: 02/22/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES Mixing diagnostic and prognostic data provided by whole-body MRI (WB-MRI) and 2-18F-fluorodeoxyglucose (2-[18F]FDG) positron emission tomography (2-[18F]FDG-PET) from a single simultaneous imaging technique for newly diagnosed multiple myeloma (NDMM) initial workup seems attractive. However, to date, the published data are scarce and this possibility has not been fully explored. In this prospective study, we aimed to explore the diagnostic performance and added clinical value of WB-2-[18F]FDG-PET/MRI imaging in NDMM. METHODS All patients with confirmed NDMM at the Nantes University Hospital were prospectively enrolled in this study and underwent WB-2-[18F]FDG-PET/MRI imaging on a 3-T Biograph mMR before receiving treatment. Before imaging, they were considered either as symptomatic or as smoldering MM (SMM). Diagnostic performance of global WB-2-[18F]FDG-PET/MRI imaging, as well as PET and MRI separately for FL and diffuse BMI detection, was assessed and compared in each group. PET-based (maximal standardized uptake value, SUVmax) and MRI-based (mean apparent diffusion coefficient value, ADCmean) quantitative features were collected for FL/para-medullary disease (PMD)/bone marrow and were compared. RESULTS A total of 52 patients were included in this study. PET and MRI were equally effective at detecting patients with FL (69% vs. 75%) and with diffuse BMI (62% for both) in the symptomatic MM group. WB-2-[18F]FDG-PET/MRI imaging detected FL in 22% of patients with SMM (with a higher diagnostic performance for MRI), resulting in a significant impact on clinical management in this population. SUVmax and ADCmean quantitative features were weakly or not correlated. CONCLUSIONS WB-2-[18F]FDG-PET/MRI could represent the next-generation imaging modality for MM. KEY POINTS • Whole-body 2-[18F]FDG-PET/MRI imaging detected at least one focal bone lesion in 75% of patients with symptomatic multiple myeloma, and PET and MRI were equally effective at identifying patients with a focal bone lesion. • Whole-body 2-[18F]FDG-PET/MRI imaging detected a focal bone lesion in 22% of patients with smoldering multiple myeloma (with a higher diagnostic performance for MRI). • MRI had a significant impact on clinical management of smoldering multiple myeloma.
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Affiliation(s)
- Bastien Jamet
- Nuclear Medicine Department, University Hospital, 1 Place Ricordeau, 44093, Nantes, France.
| | - Thomas Carlier
- Nuclear Medicine Department, University Hospital, 1 Place Ricordeau, 44093, Nantes, France
- Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France
| | - Clément Bailly
- Nuclear Medicine Department, University Hospital, 1 Place Ricordeau, 44093, Nantes, France
- Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France
| | - Caroline Bodet-Milin
- Nuclear Medicine Department, University Hospital, 1 Place Ricordeau, 44093, Nantes, France
- Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France
| | | | - Eric Frampas
- Radiology Department, University Hospital, Nantes, France
| | - Cyrille Touzeau
- Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France
- Haematology Department, University Hospital, Nantes, France
| | - Philippe Moreau
- Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France
- Haematology Department, University Hospital, Nantes, France
| | - Francoise Kraeber-Bodere
- Nuclear Medicine Department, University Hospital, 1 Place Ricordeau, 44093, Nantes, France
- Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France
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7
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Guglielmo P, Alongi P, Baratto L, Abenavoli E, Buschiazzo A, Celesti G, Conte M, Filice R, Gorica J, Jonghi-Lavarini L, Lanzafame H, Laudicella R, Librando M, Linguanti F, Mattana F, Miceli A, Olivari L, Piscopo L, Romagnolo C, Santo G, Vento A, Volpe F, Evangelista L. Head-to-Head Comparison of FDG and Radiolabeled FAPI PET: A Systematic Review of the Literature. Life (Basel) 2023; 13:1821. [PMID: 37763225 PMCID: PMC10533171 DOI: 10.3390/life13091821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
FAPI-based radiopharmaceuticals are a novel class of tracers, mainly used for PET imaging, which have demonstrated several advantages over [18F]FDG, especially in the case of low-grade or well-differentiated tumors. We conducted this systematic review to evaluate all the studies where a head-to-head comparison had been performed to explore the potential utility of FAPI tracers in clinical practice. FAPI-based radiopharmaceuticals have shown promising results globally, in particular in detecting peritoneal carcinomatosis, but studies with wider populations are needed to better understand all the advantages of these new radiopharmaceuticals.
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Affiliation(s)
| | - Pierpaolo Alongi
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, 90127 Palermo, Italy;
| | - Lucia Baratto
- Department of Radiology, Division of Pediatric Radiology, Lucile Packard Children’s Hospital, Stanford University, Stanford, CA 94304, USA;
| | - Elisabetta Abenavoli
- Nuclear Medicine Unit, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy;
| | - Ambra Buschiazzo
- Nuclear Medicine Division, Santa Croce and Carle Hospital, 12100 Cuneo, Italy;
| | - Greta Celesti
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98122 Messina, Italy; (G.C.); (M.L.)
| | - Miriam Conte
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (J.G.)
| | - Rossella Filice
- Unit of Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo, 90133 Palermo, Italy; (R.F.); (R.L.)
| | - Joana Gorica
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza University of Rome, 00185 Rome, Italy; (M.C.); (J.G.)
| | - Lorenzo Jonghi-Lavarini
- Department of Nuclear Medicine, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| | - Helena Lanzafame
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, 45147 Essen, Germany;
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147 Essen, Germany
| | - Riccardo Laudicella
- Unit of Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo, 90133 Palermo, Italy; (R.F.); (R.L.)
| | - Maria Librando
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98122 Messina, Italy; (G.C.); (M.L.)
| | - Flavia Linguanti
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy;
| | - Francesco Mattana
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCSS, 20141 Milan, Italy;
| | - Alberto Miceli
- Nuclear Medicine Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Laura Olivari
- Nuclear Medicine Unit, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy;
| | - Leandra Piscopo
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy; (L.P.); (F.V.)
| | - Cinzia Romagnolo
- Department of Nuclear Medicine, “Ospedali Riuniti” Hospital, 60126 Ancona, Italy;
| | - Giulia Santo
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Antonio Vento
- Nuclear Medicine Department, ASP 1-P.O. San Giovanni di Dio, 92100 Agrigento, Italy;
| | - Fabio Volpe
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy; (L.P.); (F.V.)
| | - Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy;
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
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8
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Wang Q, Zhao M, Zhang T, Zhang B, Zheng Z, Lin Z, Zhou S, Zheng D, Chen Z, Zheng S, Zhang Y, Lin X, Dong R, Chen J, Qian H, Hu X, Zhuang Y, Zhang Q, Jiang S, Ma Y. Comprehensive analysis of ferroptosis-related genes in immune infiltration and prognosis in multiple myeloma. Front Pharmacol 2023; 14:1203125. [PMID: 37608887 PMCID: PMC10440437 DOI: 10.3389/fphar.2023.1203125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Background: One particular type of cellular death that is known as ferroptosis is caused by the excessive lipid peroxidation. It is a regulated form of cell death that can affect the response of the tumor cells. Currently, it is not known if the presence of this condition can affect the prognosis of patients with multiple myeloma (MM). Methods: In this study, we studied the expression differences and prognostic value of ferroptosis-related genes (FRGs) in MM, and established a ferroptosis risk scoring model. In order to improve the prediction accuracy and clinical applicability, a nomogram was also established. Through gene enrichment analysis, pathways closely related to high-risk groups were identified. We then explored the differences in risk stratification in drug sensitivity and immune patterns, and evaluated their value in prognostic prediction and treatment response. Lastly, we gathered MM cell lines and samples from patients to confirm the expression of marker FRGs using quantitative real-time PCR (qRT-PCR). Results: The ability to predict the survival of MM patients is a challenging issue. Through the use of a risk model derived from ferroptosis, we were able to develop a more accurate prediction of the disease's prognosis. They were then validated by a statistical analysis, which showed that the model is an independent factor in the prognosis of MM. Patients of high ferroptosis risk scores had a much worse chance of survival than those in the low-risk groups. The calibration and power of the nomogram were also strong. We noted that the link between the ferroptosis risk score and the clinical treatment was suggested by the FRG's significant correlation with the immune checkpoint genes and the medication sensitivity. We validated the predictive model using qRT-PCR. Conclusion: We demonstrated the association between FRGs and MM, and developed a new risk model for prognosis in MM patients. Our study sheds light on the potential clinical relevance of ferroptosis in MM and highlights its potential as a therapeutic target for patients with this disease.
