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Rata M, Blackledge M, Scurr E, Winfield J, Koh DM, Dragan A, Candito A, King A, Rennie W, Gaba S, Suresh P, Malcolm P, Davis A, Nilak A, Shah A, Gandhi S, Albrizio M, Drury A, Roberts S, Jenner M, Brown S, Kaiser M, Messiou C. Implementation of Whole-Body MRI (MY-RADS) within the OPTIMUM/MUKnine multi-centre clinical trial for patients with myeloma. Insights Imaging 2022; 13:123. [PMID: 35900614 PMCID: PMC9334517 DOI: 10.1186/s13244-022-01253-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whole-body (WB) MRI, which includes diffusion-weighted imaging (DWI) and T1-w Dixon, permits sensitive detection of marrow disease in addition to qualitative and quantitative measurements of disease and response to treatment of bone marrow. We report on the first study to embed standardised WB-MRI within a prospective, multi-centre myeloma clinical trial (IMAGIMM trial, sub-study of OPTIMUM/MUKnine) to explore the use of WB-MRI to detect minimal residual disease after treatment. METHODS The standardised MY-RADS WB-MRI protocol was set up on a local 1.5 T scanner. An imaging manual describing the MR protocol, quality assurance/control procedures and data transfer was produced and provided to sites. For non-identical scanners (different vendor or magnet strength), site visits from our physics team were organised to support protocol optimisation. The site qualification process included review of phantom and volunteer data acquired at each site and a teleconference to brief the multidisciplinary team. Image quality of initial patients at each site was assessed. RESULTS WB-MRI was successfully set up at 12 UK sites involving 3 vendor systems and two field strengths. Four main protocols (1.5 T Siemens, 3 T Siemens, 1.5 T Philips and 3 T GE scanners) were generated. Scanner limitations (hardware and software) and scanning time constraint required protocol modifications for 4 sites. Nevertheless, shared methodology and imaging protocols enabled other centres to obtain images suitable for qualitative and quantitative analysis. CONCLUSIONS Standardised WB-MRI protocols can be implemented and supported in prospective multi-centre clinical trials. Trial registration NCT03188172 clinicaltrials.gov; registration date 15th June 2017 https://clinicaltrials.gov/ct2/show/study/NCT03188172.
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Affiliation(s)
- Mihaela Rata
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK.
| | - Matthew Blackledge
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Erica Scurr
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Jessica Winfield
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Dow-Mu Koh
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Alina Dragan
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Antonio Candito
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Alexander King
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Suchi Gaba
- Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Priya Suresh
- University Hospitals Plymouth NHS Foundation Trust, Plymouth, UK
| | - Paul Malcolm
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Amy Davis
- Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
| | | | - Aarti Shah
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | | | - Mauro Albrizio
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Arnold Drury
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Sadie Roberts
- University of Leeds Clinical Trial Research Unit, Leeds, UK
| | - Matthew Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Brown
- University of Leeds Clinical Trial Research Unit, Leeds, UK
| | - Martin Kaiser
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Christina Messiou
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
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Shapiro YN, O'Donnell EK. Oncologist perspective: role of imaging in myeloma. Skeletal Radiol 2022; 51:123-133. [PMID: 34272993 DOI: 10.1007/s00256-021-03856-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 02/02/2023]
Abstract
With major advancements in treatments for multiple myeloma (MM), it is critical that we evaluate our methods for both diagnosing MM and monitoring its progression over time. Imaging methods, such as conventional skeletal x-ray, low-dose whole-body CT, MRI, and PET-CT, provide valuable information that influences our clinical decision-making. In this review, we will evaluate the role of these imaging techniques throughout the MM disease course, from diagnosis to follow-up after therapy, and also provide appropriate recommendations.
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Messiou C, Porta N, Sharma B, Levine D, Koh DM, Boyd K, Pawlyn C, Riddell A, Downey K, Croft J, Morgan V, Stern S, Cheung B, Kyriakou C, Kaczmarek P, Winfield J, Blackledge M, Oyen WJG, Kaiser MF. Prospective Evaluation of Whole-Body MRI versus FDG PET/CT for Lesion Detection in Participants with Myeloma. Radiol Imaging Cancer 2021; 3:e210048. [PMID: 34559006 PMCID: PMC8489453 DOI: 10.1148/rycan.2021210048] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 05/22/2023]
Abstract
Purpose To compare disease detection of myeloma using contemporary whole-body (WB) MRI and fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT protocols and to correlate imaging with laboratory estimates of disease burden, including molecular characteristics. Materials and Methods In this observational, prospective study, participants were recruited from November 2015 to March 2018 who had a diagnosis of myeloma, who were planned to undergo chemotherapy and autologous stem cell transplantation, and who underwent baseline WB-MRI and FDG PET/CT (ClinicalTrials.gov identifier NCT02403102). Baseline clinical data, including genetics, were collected. Paired methods were used to compare burden and patterns of disease. Results Sixty participants (mean age, 60 years ± 9 [standard deviation]; 35 men) underwent baseline WB-MRI and FDG PET/CT. WB-MRI showed significantly higher detection for focal lesions at all anatomic sites (except ribs, scapulae, and clavicles) and for diffuse disease at all sites. Two participants presented with two or more focal lesions smaller than 5 mm only at WB-MRI but not FDG PET/CT. Participants with diffuse disease at MRI had higher plasma cell infiltration (percentage of nucleated cells: median, 60% [interquartile range {IQR}, 50%-61%] vs 15% [IQR, 4%-50%]; P = .03) and paraprotein levels (median, 32.0 g/L [IQR, 24.0-48.0 g/L] vs 20.0 g/L [IQR, 12.0-22.6 g/L]; P = .02) compared with those without diffuse disease. All genetically high-risk tumors showed diffuse infiltration at WB-MRI. Conclusion WB-MRI helped detect a higher number of myeloma lesions than FDG PET/CT, and diffuse disease detected at WB-MRI correlated with laboratory measures of disease burden and molecular markers of risk. Keywords: MR-Imaging, Skeletal-Appendicular, Skeletal-Axial, Bone Marrow, Hematologic Diseases, Oncology Clinical trial registration no. NCT02403102. Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Christina Messiou
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Nuria Porta
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Bhupinder Sharma
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Daniel Levine
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Dow-Mu Koh
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Kevin Boyd
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Charlotte Pawlyn
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Angela Riddell
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Katherine Downey
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - James Croft
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Veronica Morgan
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Simon Stern
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Betty Cheung
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Charalampia Kyriakou
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Pawel Kaczmarek
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Jessica Winfield
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Matthew Blackledge
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Wim J. G. Oyen
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Martin F. Kaiser
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
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Serin I, Hilmi Dogu M. An unexpected situation in isolated nasopharyngeal mass differential diagnosis: Solitary extramedullary plasmacytoma. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Romano A, Cerchione C, Conticello C, Martinelli G, Di Raimondo F. How we manage smoldering multiple myeloma. Hematol Rep 2020; 12:8951. [PMID: 33042502 PMCID: PMC7520850 DOI: 10.4081/hr.2020.8951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Indexed: 11/23/2022] Open
Abstract
Smoldering myeloma (SMM) is an asymptomatic stage characterized by bone marrow plasma cells infiltration between 10-60% in absence of myeloma-defining events and organ damage. Until the revision of criteria of MM to require treatment, two main prognostic models, not overlapping each other, were proposed and used differently in Europe and in US. Novel manageable drugs, like lenalidomide and monoclonal antibodies, with high efficacy and limited toxicity, improvement in imaging and prognostication, challenge physicians to offer early treatment to highrisk SMM. Taking advantage from the debates offered by SOHO Italy, in this review we will update the evidence and consequent clinical practices in US and Europe to offer readers a uniform view of clinical approach at diagnosis, follow-up and supportive care in the SMM setting.
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Affiliation(s)
- Alessandra Romano
- Dipartimento di Chirurgia e Specialità Medico-Chirurgiche, Sezione di Ematologia, Università degli Studi di Catania
| | - Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC)
| | - Concetta Conticello
- U.O.C. di Ematologia, Azienda Policlinico Rodolico San Marco, Catania, Italy
| | - Giovanni Martinelli
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC)
| | - Francesco Di Raimondo
- Dipartimento di Chirurgia e Specialità Medico-Chirurgiche, Sezione di Ematologia, Università degli Studi di Catania
- U.O.C. di Ematologia, Azienda Policlinico Rodolico San Marco, Catania, Italy
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Nassar S, Taher A, Spear R, Wang F, Madewell JE, Mujtaba B. Multiple Myeloma: Role of Imaging in Diagnosis, Staging, and Treatment Response Assessment. Semin Ultrasound CT MR 2020; 42:184-193. [PMID: 33814104 DOI: 10.1053/j.sult.2020.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Multiple myeloma is a common hematologic malignancy of plasma cells. Differentiating multiple myeloma from the precursor stages of monoclonal gammopathy of undetermined significance and smoldering multiple myeloma is very important because the treatment approach is different for each. The diagnosis is mainly clinical, while the role of imaging is confined to the staging process, assessing response to therapy, and monitoring for disease progression. In this article, we examine the role of different imaging modalities in patients with multiple myeloma.
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Affiliation(s)
- Sameh Nassar
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed Taher
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rosario Spear
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - John E Madewell
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bilal Mujtaba
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Madhira BR, Konala VM, Adapa S, Naramala S, Ravella PM, Parikh K, Gentile TC. Recent Advances in the Management of Smoldering Multiple Myeloma. World J Oncol 2020; 11:45-54. [PMID: 32284772 PMCID: PMC7141158 DOI: 10.14740/wjon1245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/11/2020] [Indexed: 11/26/2022] Open
Abstract
There is remarkable progress in the treatment of multiple myeloma (MM) with significant improvement in survival in the past 10 years. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) can evolve into symptomatic multiple myeloma (sy-MM) with organ involvement. SMM has associated with a much higher progression to MM compared to MGUS. In 2014, International Myeloma Working Group (IMWG) reclassified ultra-high-risk smoldering myeloma patients with bone marrow plasma cells > 60% or serum-free light chain ratio (FLCr) > 100 or > 1 focal bone lesion on the magnetic resonance imaging as MM. SMM is a heterogeneous disorder with probability for progression to myeloma up to 50% in the first 5 years. Several risk models and clinical features have been identified to stratify the risk of progression to MM. Thanks to advances in our understanding of the genomic profile of MM, there are several ongoing clinical trials, and genomic studies are being done to assess the risk of progression to MM and early intervention. There is still no standard criterion regarding when to start therapy. This review discusses identifying SMM patients who are at high risk of progression to sy-MM and recent development of new and early treatment strategies and ongoing clinical trials for these high-risk SMM patients.
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Affiliation(s)
| | | | | | - Srikanth Naramala
- Department of Rheumatology, Adventist Medical Center, Hanford, CA, USA
| | | | - Kaushal Parikh
- John Theurer Cancer Center, 92 2nd St, Hackensack, NJ, USA
| | - Teresa C Gentile
- Division of Hematology Oncology, Regional Oncology Center, SUNY Upstate Medical University, Syracuse, NY, USA
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Abstract
Smoldering multiple myeloma (SMM) is an asymptomatic, intermediate stage positioned between the plasma cell disorders of monoclonal gammopathy of undermined significance and overt multiple myeloma (MM). Although the patients with SMM have a higher risk of progression to MM in comparison to their counterparts with monoclonal gammopathy of undermined significance, their clinical course can be highly variable. The standard of care for SMM, irrespective of the risk status, continues to be observation due to paucity of high-level evidence demonstrating survival or quality-of-life benefit with early intervention. With the expanded 2014 criteria for MM utilizing biomarkers, the subset of SMM patients with 70% to 80% risk of progression at 2 years (ultra-high risk SMM) is now categorized as active MM and treated prior to the development of end-organ damage. After exclusion of this group, patients with approximately 50% risk of progression in 2 years are now considered high-risk SMM, and the value of early treatment in this subset can be established only through clinical trials. Despite its limitations, a recent phase III trial (QuiRedex) has shown survival advantage to using lenalidomide and dexamethasone doublet over observation in high-risk SMM. In this article, we review the evolving concepts in the diagnosis, risk stratification, and management of SMM.
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Gregorio LM, Soyemi TO. Multiple myeloma presenting as dural plasmacytoma. Radiol Case Rep 2019; 14:1007-1013. [PMID: 31198485 PMCID: PMC6556834 DOI: 10.1016/j.radcr.2019.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 01/05/2023] Open
Abstract
The finding of intracranial, extramedullary plasmacytoma is rare in multiple myeloma, especially with dural involvement. Meningioma remains the most common intracranial extra-axial mass. We report a case of a 39-year-old male who presented with intracranial, extra-axial mass found later to be dural plasmacytoma and additional multiple lesions on skeletal survey, leading to a diagnosis of multiple myeloma. The objective of this case is to increase awareness of the possibility of dural plasmacytoma as a differential diagnosis of meningioma and a harbinger of multiple myeloma. Magnetic resonance imaging plays a vital role in the detection of additional lesions in individuals while excluding multiple myeloma.