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Affiliation(s)
- Quanqiang Wang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Misheng Zhao
- Department of Clinical Laboratory, Wenzhou People’s Hospital, Wenzhou, China
| | - Tianyu Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Bingxin Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ziwei Zheng
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhili Lin
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shujuan Zhou
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dong Zheng
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zixing Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Sisi Zheng
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yu Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xuanru Lin
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rujiao Dong
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingjing Chen
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Honglan Qian
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xudong Hu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yan Zhuang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qianying Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Songfu Jiang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yongyong Ma
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Key Laboratory of Intelligent Treatment and Life Support for Critical Diseases of Zhejiang Province, Wenzhou, Zhejiang, China
- Zhejiang Engineering Research Center for Hospital Emergency and Process Digitization, Wenzhou, Zhejiang, China
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9
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Lee H, Hyun SH, Cho YS, Moon SH, Choi JY, Kim K, Lee KH. Cluster analysis of autoencoder-extracted FDG PET/CT features identifies multiple myeloma patients with poor prognosis. Sci Rep 2023; 13:7881. [PMID: 37188831 PMCID: PMC10185699 DOI: 10.1038/s41598-023-34653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023] Open
Abstract
F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a robust imaging modality used for staging multiple myeloma (MM) and assessing treatment responses. Herein, we extracted features from the FDG PET/CT images of MM patients using an artificial intelligence autoencoder algorithm that constructs a compressed representation of input data. We then evaluated the prognostic value of the image-feature clusters thus extracted. Conventional image parameters including metabolic tumor volume (MTV) were measured on volumes-of-interests (VOIs) covering only the bones. Features were extracted with the autoencoder algorithm on bone-covering VOIs. Supervised and unsupervised clustering were performed on image features. Survival analyses for progression-free survival (PFS) were performed for conventional parameters and clusters. In result, supervised and unsupervised clustering of the image features grouped the subjects into three clusters (A, B, and C). In multivariable Cox regression analysis, unsupervised cluster C, supervised cluster C, and high MTV were significant independent predictors of worse PFS. Supervised and unsupervised cluster analyses of image features extracted from FDG PET/CT scans of MM patients by an autoencoder allowed significant and independent prediction of worse PFS. Therefore, artificial intelligence algorithm-based cluster analyses of FDG PET/CT images could be useful for MM risk stratification.
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Affiliation(s)
- Hyunjong Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Young Seok Cho
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Kihyun Kim
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
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10
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Bezzi D, Ambrosini V, Nanni C. Clinical Value of FDG-PET/CT in Multiple Myeloma: An Update. Semin Nucl Med 2023; 53:352-370. [PMID: 36446644 DOI: 10.1053/j.semnuclmed.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/28/2022]
Abstract
FDG-PET/CT is a standardized imaging technique that has reached a great importance in the management of patients affected by Multiple Myeloma. It is proved, in fact, that it allows a deep evaluation of therapy efficacy and provides several prognostic indexes both at staging and after therapy. For this reason, it is now recognised as a gold standard for therapy assessment. Beside this, in reacent years FDG-PET/CT contribution to the understanding of Multiple Myeloma has progressively grown. Papers have been published analyzing the prognostic value of active disease volume measurement and standardization issues, the meaning of FDG positive paramedullary and extrameduallary disease, the prognostic impact of FDG positive minimal residual disease, the relation between focal lesions and clonal eterogenity of this disease and the comparison with whole body DWI-MR in terms of detection and therapy assessment. These newer aspects not of clinical impact yet, of FDG-PET/CT in Multiple Myeloma will be presented and discussed in this review.
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Affiliation(s)
- Davide Bezzi
- Nuclear Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Valentina Ambrosini
- Nuclear Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy; Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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11
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Prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography at diagnosis in untreated multiple myeloma patients: a systematic review and meta-analysis. Clin Exp Med 2023; 23:31-43. [PMID: 35000022 DOI: 10.1007/s10238-021-00775-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/30/2021] [Indexed: 11/03/2022]
Abstract
Multiple myeloma is a clonal B-lymphocyte tumor of terminally differentiated plasma cells. 18F-FDG PET/CT can provide valuable data for the diagnosis, restaging, and evaluate prognosis of multiple myeloma (MM). This meta-analysis aimed to evaluate the prognostic value of pre-treatment 18F-FDG PET/CT at diagnosis in MM patients. Related researches came from Embase, PubMed, and Cochrane Library databases through a systematic search, and the last one was updated on April 26, 2021. Cochran Q test and I-squared statistics were used to test for heterogeneity among the studies analyzed. The fixed model and random model were used to combine results when appropriate. Stata 12.0 was used to perform statistical analysis, and p < 0.05 was considered statistically significant. A total of 16 articles with 2589 patients were included in this study. Our results indicated PET/CT has an excellent prognostic role in MM, that higher SUVmax, more FL and EMD were associated with poor OS and PFS. SUVmax: OS (HR 1.89, 95% CI 1.47-2.44), PFS (HR 1.34, 95% CI 1.18-1.51); Fl: OS (HR 2.65, 95% CI 1.83-3.79), PFS (HR 1.61, 95% CI 1.40-1.86); EMD: OS (HR 2.11, 95% CI 1.41-3.16), PFS (HR 2.18, 95% CI 1.69-2.81). Furthermore, similar results were observed in most subgroup analyzes. Conclusion Pre-treatment 18F-FDG PET/CT examination has prognostic value for myeloma patients and has guiding significance for clinical treatment.
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12
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Prognostic value of semi-quantitative parameters of 18F-FDG PET/CT in newly diagnosed multiple myeloma patients. Ann Nucl Med 2023; 37:155-165. [PMID: 36528697 PMCID: PMC9943948 DOI: 10.1007/s12149-022-01812-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the prognostic value of fluroine-18 fluorodexyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) semi-quantitative parameter in newly diagnosed multiple myeloma (NDMM) and to design a new staging system including 18F-FDG PET/CT semi-quantitative parameters for NDMM. METHODS A total of 38 NDMM patients who underwent 18F-FDG PET/CT examination in Yichang Central People's Hospital from February 2014 to April 2021 were collected. The relationship between the characteristics of 18F-FDG PET/CT (metabolic tumor volume of all lesions (aMTV), total lesion glycolysis of all lesions (aTLG), maximum standardized uptake values (SUVmax) of the lesion with largest MTV (mSUVmax), extramedullary disease (EMD), focal lesions (FLs)), the laboratory parameters, and prognostic parameters (progression-free survival (PFS) and overall survival (OS)) were analyzed retrospectively. SPSS 25.0 statistical software was used for statistical processing, Kaplan-Meier method was used for survival analysis, Log-rank method was used for univariate analysis, and Cox proportional risk model was used for multivariate analysis. RESULTS Univariate analysis showed that aMTV ≥ 90.97cm3, aTLG ≥ 283.31 g, hemoglobin (Hb) < 100 g/L, focal lesions (FLs) ≥ 10, (percentage of circulating plasma cells (CPC%) ≥ 30%, creatinine (Cr) ≥ 177umol/L, lactic dehydrogenase (LDH) ≥ 250 g/L might be the adverse prognostic factors of PFS in patients with NDMM, all p < 0.05; aMTV ≥ 90.97 cm3, aTLG ≥ 283.31 g, Hb < 100 g/L, FLs ≥ 10, mSUVmax ≥ 5.8, the presence of extramedullary disease (EMD) and PCPs ≥ 30% may be adverse prognostic factors for OS in patients with NDMM, all p < 0.05. Multivariate regression analysis showed that aMTV ≥ 90.97 cm3 was an independent risk factor for PFS in NDMM patients, p < 0.05; aMTV ≥ 90.97 cm3, mSUVmax ≥ 5.8, and the presence of EMD were independent risk factors for OS in the NDMM patients, all p < 0.05. According to the multivariate analysis results of OS, the New stage (NS) was performed. The 3-year OS rates of stage I, stage II, and stage III in NDMM patients were 100.0, 53.5, and 32.1%, respectively, p = 0.000. CONCLUSION aMTV can predict PFS and OS of NDMM patients better than other parameters. NS which combined with aMTV can predict OS of NDMM patients better and can provide an accurate and simple method for risk stratification of NDMM patients.