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Affiliation(s)
- Laura M Gregorio
- Department of Radiology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Temitope O Soyemi
- Department of Radiology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103, USA
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Messiou C, Hillengass J, Delorme S, Lecouvet FE, Moulopoulos LA, Collins DJ, Blackledge MD, Abildgaard N, Østergaard B, Schlemmer HP, Landgren O, Asmussen JT, Kaiser MF, Padhani A. Guidelines for Acquisition, Interpretation, and Reporting of Whole-Body MRI in Myeloma: Myeloma Response Assessment and Diagnosis System (MY-RADS). Radiology 2019; 291:5-13. [PMID: 30806604 DOI: 10.1148/radiol.2019181949] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acknowledging the increasingly important role of whole-body MRI for directing patient care in myeloma, a multidisciplinary, international, and expert panel of radiologists, medical physicists, and hematologists with specific expertise in whole-body MRI in myeloma convened to discuss the technical performance standards, merits, and limitations of currently available imaging methods. Following guidance from the International Myeloma Working Group and the National Institute for Clinical Excellence in the United Kingdom, the Myeloma Response Assessment and Diagnosis System (or MY-RADS) imaging recommendations are designed to promote standardization and diminish variations in the acquisition, interpretation, and reporting of whole-body MRI in myeloma and allow response assessment. This consensus proposes a core clinical protocol for whole-body MRI and an extended protocol for advanced assessments. Published under a CC BY 4.0 license. Online supplemental material is available for this article.
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Affiliation(s)
- Christina Messiou
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Jens Hillengass
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Stefan Delorme
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Frédéric E Lecouvet
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Lia A Moulopoulos
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - David J Collins
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Matthew D Blackledge
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Niels Abildgaard
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Brian Østergaard
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Heinz-Peter Schlemmer
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Ola Landgren
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Jon Thor Asmussen
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Martin F Kaiser
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
| | - Anwar Padhani
- From the Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, Downs Rd, Sutton SM2 5PT, England (C.M., M.D.B., M.F.K.); Roswell Park Comprehensive Cancer Center, Buffalo, NY (J.H.); Department of Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany (S.D., H.P.S.); Department of Radiology, Cancer Center and Institute of Experimental and Clinical Research, Brussels, Belgium (F.E.L.); Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece (L.I.A.); The Royal Marsden Hospital, London, England (D.J.C.); Odense University Hospital, Odense, Denmark (N.A., J.T.A.); Vejle Hospital, Vejle, Denmark (B.Ø.); Memorial Sloan-Kettering Cancer Center, New York, NY (O.L.); and Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (A.P.)
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Zamagni E, Cavo M, Fakhri B, Vij R, Roodman D. Bones in Multiple Myeloma: Imaging and Therapy. Am Soc Clin Oncol Educ Book 2018; 38:638-646. [PMID: 30231385 DOI: 10.1200/edbk_205583] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
F-fluorodeoxyglucose (FDG)-PET/CT, MRI, and other novel imaging modalities in the management of disease in patients with plasma cell dyscrasias. We also review the state of the art in treatment of MM bone disease (MMBD) and the role of bisphosphonates and denosumab, a monoclonal antibody that binds and blocks the activity of receptor activator of nuclear factor-kappa B ligand (RANKL), which was recently approved by the U.S. Food and Drug Administration for MMBD.
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Affiliation(s)
- Elena Zamagni
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - Michele Cavo
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - Bita Fakhri
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - Ravi Vij
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - David Roodman
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
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12
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13
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Lakshman A, Rajkumar SV, Buadi FK, Binder M, Gertz MA, Lacy MQ, Dispenzieri A, Dingli D, Fonder AL, Hayman SR, Hobbs MA, Gonsalves WI, Hwa YL, Kapoor P, Leung N, Go RS, Lin Y, Kourelis TV, Warsame R, Lust JA, Russell SJ, Zeldenrust SR, Kyle RA, Kumar SK. Risk stratification of smoldering multiple myeloma incorporating revised IMWG diagnostic criteria. Blood Cancer J 2018; 8:59. [PMID: 29895887 PMCID: PMC5997745 DOI: 10.1038/s41408-018-0077-4] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/20/2018] [Accepted: 03/28/2018] [Indexed: 12/31/2022] Open
Abstract
In 2014, the International Myeloma Working Group reclassified patients with smoldering multiple myeloma (SMM) and bone marrow-plasma cell percentage (BMPC%) ≥ 60%, or serum free light chain ratio (FLCr) ≥ 100 or >1 focal lesion on magnetic resonance imaging as multiple myeloma (MM). Predictors of progression in patients currently classified as SMM are not known. We identified 421 patients with SMM, diagnosed between 2003 and 2015. The median time to progression (TTP) was 57 months (CI, 45–72). BMPC% > 20% [hazard ratio (HR): 2.28 (CI, 1.63–3.20); p < 0.0001]; M-protein > 2g/dL [HR: 1.56 (CI, 1.11–2.20); p = 0.01], and FLCr > 20 [HR: 2.13 (CI, 1.55–2.93); p < 0.0001] independently predicted shorter TTP in multivariate analysis. Age and immunoparesis were not significant. We stratified patients into three groups: low risk (none of the three risk factors; n = 143); intermediate risk (one of the three risk factors; n = 121); and high risk (≥2 of the three risk factors; n = 153). The median TTP for low-, intermediate-, and high-risk groups were 110, 68, and 29 months, respectively (p < 0.0001). BMPC% > 20%, M-protein > 2 g/dL, and FLCr > 20 at diagnosis can be used to risk stratify patients with SMM. Patients with high-risk SMM need close follow-up and are candidates for clinical trials aiming to prevent progression.
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Affiliation(s)
| | | | | | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Morie A Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Martha Q Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Amie L Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Yi Lin
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - John A Lust
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Shaji K Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.
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14
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Kosmala A, Weng AM, Krauss B, Knop S, Bley TA, Petritsch B. Dual-energy CT of the bone marrow in multiple myeloma: diagnostic accuracy for quantitative differentiation of infiltration patterns. Eur Radiol 2018; 28:5083-5090. [DOI: 10.1007/s00330-018-5537-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/01/2018] [Accepted: 05/14/2018] [Indexed: 12/21/2022]
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15
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Wennmann M, Kintzelé L, Piraud M, Menze BH, Hielscher T, Hofmanninger J, Wagner B, Kauczor HU, Merz M, Hillengass J, Langs G, Weber MA. Volumetry based biomarker speed of growth: Quantifying the change of total tumor volume in whole-body magnetic resonance imaging over time improves risk stratification of smoldering multiple myeloma patients. Oncotarget 2018; 9:25254-25264. [PMID: 29861868 PMCID: PMC5982766 DOI: 10.18632/oncotarget.25402] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/25/2018] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to improve risk stratification of smoldering multiple myeloma patients, introducing new 3D-volumetry based imaging biomarkers derived from whole-body MRI. Two-hundred twenty whole-body MRIs from 63 patients with smoldering multiple myeloma were retrospectively analyzed and all focal lesions >5mm were manually segmented for volume quantification. The imaging biomarkers total tumor volume, speed of growth (development of the total tumor volume over time), number of focal lesions, development of the number of focal lesions over time and the recent imaging biomarker ‘>1 focal lesion’ of the International Myeloma Working Group were compared, taking 2-year progression rate, sensitivity and false positive rate into account. Speed of growth, using a cutoff of 114mm3/month, was able to isolate a high-risk group with a 2-year progression rate of 82.5%. Additionally, it showed by far the highest sensitivity in this study and in comparison to other biomarkers in the literature, detecting 63.2% of patients who progress within 2 years. Furthermore, its false positive rate (8.7%) was much lower compared to the recent imaging biomarker ‘>1 focal lesion’ of the International Myeloma Working Group. Therefore, speed of growth is the preferable imaging biomarker for risk stratification of smoldering multiple myeloma patients.
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Affiliation(s)
- Markus Wennmann
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Laurent Kintzelé
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marie Piraud
- Department of Computer Science, Technical University of Munich, Munich, Germany
| | - Bjoern H Menze
- Department of Computer Science, Technical University of Munich, Munich, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johannes Hofmanninger
- Department of Biomedical Imaging and Image-Guided Therapy, Computational Imaging Research Laboratory, Medical University of Vienna, Vienna, Austria
| | - Barbara Wagner
- Department of Medicine V, Multiple Myeloma Section, University of Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Merz
- Department of Medicine V, Multiple Myeloma Section, University of Heidelberg, Heidelberg, Germany
| | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Georg Langs
- Department of Biomedical Imaging and Image-Guided Therapy, Computational Imaging Research Laboratory, Medical University of Vienna, Vienna, Austria
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
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Koutoulidis V, Papanikolaou N, Moulopoulos LA. Functional and molecular MRI of the bone marrow in multiple myeloma. Br J Radiol 2018; 91:20170389. [PMID: 29393672 DOI: 10.1259/bjr.20170389] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
MRI plays an important role in the management of patients with plasma cell neoplasms and has been recognized as a biomarker of malignancy in the novel criteria for the diagnosis of multiple myeloma. Functional and molecular MRI techniques such as diffusion-weighted imaging (spinal or whole body), intravoxel incoherent motion, and dynamic contrast enhanced MRI, provide additional information related to tumor cellularity and angiogenesis, which may have prognostic implications for patients with smoldering and symptomatic myeloma. These non-invasive functional techniques are also being evaluated as imaging biomarkers for response assessment in myeloma patients. The purpose of this article is to provide a comprehensive critical review on the current use and potential future applications of these advanced MRI techniques in multiple myeloma. In addition, we will address the technologies involved and describe the qualitative and quantitative characteristics of normal bone marrow with these techniques.
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Affiliation(s)
- Vassilis Koutoulidis
- 1 First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
| | - Nickolas Papanikolaou
- 2 Computational Clinical Imaging Group, Centre for the Unknown, Champalimaud Foundation , Lisbon , Portugal
| | - Lia A Moulopoulos
- 1 First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens , Athens , Greece
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Stecco A, Buemi F, Iannessi A, Carriero A, Gallamini A. Current concepts in tumor imaging with whole-body MRI with diffusion imaging (WB-MRI-DWI) in multiple myeloma and lymphoma. Leuk Lymphoma 2018; 59:2546-2556. [PMID: 29431555 DOI: 10.1080/10428194.2018.1434881] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Whole-body MRI (WB-MRI) with diffusion-weighted imaging (DWI) can now be used to stage and restage multiple myeloma (MM) and lymphoma. Magnetic resonance imaging (MRI) is the standard tool to detect BM involvement (BMI). The 2016 diagnostic criteria of the International Myeloma Working Group identify WB-MRI and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) as the most sensitive imaging techniques for detecting skeletal and extra-skeletal MM invasion, respectively. Preliminary findings have also shown that WB-MRI is better than CT and equal to PET/CT in staging aggressive lymphoma and Hodgkin lymphoma, whereas MRI is better for diagnosing BMI in patients with low-grade lymphoma. Signal intensity (SI) and the apparent diffusion coefficient (ADC) are useful metrics to quantify the chemotherapy response in WB-MRI.
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Affiliation(s)
- Alessandro Stecco
- a Services Diagnosis and Therapies Department - Radiology , Azienda Ospedaliero-Universitaria Maggiore della Carita , Novara , Italy
| | - Francesco Buemi
- b Radiologic Department , L'Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte , Messina , Italy
| | - Antoine Iannessi
- c Radiology Department , Centre Antoine-Lacassagne , Nice , France
| | - Alessandro Carriero
- a Services Diagnosis and Therapies Department - Radiology , Azienda Ospedaliero-Universitaria Maggiore della Carita , Novara , Italy
| | - Andrea Gallamini
- d Research, Innovation and Statistics Department , Centre Antoine-Lacassagne , Nice , France
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18
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Abstract
Smoldering multiple myeloma (SMM) is a pre-malignant condition with an inherent risk for progression to multiple myeloma (MM). The 2014 IMWG guidelines define smoldering multiple myeloma as a monoclonal gammopathy disorder with serum monoclonal protein (IgG or IgA) ≥30 g/L or urinary monoclonal protein ≥500 mg per 24 h and/or clonal bone marrow plasma cells 10-60 % without any myeloma-defining events or amyloidosis. The risk for progression of SMM to MM vary based on clinical, laboratory, imaging, and molecular characteristics. Observation, with periodic monitoring is the current standard of care for SMM. Over last few years, research advances in SMM have led to the delineation of newer risk factors for progression and identification of a "high-risk" group that would potentially benefit from early treatment. This review focuses on advances in the SMM risk-stratification model and recent clinical trials in this patient population.