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13
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Goksel S, Ilkkilic K, Bulbul O, Akdogan E. Relation of whole-body metabolic tumor volume and total lesion glycolysis on fluorodeoxyglucose PET/computed tomography with clinical and laboratory parameters in newly diagnosed multiple myeloma. Nucl Med Commun 2022; 43:1077-1083. [PMID: 36006402 DOI: 10.1097/mnm.0000000000001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aims to evaluate the relationships of metabolic fluorodeoxyglucose PET/computed tomography (FDG PET/CT) parameters such as whole-body metabolic tumor volume (WB MTV), WB-total lesion glycolysis (TLG), and bone marrow (BM)-mean standard uptake value (SUVmean) with clinical stage and other prognostic biomarkers in newly diagnosed multiple myeloma (MM) patients. METHODS Patients who underwent pretreatment PET/CT with the diagnosis of MM were evaluated retrospectively. The number of focal lesions, WB MTV, WB TLG, and BM SUVmean values were measured on FDG PET/CT images. Clinical stages and prognostic laboratory parameters were recorded the pretreatment period. RESULTS WB MTV and WB TLG values were significantly higher in patients with more than three focal lesions on FDG PET/CT scan (all P < 0.001). According to the Revised International Staging System (R-ISS), all WB MTV, WB TLG, and BM SUVmean values are significantly higher in patients with stage 3 disease than in stages 1-2 ( P = 0.027, P = 0.019, P = 0.001, respectively). Serum creatinine level is positively correlated with WB MTV, WB TLG, and BM SUVmean values ( P = 0.020, P = 0.004, P < 0.001, respectively). In addition, the β2 microglobulin level, an essential biochemical prognostic parameter, was positively correlated with the BM SUVmean value ( P = 0.013). CONCLUSION The BM SUVmean, WB MTV, and WB TLG values, which reflect FDG avid WB tumor burden, are associated with prognostic biomarkers and R-ISS stage in newly diagnosed MM patients. It contributes to the identification of high-risk patients at the pretreatment staging.
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Affiliation(s)
| | - Kadir Ilkkilic
- Hematology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | | | - Elif Akdogan
- Hematology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
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14
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Terao T, Matsue K. Progress of modern imaging modalities in multiple myeloma. Int J Hematol 2022; 115:778-789. [DOI: 10.1007/s12185-022-03360-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 12/26/2022]
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15
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Wu Z, Bian T, Dong C, Duan S, Fei H, Hao D, Xu W. Spinal MRI-Based Radiomics Analysis to Predict Treatment Response in Multiple Myeloma. J Comput Assist Tomogr 2022; 46:447-454. [PMID: 35405690 DOI: 10.1097/rct.0000000000001298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to explore the clinical utility of spinal magnetic resonance imaging-based radiomics to predict treatment response (TR) in patients with multiple myeloma (MM). METHODS A total of 123 MM patients (85 in the training cohort and 38 in the test cohort) with complete response (CR) (n = 40) or non-CR (n = 83) were retrospectively enrolled in the study. Key feature selection and data dimension reduction were performed using the least absolute shrinkage and selection operator regression. A nomogram was built by combining radiomic signatures and independent clinical risk factors. The prediction performance of the nomogram was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. Treatment response was assessed by determining the serum and urinary levels of M-proteins, serum-free light chain ratio, and the percentage of bone marrow plasma cells. RESULTS Thirteen features were selected to build a radiomic signature. The International Staging System (ISS) stage was selected as an independent clinical factor. The radiomic signature and nomogram showed better calibration and higher discriminatory capacity (AUC of 0.929 and 0.917 for the radiomics and nomogram in the training cohort, respectively, and 0.862 and 0.874 for the radiomics and nomogram in the test cohort, respectively) than the clinical model (AUC of 0.661 and 0.674 in the training and test cohort, respectively). Decision curve analysis confirmed the clinical utility of the radiomics model. CONCLUSIONS Nomograms incorporating a magnetic resonance imaging-based radiomic signature and ISS stage help predict the response to chemotherapy for MM and can be useful in clinical decision-making.
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Affiliation(s)
| | - Tiantian Bian
- Breast Disease Center, the Affiliated Hospital of Qingdao University, Qingdao, Shandong
| | | | | | - Hairong Fei
- Department of Hematology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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16
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Zukovs R, Antke C, Mamlins E, Sawicki LM, Mohring A, Lopez Y Niedenhoff D, Boquoi A, Kondakci M, Antoch G, Müller HW, Fenk R, Haas R. 18F-FDG-PET/CT in relapsed multiple myeloma: Are prognostic thresholds different from first-line therapy? BMC Med Imaging 2022; 22:63. [PMID: 35379187 PMCID: PMC8981746 DOI: 10.1186/s12880-022-00788-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/25/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose While 18F-FDG PET/CT yields valuable prognostic information for patients in first-line therapy of multiple myeloma (MM), its prognostic relevance in relapse is not established. Available studies of relapsed MM describe prognostic thresholds for frequently used PET/CT parameters that are significantly higher than those identified in the first-line setting. The purpose of this study was to evaluate the prognostic role of PET/CT in relapsed MM, based on parameters used in the first-line setting. Methods Our retrospective study included 36 patients with MM who had received autologous or allogeneic stem cell transplantation, suffered at least one relapse, and underwent FDG-PET/CT at relapse. Number of focal bone lesions (FL), maximal standardised uptake value (SUVmax), and presence of PET-positive extramedullary lesions (EMD) were analysed. Results For the number of FLs, the prognostic value was demonstrated with a cut-off of > 3 (median OS 3.8 months vs. not reached, p = 0.003). Median OS of patients with SUVmax ≤ 4 was not reached, while it was 3.9 months in patients with SUVmax > 4 (p = 0.014). Presence of EMD was a significant prognostic parameter too, with median OS of 3.6 months versus not reached (p = 0.004). The above-mentioned parameters showed prognostic significance for PFS as well. Combination of higher ISS stage and PET/CT parameters identified patients with particularly short OS (3.7 months vs. not reached, p < 0.001) and PFS (3.6 vs. 11.7 months p < 0.001). Conclusion The PET/CT parameters SUVmax > 4, nFL > 3, and presence of EMD identify patients with poor prognosis not only in the first-line setting but also in relapsed MM.
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Affiliation(s)
- Romans Zukovs
- Department for Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich Heine University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany.
| | - Christina Antke
- Clinic for Nuclear Medicine, Medical Faculty, Heinrich Heine University Dusseldorf, 40225, Dusseldorf, Germany
| | - Eduards Mamlins
- Clinic for Nuclear Medicine, Medical Faculty, Heinrich Heine University Dusseldorf, 40225, Dusseldorf, Germany
| | - Lino Morris Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, 40225, Dusseldorf, Germany
| | - Annemarie Mohring
- Department for Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich Heine University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - David Lopez Y Niedenhoff
- Department for Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich Heine University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Amelie Boquoi
- Department for Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich Heine University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Mustafa Kondakci
- Department for Oncology and Hematology, St. Lukas Clinic Solingen, 42697, Solingen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Dusseldorf, 40225, Dusseldorf, Germany
| | - Hans-Wilhelm Müller
- Clinic for Nuclear Medicine, Medical Faculty, Heinrich Heine University Dusseldorf, 40225, Dusseldorf, Germany
| | - Roland Fenk
- Department for Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich Heine University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
| | - Rainer Haas
- Department for Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich Heine University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany
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17
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Mesguich C, Hulin C, Latrabe V, Lascaux A, Bordenave L, Hindié E. 18 F-FDG PET/CT and MRI in the Management of Multiple Myeloma: A Comparative Review. FRONTIERS IN NUCLEAR MEDICINE (LAUSANNE, SWITZERLAND) 2022; 1:808627. [PMID: 39355637 PMCID: PMC11440970 DOI: 10.3389/fnume.2021.808627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/27/2021] [Indexed: 10/03/2024]
Abstract
During the last two decades, the imaging landscape of multiple myeloma (MM) has evolved with whole-body imaging techniques such as fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) and MRI replacing X-ray skeletal survey. Both imaging modalities have high diagnostic performance at the initial diagnosis of MM and are key players in the identification of patients needing treatment. Diffusion-weighted MRI has a high sensitivity for bone involvement, while 18F-FDG PET/CT baseline parameters carry a strong prognostic value. The advent of more efficient therapeutics, such as immunomodulatory drugs and proteasome inhibitors, has called for the use of sensitive imaging techniques for monitoring response to treatment. Diffusion-weighted MRI could improve the specificity of MRI for tumor response evaluation, but questions remain regarding its role as a prognostic factor. Performed at key time points of treatment in newly diagnosed MM patients, 18F-FDG PET/CT showed a strong association with relapse risk and survival. The deployment of minimal residual disease detection at the cellular or the molecular level may raise questions on the role of these imaging techniques, which will be addressed. This review summarizes and outlines the specificities and respective roles of MRI and 18F-FDG PET/CT in the management of MM.