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Ippolito D, Talei Franzesi C, Spiga S, Besostri V, Pezzati S, Rossini F, Sironi S. Diagnostic value of whole-body ultra-low dose computed tomography in comparison with spinal magnetic resonance imaging in the assessment of disease in multiple myeloma. Br J Haematol 2017; 177:395-403. [PMID: 28233900 DOI: 10.1111/bjh.14545] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/23/2016] [Indexed: 02/05/2023]
Abstract
This study compared the diagnostic value of Whole-Body Ultra Low-Dose computed tomography (WBULDCT) with that of Spinal Magnetic Resonance Imaging (SMRI) in identification of spinal bone marrow involvement in patients with Multiple Myeloma (MM). Thirty-five patients with histologically proven MM underwent WBULDCT and dedicated SMRI. Unenhanced WBULDCT was performed on a 256-slice scanner, with 120 kV and 40 mAs. SMRI was performed on a 1·5T magnet, with T1-turbo spin echo and T2-short tau inversion recovery sequences on sagittal plane. WBULDCT was compared with SMRI in terms of lesion detection, pattern and bone marrow involvement. The overall concordance between WBULDCT and SMRI in lesion detection was 76·7%, detecting (25/35) or excluding (8/35) involvement of the axial skeleton, while in 2/35 patients WBULDCT and SMRI were discordant in terms of axial skeleton involvement. The concordance in spinal distribution of lesions was 61·6% on cervical, 71·5% on dorsal, 86·4% on lumbar and 94·4% on sacral, while for the pattern of disease, it was 56·1% for the focal and 88·7% for the combined pattern. Cohen's kappa index was 0·85 (P < 0·001) assessing an excellent agreement. WBULDCT represents a useful diagnostic tool in the detection of spinal involvement of MM patients, offering detailed information about extra-axial involvement, which could be potentially missed with dedicated SMRI.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Sara Spiga
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Valeria Besostri
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Sara Pezzati
- Department of Haematology, San Gerardo Hospital, Monza, MB, Italy
| | - Fausto Rossini
- Department of Haematology, San Gerardo Hospital, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
- Department of Diagnostic Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
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20
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Terpos E, Dimopoulos MA, Moulopoulos LA. The Role of Imaging in the Treatment of Patients With Multiple Myeloma in 2016. Am Soc Clin Oncol Educ Book 2017; 35:e407-17. [PMID: 27249748 DOI: 10.1200/edbk_159074] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The novel criteria for the diagnosis of symptomatic multiple myeloma have revealed the value of modern imaging for the management of patients with myeloma. Whole-body low-dose CT (LDCT) has increased sensitivity over conventional radiography for the detection of osteolytic lesions, and several myeloma organizations and institutions have suggested that whole-body LDCT should replace conventional radiography for the work-up of patients with myeloma. MRI is the best imaging method for the depiction of marrow infiltration by myeloma cells. Whole-body MRI (or at least MRI of the spine and pelvis if whole-body MRI is not available) should be performed for all patients with smoldering multiple myeloma with no lytic lesions to look for occult disease, which may justify treatment. In addition, MRI accurately illustrates the presence of plasmacytomas, spinal cord, and/or nerve compression for surgical intervention or radiation therapy; it is also recommended for the work-up of solitary bone plasmacytoma, and it may distinguish malignant from benign fractures (which is very important in cases of patients in biochemical remission with no other signs of progression). Diffusion weighted imaging (DWI) seems to improve MRI diagnosis in patients with myeloma. PET/CT is a functional imaging technique, more sensitive than conventional radiography for the detection of lytic lesions, which probably allows better definition of complete response and minimal residual disease compared with all other imaging methods. PET/CT has shown the best results in the follow-up of patients with myeloma and has an independent prognostic value both at diagnosis and following treatment. PET/CT can also be used for the work-up of solitary bone plasmacytoma and nonsecretory myeloma.
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Affiliation(s)
- Evangelos Terpos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Meletios A Dimopoulos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Lia A Moulopoulos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
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21
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Koutoulidis V, Fontara S, Terpos E, Zagouri F, Matsaridis D, Christoulas D, Panourgias E, Kastritis E, Dimopoulos MA, Moulopoulos LA. Quantitative Diffusion-weighted Imaging of the Bone Marrow: An Adjunct Tool for the Diagnosis of a Diffuse MR Imaging Pattern in Patients with Multiple Myeloma. Radiology 2016; 282:484-493. [PMID: 27610934 DOI: 10.1148/radiol.2016160363] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose To evaluate the apparent diffusion coefficients (ADCs) of magnetic resonance (MR) imaging patterns in the bone marrow of patients with multiple myeloma (MM) and to determine a threshold ADC that may help distinguish a diffuse from a normal pattern with high accuracy. Materials and Methods This prospective study was approved by the ethics review board, and informed consent was obtained. Ninety-nine patients with newly diagnosed, untreated MM and 16 healthy control subjects underwent spinal MR imaging including diffusion-weighted imaging, and bone marrow ADCs were calculated. Pattern assignment was based on visual assessment of conventional MR images. The Kruskal-Wallis H test, the Mann-Whitney test, and the one-way analysis of variance were used to compare ADCs between patient subsets and control subjects, and a receiver operating characteristic analysis was performed. Results Mean ADCs ± standard deviation in patients with MM for the normal, focal, and diffuse MR imaging patterns were 0.360 × 10-3 mm2/sec ± 0.110, 1.046 × 10-3 mm2/sec ± 0.232, and 0.770 × 10-3 mm2/sec ± 0.135, respectively. There were significant differences in ADCs between diffuse and normal (P < .001), diffuse and focal (P < .001), and focal and normal (P < .001) patterns. Patients with a diffuse pattern had more features of advanced disease, higher international staging system score, increased incidence of high-risk cytogenetics, and higher revised international staging system score. ADCs greater than 0.548 × 10-3 mm2/sec showed 100% sensitivity (26 of 26) and 98% specificity (48 of 49) for the diagnosis of a diffuse (vs normal) MR imaging pattern, whereas an ADC greater than 0.597 × 10-3 mm2/sec showed 96% sensitivity (25 of 26) and 100% specificity (49 of 49). Conclusion ADCs of MR imaging patterns in patients with MM differ significantly. A diffuse MR imaging pattern can be distinguished more objectively from a normal MR imaging pattern by adding quantitative diffusion-weighted imaging to standard MR imaging protocols. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Vassilis Koutoulidis
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Sophia Fontara
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Evangelos Terpos
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Flora Zagouri
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Dimitris Matsaridis
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Dimitrios Christoulas
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Evangelia Panourgias
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Efstathios Kastritis
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Meletios A Dimopoulos
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
| | - Lia A Moulopoulos
- From the First Department of Radiology (V.K., S.F., D.M., E.P., L.A.M.) and Department of Clinical Therapeutics (E.T., F.Z., D.C., E.K., M.A.D.), School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 76, Vas. Sophias Avenue, 11528 Athens, Greece
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22
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Bhutani M, Turkbey B, Tan E, Korde N, Kwok M, Manasanch EE, Tageja N, Mailankody S, Roschewski M, Mulquin M, Carpenter A, Lamping E, Minter AR, Weiss BM, Mena E, Lindenberg L, Calvo KR, Maric I, Usmani SZ, Choyke PL, Kurdziel K, Landgren O. Bone marrow abnormalities and early bone lesions in multiple myeloma and its precursor disease: a prospective study using functional and morphologic imaging. Leuk Lymphoma 2016; 57:1114-21. [PMID: 26690712 DOI: 10.3109/10428194.2015.1090572] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The incidence and importance of bone marrow involvement and/or early bone lesions in multiple myeloma (MM) precursor diseases is largely unknown. This study prospectively compared the sensitivity of several imaging modalities in monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM) and MM. Thirty patients (10 each with MGUS, SMM and MM) were evaluated with skeletal survey, [18F]FDG-PET/CT, [18F]NaF-PET/CT and morphologic dynamic contrast enhanced (DCE)-MRI. An additional 16 SMM patients had skeletal surveys and FDG-PET/CT. Among MGUS patients, DCE-MRI found only one focal marrow abnormality; other evaluations were negative. Among 26 SMM patients, five (19%) were re-classified as MM based on lytic bone lesions on CT and six had unifocal or diffuse marrow abnormality. Among MM, marrow abnormalities were observed on FDG-PET/CT in 8/10 patients and on DCE-MRI in nine evaluable patients. Abnormal NaF uptake was observed only in MM patients with lytic lesions on CT, providing no additional clinical information.
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Affiliation(s)
- Manisha Bhutani
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA ;,b Levine Cancer Institute , Carolinas HealthCare System , Charlotte , NC , USA
| | - Baris Turkbey
- c Molecular Imaging Program , CCR, NCI, NIH , Bethesda , MD , USA
| | - Esther Tan
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA
| | - Neha Korde
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA ;,d Memorial Sloan-Kettering Cancer Center , New York , NY , USA
| | - Mary Kwok
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA
| | - Elisabet E Manasanch
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA ;,e The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Nishant Tageja
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA
| | - Sham Mailankody
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA
| | - Mark Roschewski
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA
| | - Marcia Mulquin
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA
| | - Ashley Carpenter
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA
| | - Elizabeth Lamping
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA
| | - Alex R Minter
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA
| | - Brendan M Weiss
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA ;,f Abramson Cancer Center , University of Pennsylvania , Philadelphia , PA , USA
| | - Esther Mena
- c Molecular Imaging Program , CCR, NCI, NIH , Bethesda , MD , USA
| | - Liza Lindenberg
- c Molecular Imaging Program , CCR, NCI, NIH , Bethesda , MD , USA
| | | | - Irina Maric
- g Hematology Section , DLM, CC, NIH , Bethesda , MD , USA
| | - Saad Z Usmani
- b Levine Cancer Institute , Carolinas HealthCare System , Charlotte , NC , USA
| | - Peter L Choyke
- c Molecular Imaging Program , CCR, NCI, NIH , Bethesda , MD , USA
| | - Karen Kurdziel
- c Molecular Imaging Program , CCR, NCI, NIH , Bethesda , MD , USA
| | - Ola Landgren
- a Multiple Myeloma Section , Lymphoid Malignancies Branch, CCR, NCI, NIH , Bethesda , MD , USA ;,d Memorial Sloan-Kettering Cancer Center , New York , NY , USA
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23
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Caers J, Fernández de Larrea C, Leleu X, Heusschen R, Zojer N, Decaux O, Kastritis E, Minnema M, Jurczyszyn A, Beguin Y, Wäsch R, Palumbo A, Dimopoulos M, Mateos MV, Ludwig H, Engelhardt M. The Changing Landscape of Smoldering Multiple Myeloma: A European Perspective. Oncologist 2016; 21:333-42. [PMID: 26921288 DOI: 10.1634/theoncologist.2015-0303] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 12/04/2015] [Indexed: 11/17/2022] Open
Abstract
Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell disorder and bridges monoclonal gammopathy of undetermined significance to multiple myeloma (MM), based on higher levels of circulating monoclonal immunoglobulin and bone marrow plasmocytosis without end-organ damage. Until a Spanish study reported fewer MM-related events and better overall survival among patients with high-risk SMM treated with lenalidomide and dexamethasone, prior studies had failed to show improved survival with earlier intervention, although a reduction in skeletal-related events (without any impact on disease progression) has been described with bisphosphonate use. Risk factors have now been defined, and a subset of ultra-high-risk patients have been reclassified by the International Myeloma Working Group as MM, and thus will require optimal MM treatment, based on biomarkers that identify patients with a >80% risk of progression. The number of these redefined patients is small (∼10%), but important to unravel, because their risk of progression to overt MM is substantial (≥80% within 2 years). Patients with a high-risk cytogenetic profile are not yet considered for early treatment, because groups are heterogeneous and risk factors other than cytogenetics are deemed to weight higher. Because patients with ultra-high-risk SMM are now considered as MM and may be treated as such, concerns exist that earlier therapy may increase the risk of selecting resistant clones and induce side effects and costs. Therefore, an even more accurate identification of patients who would benefit from interventions needs to be performed, and clinical judgment and careful discussion of pros and cons of treatment initiation need to be undertaken. For the majority of SMM patients, the standard of care remains observation until development of symptomatic MM occurs, encouraging participation in ongoing and upcoming SMM/early MM clinical trials, as well as consideration of bisphosphonate use in patients with early bone loss.