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Affiliation(s)
- Charles Mesguich
- Department of Nuclear Medicine, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- University of Bordeaux, IMB, UMR CNRS 5251, INRIA Project Team Monc, Talence, France
| | - Cyrille Hulin
- Department of Haematology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Valérie Latrabe
- Department of Radiology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Axelle Lascaux
- Department of Haematology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Laurence Bordenave
- Department of Nuclear Medicine, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Elif Hindié
- Department of Nuclear Medicine, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- University of Bordeaux, INCIA UMR-CNRS 5287, Talence, France
- Institut Universitaire de France (IUF), Paris, France
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18
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Elboga U, Sahin E, Cayirli YB, Okuyan M, Aktas G, Haydaroglu Sahin H, Dogan I, Kus T, Akkurd DM, Cimen U, Mumcu V, Kilbas B, Celen YZ. Comparison of [68Ga]-FAPI PET/CT and [18F]-FDG PET/CT in Multiple Myeloma: Clinical Experience. Tomography 2022; 8:293-302. [PMID: 35202189 PMCID: PMC8875266 DOI: 10.3390/tomography8010024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: In this study, we aimed to compare [68Ga]FAPI PET/CT and [18F]FDG PET/CT imaging to detect lesions in multiple myeloma. Methods: A total of 14 patients with multiple myeloma who underwent [68Ga]FAPI PET/CT and [18F]FDG PET/CT imaging were included in this retrospective study. SUVmax values of [68Ga]FAPI and [18F]FDG were compared according to lesion locations. Also, lesion localization ability of both imaging methods was compared on the patient basis. Results: In 4 of 14 patients, [68Ga]FAPI PET/CT and [18F]FDG PET/CT have not detected any bone lesions. In 8 of the remaining 10 patients [18F]FDG PET/CT detected bone lesions but in this group, 6 patients showed more higher SUVmax values than [18F]FDG PET/CT in [68Ga]FAPI PET/CT.In contrast, 2 of 8 patients showed more higher SUVmax values than [68Ga]FAPI PET/CT in [18F]FDG PET/CT. Moreover, [68Ga]FAPI PET/CT detected bone lesions in two patients, which werenot detected by [18F]FDG PET/CT. Also, in five patients, [68Ga]FAPI PET/CT showed more bone lesions in comparison with[18F]FDG PET/CT. Only one patient, [18F]FDG PET/CT showed more bone lesions. Three extramedullary involvements were observed in the following locations: lung, presacral lymph node, and soft tissue mass lateral to the right maxillary sinus. Among these involvements, higher SUVmax values were observed in the lung and presacral lymph node with [68Ga]FAPI compared to [18F]FDG. However, the soft tissue mass showed a higher SUVmax value in [18F]FDG than [68Ga]FAPI. Conclusions: No significant superiority was observed in [68Ga]FAPI PET/CT over [18F]FDG PET/CT in patients with MM. However, [68Ga]FAPI PET/CT can be utilized as a complementary imaging method to [18F]FDG PET/CT in some settings, especially in low-[18F]FDG affinity and inconclusive cases. Considering the favorable aspects of [68Ga]FAPI PET/CT in MM, such as low background activity, absence of non-specific bone marrow, and physiological brain involvement, further studies with a larger sample size should be conducted.
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Affiliation(s)
- Umut Elboga
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
- Correspondence:
| | - Ertan Sahin
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
| | - Yusuf Burak Cayirli
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
| | - Merve Okuyan
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
| | - Gokmen Aktas
- Department of Oncology, Medical Park Private Hospital, Gaziantep 27090, Turkey;
| | | | - Ilkay Dogan
- Department of Biostatistics, Gaziantep University, Gaziantep 27310, Turkey;
| | - Tulay Kus
- Department of Oncology, Gaziantep University, Gaziantep 27310, Turkey;
| | - Dervis Murat Akkurd
- Department of Hematology, Gaziantep University, Gaziantep 27310, Turkey; (H.H.S.); (D.M.A.)
| | - Ufuk Cimen
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
| | - Vuslat Mumcu
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
| | - Benan Kilbas
- Department of R&D, Moltek Health Services Production & Marketing Inc., Kocaeli 41400, Turkey;
| | - Yusuf Zeki Celen
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
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19
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Mikulski D, Robak P, Perdas E, Węgłowska E, Łosiewicz A, Dróżdż I, Jarych D, Misiewicz M, Szemraj J, Fendler W, Robak T. Pretreatment Serum Levels of IL-1 Receptor Antagonist and IL-4 Are Predictors of Overall Survival in Multiple Myeloma Patients Treated with Bortezomib. J Clin Med 2021; 11:112. [PMID: 35011853 PMCID: PMC8745099 DOI: 10.3390/jcm11010112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 12/22/2022] Open
Abstract
Multiple myeloma (MM) is characterized by the malignant proliferation of monoclonal plasma cells in the bone marrow with an elevation in monoclonal paraprotein, renal impairment, hypercalcemia, lytic bony lesions, and anemia. Immune cells and associated cytokines play a significant role in MM growth, progression, and dissemination. While some cytokines and their clinical significance are well described in MM biology, others remain relatively unknown. The present study examines the influence on progression-free survival (PFS) and overall survival (OS) by the serum levels of 27 selected cytokines in 61 newly diagnosed MM patients receiving first-line therapy with bortezomib-based regimens. The measurements were performed using a Bio-Rad Bio-Plex Pro Human Cytokine 27-Plex Assay and a MAGPIX Multiplex Reader, based on the Bio-Plex® 200 System (Bio-Rad). The following levels were determined: IL-1β, IL-1Ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12, IL-13, IL-15, IL-17, Eotaxin, FGF, G-CSF, GM-CSF, IFN-γ, IP-10, MCP-1, MIP-1α, MIP-1β, PDGF-BB, RANTES, TNF-α, and VEGF. Most patients received a VCD chemotherapy regimen (bortezomib, cyclophosphamide, and dexamethasone). In the final multivariate model, IL-13 cytokine level (HR 0.1411, 95% CI: 0.0240-0.8291, p = 0.0302) and ASCT (HR 0.3722, 95% CI: 0.1826-0.7585, p = 0.0065) significantly impacted PFS. Furthermore, ASCT (HR 0.142, 95% CI: 0.046-0.438, p = 0.0007), presence of bone disease at diagnosis (HR 3.826, 95% CI: 1.471-9.949, p = 0.0059), and two cytokine levels-IL-1Ra (HR 1.017, 95% CI: 1.004-1.030, p = 0.0091) and IL-4 (HR 0.161, 95% CI: 0.037-0.698, p = 0.0147)-were independent predictors of OS. Three clusters of MM patients were identified with different cytokine profiles. In conclusion, serum pretreatment levels of IL-13 and IL-4 are predictors of better PFS and OS, respectively, whereas IL-1Ra pretreatment levels negatively impact OS in MM patients treated with bortezomib-based chemotherapy. Cytokine signature profile may have a potential influence on the outcome of patients treated with bortezomib.
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Affiliation(s)
- Damian Mikulski
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 93-215 Lodz, Poland; (D.M.); (E.P.); (A.Ł.); (W.F.)
- Copernicus Memorial Hospital, 93-510 Lodz, Poland; (P.R.); (M.M.)
| | - Paweł Robak
- Copernicus Memorial Hospital, 93-510 Lodz, Poland; (P.R.); (M.M.)