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Affiliation(s)
- Jo Caers
- Department of Hematology, University Hospital of Liège, Liège, Belgium
| | - Carlos Fernández de Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Xavier Leleu
- Hopital La Miletrie, CHU Poitiers, Poitiers, France
| | - Roy Heusschen
- Hematology Laboratory, Groupe Interdisciplinaire de Génoprotéomique Appliquée-I3, University of Liège, Liège, Belgium
| | - Niklas Zojer
- Department of Medicine I, Wilhelminen Hospital, Vienna, Austria
| | - Olivier Decaux
- Internal Medicine Department, Rennes University Hospitals, Hôpital Sud, Rennes, France
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Monique Minnema
- Department of Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Artur Jurczyszyn
- Department of Hematology Jagiellonian University, Cracow, Poland
| | - Yves Beguin
- Department of Hematology, University Hospital of Liège, Liège, Belgium
| | - Ralph Wäsch
- Department of Hematology and Oncology, University of Freiburg Medical Center, Freiburg, Germany
| | - Antonio Palumbo
- Myeloma Unit, Divisione di Ematologia dell'Università di Torino, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Italy
| | - Meletios Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Victoria Mateos
- Instituto de Investigación Biomédica de Salamanca-Hematology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Heinz Ludwig
- Department of Medicine I, Wilhelminen Hospital, Vienna, Austria
| | - Monika Engelhardt
- Department of Hematology and Oncology, University of Freiburg Medical Center, Freiburg, Germany
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24
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Abstract
The recent consensus statement from the International Myeloma Working Group has introduced the role of whole body (WB) magnetic resonance imaging (MRI) into the management pathway for patients with multiple myeloma. The speed, coverage and high sensitivity of WB diffusion weighted (DW)-MRI and the unique capability to quantify both burden of disease and response to treatment has led to increasing implementation at leading centres worldwide for imaging malignant marrow disease, both primary and metastatic. WB DW-MRI is likely to have a significant impact on management decisions and pathways for patients with multiple myeloma. This review will introduce the basic principles of DW-MRI, present current evidence for patients with myeloma and will discuss practicalities and exciting future applications.
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Affiliation(s)
| | - Martin Kaiser
- Division of Molecular PathologyThe Institute of Cancer ResearchSuttonSurreyUK
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25
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Bories C, Jagannath S. Asymptomatic monoclonal gammopathies. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 14 Suppl:S78-86. [PMID: 25486961 DOI: 10.1016/j.clml.2014.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/19/2014] [Indexed: 11/27/2022]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) represent the earlier phases of plasma cell dyscrasias. Their definition is based on absence of end-organ damage with presence of a malignant clone that grows in the bone marrow. They share, as a common feature, the risk of progression to a symptomatic disease. MGUS progression risk is approximately 1% per year, and SMM has a risk of progression of 10% for the first 5 years which tapers off over time. The main purpose of identification of these earlier phases of the plasma cell dyscrasia was to identify patients who do not warrant treatment with chemotherapy, in whom the risk of treatment outweighs the benefit. Over the years, the definitions have not been modified to incorporate developments in imaging (magnetic resonance or positron emission and computed tomography), or genomics to identify patients at highest risk of progression within 2 years, where wait and watch might not be an appropriate option. In the absence of such definition, patients who have only a 50% chance of progression within 2 years are being offered therapy, which might also not be an optimal approach. In this review, we provide an overview of the definition, current prognostic factors, and risk stratifications in asymptomatic gammopathies, and discuss clinical trial outcomes in high-risk SMM.
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Affiliation(s)
| | - Sundar Jagannath
- Department of Hematology/Oncology, Mt Sinai Medical Center, New York, NY.
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26
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Giles SL, deSouza NM, Collins DJ, Morgan VA, West S, Davies FE, Morgan GJ, Messiou C. Assessing myeloma bone disease with whole-body diffusion-weighted imaging: comparison with x-ray skeletal survey by region and relationship with laboratory estimates of disease burden. Clin Radiol 2015; 70:614-21. [PMID: 25799364 PMCID: PMC4443503 DOI: 10.1016/j.crad.2015.02.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/13/2015] [Accepted: 02/19/2015] [Indexed: 11/23/2022]
Abstract
AIM To estimate and compare the extent of myeloma bone disease by skeletal region using whole-body diffusion-weighted imaging (WB-DWI) and skeletal survey (SS) and record interobserver agreement, and to investigate differences in imaging assessments of disease extent and apparent diffusion coefficient (ADC) between patients with pathological high versus low disease burden. MATERIALS AND METHODS Twenty patients with relapsed myeloma underwent WB-DWI and SS. Lesions were scored by number and size for each skeletal region by two independent observers using WB-DWI and SS. Observer scores, ADC, and ADC-defined volume of tumour-infiltrated marrow were compared between patients with high and low disease burden (assessed by serum paraproteins and marrow biopsy). RESULTS Observer scores were higher on WB-DWI than SS in every region (p<0.05) except the skull, with greater interobserver reliability in rating the whole skeleton (WB-DWI: ICC = 0.74, 95% CI: 0.443-0.886; SS: ICC = 0.44, 95% CI: 0.002-0.730) and individual body regions. WB-DWI scores were not significantly higher in patients with high versus low disease burden (observer 1: mean ± SD: 48.8 ± 7, 38.6 ± 14.5, observer 2: mean ± SD: 37.3 ± 13.5, 30.4 ± 15.5; p = 0.06, p = 0.35). CONCLUSION WB-DWI demonstrated more lesions than SS in all regions except the skull with greater interobserver agreement. Sensitivity is not a limiting factor when considering WB-DWI in the management pathway of patients with myeloma.
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Affiliation(s)
- S L Giles
- MRI Department, Royal Marsden Hospital, Sutton, Surrey, UK.
| | - N M deSouza
- Clinical Magnetic Resonance Unit, Institute of Cancer Research, Sutton, Surrey, UK
| | - D J Collins
- Clinical Magnetic Resonance Unit, Institute of Cancer Research, Sutton, Surrey, UK
| | - V A Morgan
- MRI Department, Royal Marsden Hospital, Sutton, Surrey, UK
| | - S West
- Haemato-oncology Department, Royal Marsden Hospital, Sutton, Surrey, UK
| | - F E Davies
- Haemato-oncology Department, Royal Marsden Hospital, Sutton, Surrey, UK; Molecular Pathology, Institute of Cancer Research, Sutton, Surrey, UK
| | - G J Morgan
- Haemato-oncology Department, Royal Marsden Hospital, Sutton, Surrey, UK; Molecular Pathology, Institute of Cancer Research, Sutton, Surrey, UK
| | - C Messiou
- MRI Department, Royal Marsden Hospital, Sutton, Surrey, UK
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Smoldering multiple myeloma. BIOMED RESEARCH INTERNATIONAL 2015; 2015:623254. [PMID: 26000300 PMCID: PMC4426782 DOI: 10.1155/2015/623254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/06/2014] [Indexed: 01/24/2023]
Abstract
Smoldering multiple myeloma (SMM) is an asymptomatic precursor stage of multiple myeloma (MM) characterized by clonal bone marrow plasma cells (BMPC) ≥ 10% and/or M protein level ≥ 30 g/L in the absence of end organ damage. It represents an intermediate stage between monoclonal gammopathy of undetermined significance (MGUS) and symptomatic MM. The risk of progression to symptomatic MM is not uniform, and several parameters have been reported to predict the risk of progression. These include the level of M protein and the percentage of BMPC, the proportion of immunophenotypically aberrant plasma cells, and the presence of immunoparesis, free light-chain (FLC) ratio, peripheral blood plasma cells (PBPC), pattern of serum M protein evolution, abnormal magnetic resonance imaging (MRI), cytogenetic abnormalities, IgA isotype, and Bence Jones proteinuria. So far treatment is still not recommended for SMM, because several trials suggested that patients with SMM do not benefit from early treatment. However, the Mateos et al. trial showed a survival benefit after early treatment with lenalidomide plus dexamethasone in patients with high-risk SMM. This trial has prompted a reevaluation of early treatment in an asymptomatic patient population.