- Department of Experimental Hematology, Medical University of Lodz, 93-510 Lodz, Poland
| | - Ewelina Perdas
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 93-215 Lodz, Poland; (D.M.); (E.P.); (A.Ł.); (W.F.)
| | - Edyta Węgłowska
- Laboratory of Personalized Medicine, Bionanopark, 93-465 Lodz, Poland; (E.W.); (D.J.)
| | - Aleksandra Łosiewicz
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 93-215 Lodz, Poland; (D.M.); (E.P.); (A.Ł.); (W.F.)
| | - Izabela Dróżdż
- Department of Clinical Genetics, Medical University of Lodz, 92-213 Lodz, Poland;
| | - Dariusz Jarych
- Laboratory of Personalized Medicine, Bionanopark, 93-465 Lodz, Poland; (E.W.); (D.J.)
- Laboratory of Virology, Institute of Medical Biology, Polish Academy of Sciences, 93-232 Lodz, Poland
| | - Małgorzata Misiewicz
- Copernicus Memorial Hospital, 93-510 Lodz, Poland; (P.R.); (M.M.)
- Department of Hematology, Medical University of Lodz, 93-510 Lodz, Poland
| | - Janusz Szemraj
- Department of Medical Biochemistry, Medical University of Lodz, 92-215 Lodz, Poland;
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 93-215 Lodz, Poland; (D.M.); (E.P.); (A.Ł.); (W.F.)
| | - Tadeusz Robak
- Copernicus Memorial Hospital, 93-510 Lodz, Poland; (P.R.); (M.M.)
- Department of Hematology, Medical University of Lodz, 93-510 Lodz, Poland
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20
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Shang Y, Jin Y, Liu H, Ding L, Tong X, Tu H, Zang L, Lin C, Hu J, Zhou F. Evaluation of prognostic staging systems of multiple myeloma in the era of novel agents. Hematol Oncol 2021; 40:212-222. [PMID: 34860428 DOI: 10.1002/hon.2955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/07/2021] [Accepted: 11/30/2021] [Indexed: 11/08/2022]
Abstract
This study aimed to evaluate the existing staging systems for multiple myeloma (MM) in the real world. From January 2010 to June 2019, we retrospectively analyzed 859 newly diagnosed MM patients from two institutions. Clinical data including laboratory findings, imaging examinations and staging system were obtained by reviewing medical records. Survival distributions were estimated using the Kaplan-Meier curve analysis, and Cox proportional hazards model were used to identified risk factors. The overall survival (OS) of eligible patients was 61.0 months. The Revised International Staging System (R-ISS) had a larger receiver operating characteristic curve area (0.603) than both the International Staging System (0.573) and the Durie Salmon staging system (0.567). In the group receiving immunomodulatory agents-based regimens, the median OS was 92.0 months in R-ISS I, 63.0 months in R-ISS II and 18.0 months in R-ISS III (p < 0.0001). In the group receiving proteasome inhibitors-based regimens, the median OS was 102.0 months in R-ISS I, 63.0 months in R-ISS II and 22.0 months in R-ISS III (p < 0.0001). In different subgroups grouped according to age, hemoglobin (HGB), creatinine, and Ca, R-ISS also had a good stratification effect. Patients in R-ISS II, which accounted for 69.9% of all patients, were further analyzed. Univariate and multivariate Cox analyses revealed that age >65 years (p = 0.001), HGB < 100 g/L (p < 0.001), elevated LDH (p = 0.001), and Ca (p = 0.010) were independent predictors of worse prognosis within R-ISS II. To conclusion, R-ISS remains a valuable staging system in the real world of the novel drug era. However, patients classified as R-ISS II still have great heterogeneity.
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Affiliation(s)
- Yufeng Shang
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yanxia Jin
- Hubei Key Laboratory of Edible Wild Plants Conservation and Utilization, Hubei Normal University, Huangshi, Hubei, China
| | - Hailing Liu
- Department of Clinical Hematology, Second Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lu Ding
- Scientific Research Office, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiqin Tong
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Honglei Tu
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Longkai Zang
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chenyao Lin
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jinsong Hu
- Department of Cell Biology and Genetics, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, China
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21
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Cui J, Zou Z, Duan J, Tang W, Li Y, Zhang L, Pan L, Niu T. Predictive Values of PET/CT in Combination With Regulatory B Cells for Therapeutic Response and Survival in Contemporary Patients With Newly Diagnosed Multiple Myeloma. Front Immunol 2021; 12:671904. [PMID: 34489930 PMCID: PMC8417409 DOI: 10.3389/fimmu.2021.671904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/26/2021] [Indexed: 02/05/2023] Open
Abstract
To assess patients with multiple myeloma (MM), the whole-body positron-emission tomography/computed tomography (PET/CT) occupies a pivotal position for diagnostic stratification, response evaluation, and survival prediction, while important limitations are recognized as incapable of representing tumor microenvironment. Regulatory B cells (Bregs) have been reported to have an inhibitory immune function, contributing to bone marrow (BM)-immunosuppressive microenvironment for MM. Therefore, to investigate the role of PET/CT in combination with Bregs’ ratios to predict therapeutic response and survival, we sequentially enrolled 120 patients with newly diagnosed MM (NDMM) who were treated with novel agents in our center, while conventional PET/CT parameters including maximum standard uptake value (SUVmax), ratios of BM-derived Bregs within CD19+ B cells, and patients’ clinical characteristics were collected. After a median follow-up of 28.20 months (range 7.00–46.93 months), SUVmax > 4.2 at onset, accounting for 53.2% of NDMM, was uncovered to predict inferior progression-free survival (PFS) as well as overall survival (OS). With regard to the ratios of BM-derived Bregs within CD19+ B cells, the cohort with the Bregs’ proportions lower than 10%, accounting for 46.2%, exerted poorer OS. Additionally, the patients with both SUVmax > 4.2 and Bregs’ ratios < 10%, accounting for 31.7%, yielded compromised therapeutic response and long-term survival. Collectively, this study may draw attention on the prognostic value of combination of PET/CT and Bregs’ ratios when clinical decisions are made for MM in the era of novel agents.
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Affiliation(s)
- Jian Cui
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhongqing Zou
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.,Department of Hematology, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, China
| | - Jiayu Duan
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Wenjiao Tang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Li
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Zhang
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Pan
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Niu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
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22
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Huang HY, Wang Y, Wang WD, Wei XL, Gale RP, Li JY, Zhang QY, Shu LL, Li L, Li J, Lin HX, Liang Y. A prognostic survival model based on metabolism-related gene expression in plasma cell myeloma. Leukemia 2021; 35:3212-3222. [PMID: 33686197 DOI: 10.1038/s41375-021-01206-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/29/2021] [Accepted: 02/18/2021] [Indexed: 11/09/2022]
Abstract
Accurate survival prediction of persons with plasma cell myeloma (PCM) is challenging. We interrogated clinical and laboratory co-variates and RNA matrices of 1040 subjects with PCM from public datasets in the Gene Expression Omnibus database in training (N = 1) and validation (N = 2) datasets. Genes regulating plasma cell metabolism correlated with survival were identified and seven used to build a metabolic risk score using Lasso Cox regression analyses. The score had robust predictive performance with 5-year survival area under the curve (AUCs): 0.71 (95% confidence interval, 0.65, 0.76), 0.88 (0.67, 1.00) and 0.64 (0.57, 0.70). Subjects in the high-risk training cohort (score > median) had worse 5-year survival compared with those in the low-risk cohort (62% [55, 68%] vs. 85% [80, 90%]; p < 0.001). This was also so for the validation cohorts. A nomogram combining metabolic risk score with Revised International Staging System (R-ISS) score increased survival prediction from an AUC = 0.63 [0.58, 0.69] to an AUC = 0.73 [0.66, 0.78]; p = 0.015. Modelling predictions were confirmed in in vitro tests with PCM cell lines. Our metabolic risk score increases survival prediction accuracy in PCM.
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Affiliation(s)
- Han-Ying Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Yun Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Wei-da Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Xiao-Li Wei
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Robert Peter Gale
- Department of Immunology and Inflammation, Haematology Research Centre, Imperial College London, London, UK
| | - Jin-Yuan Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Qian-Yi Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Ling-Ling Shu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Liang Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Juan Li
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Huan-Xin Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
| | - Yang Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China. .,Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
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23
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Ahn SY, Park HK, Moon JH, Baek DW, Cho HJ, Sohn SK, Kang SR, Min JJ, Bom HS, Hong CM, Jeong SY, Song GY, Yang DH, Ahn JS, Kim HJ, Jung SH, Lee JJ. Prognostic impact of 18F-FDG PET/CT in patients with multiple myeloma presenting with renal impairment. Int J Hematol 2021; 113:668-674. [PMID: 33475961 DOI: 10.1007/s12185-021-03079-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/29/2022]
Abstract
Renal insufficiency (RI) is a frequent manifestation of multiple myeloma (MM) at time of diagnosis but there is no reliable prognostic factor for patients with MM presenting with RI. This study investigated the prognostic impact of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with MM with RI at diagnosis. The records of 209 patients with MM between June 2011 and November 2018 were retrospectively analyzed. PET/CT positivity was defined as the presence of more than three focal lesions or the presence of extramedullary disease. Of 209 patients, 90 (43.1%) had RI and showed similar survival outcomes to patients who had normal renal function. In total, 113 patients (54.0%) were PET/CT-positive, and 46.6% of patients with RI were PET/CT-positive at baseline. In patients with RI, those who were PET/CT-positive showed significantly inferior survival outcomes to those who were PET/CT-negative [progression-free survival (PFS), 12.7 vs. 34.0 months, P < 0.001; overall survival (OS), 42.2 months vs. not reached, P = 0.001]. On multivariate analysis, PET/CT positivity was significantly associated with PFS and OS in patients with RI. In conclusion, PET/CT is a reliable imaging technique for predicting survival outcomes in patients with MM with RI.
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Affiliation(s)
- Seo-Yeon Ahn
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Hwa Kyung Park
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Joon Ho Moon
- Department of Hematology-Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Dong Won Baek
- Department of Hematology-Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hee-Jeong Cho
- Department of Hematology-Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sang Kyun Sohn
- Department of Hematology-Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Chae Moon Hong
- Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ga-Young Song
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Deok-Hwan Yang
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Jae-Sook Ahn
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Hyeoung-Joon Kim
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Sung-Hoon Jung
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea.
| | - Je-Jung Lee
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
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24
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Zhong X, Diao W, Zhao C, Jia Z. Fluorodeoxyglucose-avid focal lesions and extramedullary disease on 18F-FDG PET/computed tomography predict the outcomes of newly diagnosed symptomatic multiple myeloma patients. Nucl Med Commun 2020; 41:950-958. [PMID: 32796484 DOI: 10.1097/mnm.0000000000001242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate whether the number of fluorodeoxyglucose (FDG)-avid focal lesions and the presence of extramedullary disease (EMD) on F-FDG PET/computed tomography (PET/CT) can predict the outcomes of newly diagnosed symptomatic multiple myeloma patients. METHODS We performed a meta-analysis to research the prognostic significance of focal lesions and EMD on F-FDG PET/CT for overall survival (OS) and progression-free survival (PFS) using a fix-effected model. The PubMed, EMBASE and Cochrane Library databases were searched. Manual searches were also conducted. RESULTS Of the 398 citations identified in the original search, 13 original studies with a total of 2823 patients met the inclusion criteria. The pooled hazard ratios of focal lesions were 1.63 [95% confidence interval (CI) 1.41-1.86, P = 0.442, I= 0%] for PFS and 2.15 (95% CI 1.74-2.57, P = 0.615, I= 0%) for OS. The pooled hazard ratios of EMD were 1.89 (95% CI 1.44-2.34, P = 0.497, I= 0%) for PFS and 1.91 (95% CI 1.08-2.73, P = 0.182, I= 29.6%) for OS. The results of the subgroup analysis showed the same trend. No significant heterogeneity was observed among studies. CONCLUSION This meta-analysis demonstrated that patients with a higher number of FDG-avid focal lesions and EMD on PET/CT may experience a higher risk for progression and a shorter survival time than those with a few focal lesions and no EMD.
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Affiliation(s)
- Xiao Zhong
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Han S, Woo S, Kim YI, Yoon DH, Ryu JS. Prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in newly diagnosed multiple myeloma: a systematic review and meta-analysis. Eur Radiol 2020; 31:152-162. [PMID: 32809165 DOI: 10.1007/s00330-020-07177-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/18/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We performed a systematic review and meta-analysis on the prognostic values of 18F-FDG PET/CT in patients with newly diagnosed multiple myeloma (MM). METHODS PubMed and Embase were searched until July 10, 2019, for studies that reported the prognostic significance of 18F-FDG PET in patients with newly diagnosed MM, with overall (OS) and progression-free survival (PFS) included as outcomes. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were meta-analytically pooled using a random-effects model. RESULTS Fifteen studies (1670 patients) were included for qualitative synthesis. Among multiple PET parameters, the presence of extramedullary disease (EMD), more than three focal lesions (FLs), and high FDG uptake were widely evaluated and significantly associated with shorter OS and PFS in most of the included studies. Among 11 studies included in quantitative synthesis, the overall HRs of EMD, more than three FLs, and high FDG uptake on PFS were 2.12 (95% CI, 1.52-2.96), 2.38 (95% CI, 1.84-3.07), and 2.02 (95% CI, 1.51-2.68), respectively. The pooled HRs of those three parameters on OS were 2.37 (95% CI, 1.77-3.16), 3.29 (95% CI, 2.38-4.56), and 2.28 (95% CI, 1.67-3.13). No statistical differences were found across parameters for either PFS (p = 0.6822) or OS (p = 0.2147). CONCLUSIONS Pretreatment 18F-FDG PET/CT is a significant predictor for disease progression and survival in patients with MM. It may be a useful prognostic biomarker capable of accurate risk stratification and application in clinical decision-making for newly diagnosed MM. KEY POINTS • There remain unmet clinical needs for reliable prognostic biomarkers in patients with newly diagnosed multiple myeloma. • This meta-analysis shows that the presence of extramedullary disease, more than three focal lesions, and high FDG uptake from baseline 18F-FDG PET are significant prognostic factors. • These imaging biomarkers might help the accurate stratification of patient prognosis which is required for choosing an appropriate therapeutic strategy in clinical practice.
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Affiliation(s)
- Sangwon Han
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yong-Il Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Jung SH, Jo JC, Song GY, Ahn SY, Yang DH, Ahn JS, Kim HJ, Lee JJ. Frontline therapy for newly diagnosed patients with multiple myeloma. Blood Res 2020; 55:S37-S42. [PMID: 32719175 PMCID: PMC7386893 DOI: 10.5045/br.2020.s007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 12/18/2022] Open
Abstract
Since the introduction of an alkylator to the treatment of multiple myeloma (MM), new effective agents have been developed, such as immunomodulatory drugs including thalidomide, lenalidomide, and pomalidomide; proteasome inhibitors including bortezomib, carfilzomib, and ixazomib; monoclonal antibodies including daratumumab and elotuzumab; and deacetylase inhibitors including panobinostat. Numerous regimens with these new agents have been developed and they have contributed in improving survival outcomes in MM patients. In addition, the recommended therapies for newly diagnosed MM change every year based on the results of clinical trials. This review will discusses the appropriate induction therapies based on recent clinical trials for patients with newly diagnosed MM.
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Affiliation(s)
- Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jae-Cheol Jo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ga-Young Song
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Seo-Yeon Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Deok-Hwan Yang
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jae-Sook Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyeoung-Joon Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
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Pan Q, Cao X, Luo Y, Li J, Feng J, Li F. Chemokine receptor-4 targeted PET/CT with 68Ga-Pentixafor in assessment of newly diagnosed multiple myeloma: comparison to 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging 2019; 47:537-546. [PMID: 31776631 DOI: 10.1007/s00259-019-04605-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/07/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE 18F-FDG PET/CT has some limitations in the evaluation of multiple myeloma (MM). Since chemokine receptor-4 is overexpressed in MM, we perform a prospective cohort study to compare the performance of 68Ga-Pentixafor and 18F-FDG PET/CT in newly diagnosed MM. METHODS Thirty patients with newly diagnosed MM were recruited. All patients underwent 68Ga-Pentixafor and18F-FDG PET/CT within 1 week after enrollment. A positive PET/CT was defined as the presence of focal PET-positive lesions in bone marrow or diffuse bone marrow patterns (uptake > liver). Bone marrow uptake values in 68Ga-Pentixafor and18F-FDG PET/CT (total bone marrow glycolysis [TBmGFDG], total bone marrow uptake with 68Ga-Pentixafor [TBmUCXCR4], total bone marrow volume [TBmV], SUVmean, and SUVmax) were obtained by drawing total bone marrow volume of interest on PET/CT. The positive rates of the PET/CT scans were statistically compared, and the correlation between quantitative bone marrow uptake values and clinical characteristics, laboratory findings, and staging was analyzed. RESULTS 68Ga-Pentixafor PET/CT had a higher positive rate than 18F-FDG PET/CT in recruited patients (93.3 vs. 53.3%, p = 0.0005). In quantitative analysis, bone marrow uptake values in 68Ga-Pentixafor (TBmUCXCR4, SUVmax, and SUVmean) were positively correlated with end organ damage, staging, and laboratory biomarkers related to tumor burden including serum β2-microglobulin, serum free light chain, and 24-h urine light chain (p < 0.05). In 18F-FDG PET/CT, only the SUVmean of total bone marrow was positively correlated with serum free light chain and 24-h urine light chain (p < 0.05). CONCLUSIONS 68Ga-Pentixafor PET/CT is promising in assessment of newly diagnosed MM. TRIAL REGISTRATION NUMBER NCT03436342.
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Affiliation(s)
- Qingqing Pan
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China
| | - Xinxin Cao
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China
| | - Yaping Luo
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China. .,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China.
| | - Jian Li
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China
| | - Jun Feng
- Department of Hematology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China
| | - Fang Li
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China.,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Wangfujing, Dongcheng District, 100730, Beijing, People's Republic of China
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28
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Visual and volumetric parameters by 18F-FDG-PET/CT: a head to head comparison for the prediction of outcome in patients with multiple myeloma. Ann Hematol 2019; 99:127-135. [DOI: 10.1007/s00277-019-03852-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/17/2019] [Indexed: 12/22/2022]
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29
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Alonso R, Cedena MT, Gómez‐Grande A, Ríos R, Moraleda JM, Cabañas V, Moreno MJ, López‐Jiménez J, Martín F, Sanz A, Valeri A, Jiménez A, Sánchez R, Lahuerta JJ, Martínez‐López J. Imaging and bone marrow assessments improve minimal residual disease prediction in multiple myeloma. Am J Hematol 2019; 94:853-861. [PMID: 31074033 DOI: 10.1002/ajh.25507] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/04/2019] [Accepted: 05/07/2019] [Indexed: 01/01/2023]
Abstract
The value of minimal residual disease (MRD) status by bone marrow and imaging analysis as independent prognostic factors has been well established in multiple myeloma (MM). Nevertheless data about their potential complementarity for a more accurate assessment are limited. With this aim, we retrospectively analyzed the prediction of outcome with the combination of PET-CT and MRD, assessed by multiparameter flow cytometry (MFC) in 103 patients with newly diagnosed MM. We confirmed the benefit in terms of progression-free survival (PFS), linked to the achievement of negativity by MFC (hazard ratio [HR] 0.53; 95% confidence interval [CI]: 0.28-0.98), and PET-CT (HR 0.18; 95% CI: 0.09-0.36) individually. By combining both techniques, patients who became MRD-/PET-, with a median of PFS 92 months, had significant prolonged median PFS (P < .001). This is compared with MRD+/PET- and PET+ patients (median PFS of 45 and 28 months, respectively). We observed a significant difference (P = .003) in overall survival (OS) outcomes between MRD-/PET- and MRD+/PET- patients (4-year OS 94.2% and 100%, respectively), vs PET+ patients (4-year OS 73.8%). All survival results were confirmed in a conditional landmark analysis. These findings support the potential complementarity between PET-CT and MFC, and highlight their better predictive capability when improving sensitivity.
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Affiliation(s)
- Rafael Alonso
- Department of Hematology , Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Departamento de MedicinaH12O CNIO Clinical Research Hematology Unit; CIBERONC Madrid Spain
| | - María Teresa Cedena
- Department of Hematology , Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Departamento de MedicinaH12O CNIO Clinical Research Hematology Unit; CIBERONC Madrid Spain
| | - Adolfo Gómez‐Grande
- Department of Nuclear MedicineHospital Universitario 12 de Octubre Madrid Spain
| | - Rafael Ríos
- Department of HematologyHospital Universitario Virgen de las Nieves Granada Spain
| | - José María Moraleda
- Department of HematologyHospital Clínico Universitario Virgen de la Arrixaca Murcia Spain
| | - Valentín Cabañas
- Department of HematologyHospital Clínico Universitario Virgen de la Arrixaca Murcia Spain
| | - María José Moreno
- Department of HematologyHospital Clínico Universitario Virgen de la Arrixaca Murcia Spain
| | | | - Fernando Martín
- Department of HematologyHospital Universitario Ramón y Cajal Madrid Spain
| | - Alejandro Sanz
- Department of HematologyHospital Universitario Ramón y Cajal Madrid Spain
| | - Antonio Valeri
- Department of Hematology , Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Departamento de MedicinaH12O CNIO Clinical Research Hematology Unit; CIBERONC Madrid Spain
| | - Ana Jiménez
- Department of Hematology , Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Departamento de MedicinaH12O CNIO Clinical Research Hematology Unit; CIBERONC Madrid Spain
| | - Ricardo Sánchez
- Department of Hematology , Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Departamento de MedicinaH12O CNIO Clinical Research Hematology Unit; CIBERONC Madrid Spain
| | - Juan José Lahuerta
- Department of Hematology , Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Departamento de MedicinaH12O CNIO Clinical Research Hematology Unit; CIBERONC Madrid Spain
| | - Joaquín Martínez‐López
- Department of Hematology , Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Departamento de MedicinaH12O CNIO Clinical Research Hematology Unit; CIBERONC Madrid Spain
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30
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Medullary Abnormalities in Appendicular Skeletons Detected With 18F-FDG PET/CT Predict an Unfavorable Prognosis in Newly Diagnosed Multiple Myeloma Patients With High-Risk Factors. AJR Am J Roentgenol 2019; 213:918-924. [PMID: 31216203 DOI: 10.2214/ajr.19.21283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE. The prognostic value of medullary abnormalities in the appendicular skeleton (AS) of patients with multiple myeloma (MM) has recently been suggested. However, functional evaluation of these abnormalities using PET/CT has not been investigated to date. This study aimed to explore the prevalence and prognostic relevance of AS medullary abnormalities depicted by PET/CT in patients with MM. MATERIALS AND METHODS. This retrospective study included 228 consecutive patients with newly diagnosed, symptomatic MM who were treated with novel agents. All patients underwent pretreatment 18F-FDG PET/CT. RESULTS. There were 157 (68.9%) patients with zero AS focal lesions, 33 (14.5%) with one to three AS focal lesions, and 38 (16.7%) with more than three AS focal lesions on pre-treatment PET/CT. Patients with more than three AS focal lesions showed significantly shorter progression-free survival (PFS) and overall survival (OS) than did those with fewer lesions (both, p < 0.001). In multivariate analysis, the presence of more than three AS focal lesions remained prognostic for both PFS and OS (both, p < 0.001). Furthermore, the presence of more than three AS focal lesions discriminated patients with both significantly shorter PFS and significantly shorter OS even among patients with established high-risk parameters, including high-risk cytogenetic abnormalities, advanced disease stage, and established high-risk PET/CT findings. CONCLUSION. The presence of more than three focal lesions in the AS on pretreatment PET/CT was an independent predictor of poor survival in patients with newly diagnosed MM. Remarkably, this finding discriminated patients with shorter survival from among those with established high-risk factors. Evaluation of findings in the AS may complement and improve the prognostic performance of known stratification systems as well as PET/CT.
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Jamet B, Bailly C, Carlier T, Touzeau C, Nanni C, Zamagni E, Barré L, Michaud AV, Chérel M, Moreau P, Bodet-Milin C, Kraeber-Bodéré F. Interest of Pet Imaging in Multiple Myeloma. Front Med (Lausanne) 2019; 6:69. [PMID: 31024917 PMCID: PMC6465522 DOI: 10.3389/fmed.2019.00069] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/20/2019] [Indexed: 12/15/2022] Open
Abstract
The interest of 18Fluoro-deoxyglucose (FDG) positron emission tomography (PET) imaging in the management of patients with multiple myeloma (MM) for the workup at diagnosis and for therapeutic evaluation has recently been demonstrated. FDG-PET is a powerful imaging tool for bone lesions detection at initial diagnosis with high sensitivity and specificity values. The independent pejorative prognostic value on progression-free survival (PFS) and overall survival (OS) of baseline PET-derived parameters (presence of extra-medullary disease (EMD), number of focal bone lesions (FLs), and maximum standardized uptake values [SUVmax]) has been reported in several large independent prospective studies. During therapeutic evaluation, FDG-PET is considered as the reference imaging technique, because it can be performed much earlier than MRI which lacks specificity. Persistence of significant FDG uptake after treatment, notably before maintenance therapy, is an independent pejorative prognostic factor, especially for patients with a complete biological response. So FDG-PET and medullary flow cytometry are complementary tools for detection of minimal residual disease before maintenance therapy. However, the definition of PET metabolic complete response should be standardized. In patients with smoldering multiple myeloma, the presence of at least one hyper-metabolic lytic lesions on FDG-PET may be considered as a criterion for initiating therapy. FDG-PET is also indicated for initial staging of a solitary plasmacytoma so as to not disregard other bone or extra-medullary localizations. Development of nuclear medicine offer new perspectives for MM imaging. Recent PET tracers are willing to overcome limitations of FDG. (11)C-Methionine, which uptake reflects the increased protein synthesis of malignant cells seems to correlate well with bone marrow infiltration. Lipid tracers, such as Choline or acetate, and some peptide tracers, such as (68) Ga-Pentixafor, that targets CXCR4 (chemokine receptor-4, which is often expressed with high density by myeloma cells), are other promising PET ligands. 18F-fludarabine and immuno-PET targeting CD138 and CD38 also showed promising results in preclinical models.
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Affiliation(s)
- Bastien Jamet
- Nuclear Medicine Unit, University Hospital, Nantes, France
| | - Clément Bailly
- Nuclear Medicine Unit, University Hospital, Nantes, France.,CRCINA, INSERM, CNRS, Nantes University, Nantes, France
| | - Thomas Carlier
- Nuclear Medicine Unit, University Hospital, Nantes, France.,CRCINA, INSERM, CNRS, Nantes University, Nantes, France
| | - Cyrille Touzeau
- CRCINA, INSERM, CNRS, Nantes University, Nantes, France.,Haematology Department, University Hospital, Nantes, France
| | - Cristina Nanni
- Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elena Zamagni
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | | | - Michel Chérel
- CRCINA, INSERM, CNRS, Nantes University, Nantes, France
| | - Philippe Moreau
- CRCINA, INSERM, CNRS, Nantes University, Nantes, France.,Haematology Department, University Hospital, Nantes, France
| | - Caroline Bodet-Milin
- Nuclear Medicine Unit, University Hospital, Nantes, France.,CRCINA, INSERM, CNRS, Nantes University, Nantes, France
| | - Françoise Kraeber-Bodéré
- Nuclear Medicine Unit, University Hospital, Nantes, France.,CRCINA, INSERM, CNRS, Nantes University, Nantes, France.,Nuclear Medicine Unit, ICO-Gauducheau, Nantes-Saint-Herblain, France
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32
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Bailly C, Carlier T, Jamet B, Touzeau C, Moreau P, Kraeber-Bodéré F, Bodet-Milin C. 18F-FDG PET/CT in multiple myeloma: critical insights and future directions. Eur J Nucl Med Mol Imaging 2019; 46:1048-1050. [PMID: 30770949 DOI: 10.1007/s00259-019-04279-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/31/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Clément Bailly
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Nuclear Medicine, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Thomas Carlier
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Nuclear Medicine, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Bastien Jamet
- Department of Nuclear Medicine, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Cyrille Touzeau
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Hematology, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Philippe Moreau
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Hematology, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France
| | - Françoise Kraeber-Bodéré
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France.,Department of Nuclear Medicine, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.,Department of Nuclear Medicine, ICO-René Gauducheau, Boulevard Jacques Monod, 44805, Saint-Herblain, France
| | - Caroline Bodet-Milin
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France. .,Department of Nuclear Medicine, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
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Pretreatment 18F-FDG PET/CT combined with quantification of clonal circulating plasma cells as a potential risk model in patients with newly diagnosed multiple myeloma. Eur J Nucl Med Mol Imaging 2019; 46:1325-1333. [PMID: 30687892 DOI: 10.1007/s00259-019-4275-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/15/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Both 18F-FDG PET/CT and clonal circulating plasma cell (CPC) quantification are emerging tools for multiple myeloma (MM) prognostication that have been validated in recent studies. This study investigated the value of PET/CT coupled with CPC quantification for MM prognostication that may contribute to future risk-adapted treatment. METHODS We retrospectively analysed the prognostic relevance of a combination of pretreatment PET/CT findings and CPC levels in 163 consecutive patients with newly diagnosed, symptomatic MM receiving novel agents during induction therapies. RESULTS High-risk PET/CT findings and elevated CPC levels were defined by the presence of >3 focal lesions with or without extramedullary disease and CPCs ≥0.10% of the total mononuclear cells evaluated, respectively. Subsequently, patients were divided into three groups: PET-CPC stage I included patients with no high-risk PET/CT findings and low CPC levels; stage III included patients with high-risk PET/CT findings and high CPC levels; and stage II included the remaining patients. The three groups of patients differed significantly in terms of both progression-free survival (PFS) and overall survival (OS) (median PFS: not reached [NR] and 36.4 and 15.9 months, and median OS: NR, NR, and 40.4 months for stages I, II, and III, respectively; P < 0.001 for both PFS and OS). This system discriminated both PFS and OS even among younger (age < 75 years) or older (≥ 75 years) patients, patients with Revised International Staging System stage II or III, and patients with or without high-risk cytogenetic characteristics. In the multivariate analysis, the PET-CPC staging system remained prognostic for both PFS and OS. CONCLUSIONS The PET-CPC staging system predicted survival outcomes independently of established risk factors in patients with newly diagnosed MM. Pretreatment 18F-FDG PET/CT assessment combined with CPC quantification may improve the prognostication of MM and facilitate the development of novel risk-adapted approaches for MM.
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Uckun FM, Qazi S, Demirer T, Champlin RE. Contemporary patient-tailored treatment strategies against high risk and relapsed or refractory multiple myeloma. EBioMedicine 2019; 39:612-620. [PMID: 30545798 PMCID: PMC6354702 DOI: 10.1016/j.ebiom.2018.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 01/03/2023] Open
Abstract
Recurrence of disease due to chemotherapy drug resistance remains a major obstacle to a more successful survival outcome of multiple myeloma (MM). Overcoming drug resistance and salvaging patients with relapsed and/or refractory (R/R) MM is an urgent and unmet medical need. Several new personalized treatment strategies have been developed against molecular targets to overcome this drug resistance. There are several targeted therapeutics with anti-MM activity in clinical pipeline, including inhibitors of anti-apoptotic proteins, monoclonal antibodies, antibody-drug conjugates, bispecific antibodies, fusion proteins, and various cell therapy platforms. For example, B-cell maturation antigen (BCMA)-specific CAR-T cell platforms showed promising activity in heavily pretreated R/R MM patients. Therefore, there is renewed hope for high-risk as well as R/R MM patients in the era of personalized medicine.
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Affiliation(s)
- Fatih M Uckun
- Immuno-Oncology Program, Ares Pharmaceuticals, St. Paul, MN 55110, USA; Norris Comprehensive Cancer Center and Childrens Center for Cancer and Blood Diseases, University of Southern California Keck School of Medicine (USC KSOM), Los Angeles, CA 90027, USA.
| | - Sanjive Qazi
- Norris Comprehensive Cancer Center and Childrens Center for Cancer and Blood Diseases, University of Southern California Keck School of Medicine (USC KSOM), Los Angeles, CA 90027, USA; Bioinformatics Program, Gustavus Adolphus College, 800 W College Avenue, St. Peter, MN 56082, USA
| | - Taner Demirer
- Ankara University School of Medicine, Cebeci Hospital, Cebeci, 6590 Cankaya, Ankara, Turkey
| | - Richard E Champlin
- Department of Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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