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Abstract
Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell disorder. SMM is distinguished from monoclonal gammopathy of undetermined significance by a much higher risk of progression to multiple myeloma (MM). There have been major advances in the diagnosis, prognosis, and management of SMM in the last few years. These include a revised disease definition, identification of several new prognostic factors, a classification based on underlying cytogenetic changes, and new treatment options. Importantly, a subset of patients previously considered SMM is now reclassified as MM on the basis of biomarkers identifying patients with an ≥80% risk of progression within 2 years. SMM has assumed greater significance on the basis of recent trials showing that early therapy can be potentially beneficial to patients. As a result, there is a need to accurately diagnose and risk-stratify patients with SMM, including routine incorporation of modern imaging and laboratory techniques. In this review, we outline current concepts in diagnosis and risk stratification of SMM, and provide specific recommendations on the management of SMM.
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Dimopoulos MA, Hillengass J, Usmani S, Zamagni E, Lentzsch S, Davies FE, Raje N, Sezer O, Zweegman S, Shah J, Badros A, Shimizu K, Moreau P, Chim CS, Lahuerta JJ, Hou J, Jurczyszyn A, Goldschmidt H, Sonneveld P, Palumbo A, Ludwig H, Cavo M, Barlogie B, Anderson K, Roodman GD, Rajkumar SV, Durie BG, Terpos E. Role of Magnetic Resonance Imaging in the Management of Patients With Multiple Myeloma: A Consensus Statement. J Clin Oncol 2015; 33:657-64. [DOI: 10.1200/jco.2014.57.9961] [Citation(s) in RCA: 277] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose The aim of International Myeloma Working Group was to develop practical recommendations for the use of magnetic resonance imaging (MRI) in multiple myeloma (MM). Methods An interdisciplinary panel of clinical experts on MM and myeloma bone disease developed recommendations for the value of MRI based on data published through March 2014. Recommendations MRI has high sensitivity for the early detection of marrow infiltration by myeloma cells compared with other radiographic methods. Thus, MRI detects bone involvement in patients with myeloma much earlier than the myeloma-related bone destruction, with no radiation exposure. It is the gold standard for the imaging of axial skeleton, for the evaluation of painful lesions, and for distinguishing benign versus malignant osteoporotic vertebral fractures. MRI has the ability to detect spinal cord or nerve compression and presence of soft tissue masses, and it is recommended for the workup of solitary bone plasmacytoma. Regarding smoldering or asymptomatic myeloma, all patients should undergo whole-body MRI (WB-MRI; or spine and pelvic MRI if WB-MRI is not available), and if they have > one focal lesion of a diameter > 5 mm, they should be considered to have symptomatic disease that requires therapy. In cases of equivocal small lesions, a second MRI should be performed after 3 to 6 months, and if there is progression on MRI, the patient should be treated as having symptomatic myeloma. MRI at diagnosis of symptomatic patients and after treatment (mainly after autologous stem-cell transplantation) provides prognostic information; however, to date, this does not change treatment selection.
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Affiliation(s)
- Meletios A. Dimopoulos
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Jens Hillengass
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Saad Usmani
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Elena Zamagni
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Suzanne Lentzsch
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Faith E. Davies
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Noopur Raje
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Orhan Sezer
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Sonja Zweegman
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Jatin Shah
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Ashraf Badros
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Kazuyuki Shimizu
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Philippe Moreau
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Chor-Sang Chim
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Juan José Lahuerta
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Jian Hou
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Artur Jurczyszyn
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Hartmut Goldschmidt
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Pieter Sonneveld
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Antonio Palumbo
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Heinz Ludwig
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Michele Cavo
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Bart Barlogie
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Kenneth Anderson
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - G. David Roodman
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - S. Vincent Rajkumar
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Brian G.M. Durie
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
| | - Evangelos Terpos
- Meletios A. Dimopoulos and Evangelos Terpos, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Jens Hillengass and Hartmut Goldschmidt, University Hospital Heidelberg, Heidelberg, Germany; Saad Usmani, Carolinas Healthcare System, Charlotte, NC; Elena Zamagni and Michele Cavo, Bologna University School of Medicine, Bologna; Antonio Palumbo, S. Giovanni Battista Hospital, University of Turin, Turin, Italy; Suzanne Lentzsch, Columbia University College of Physicians and
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Abstract
CLINICAL ISSUE Emerging clinical trial data support treatment of high-risk smoldering multiple myeloma (SMM) upon diagnosis, and not only at the time of progression to symptomatic complications (multiple myeloma). Early detection of bone and/or bone marrow involvement by sensitive imaging modalities may help define SMM patients at a high risk of progression. STANDARD RADIOLOGICAL METHODS Current (2011) consensus guidelines recognize skeletal survey as a cornerstone modality for assessment of bone involvement at initial diagnosis and during follow-up of SMM. Skeletal survey has severe limitations related to underdetection of bone lesions and also provides no information on bone marrow abnormalities. METHODICAL INNOVATIONS Modern imaging strategies such as fluorodeoxyglucose positron-emission tomography/CT (FDG PET/CT) and MRI, in conjunction with functional innovations, provide improved estimates of global abnormalities in the bone marrow and bone compartments. These methods have the potential to objectively quantify early transformation from SMM to multiple myeloma. PERFORMANCE Although frequently used for staging and risk prognostication in multiple myeloma, modern imaging techniques have only been evaluated to a limited extent in SMM. Scant data in SMM indicate the prognostic value of two or more MRI-detected focal bone marrow abnormalities, which, if present, predict rapid progression to multiple myeloma. Data evaluating the role of FDG PET/CT in detecting early bone marrow abnormalities as an aid to predicting risk or directing treatment in SMM is currently lacking. ACHIEVEMENTS The superior specificity and sensitivity of modern imaging techniques compared to skeletal survey suggest that these should have a place in standard practice management of patients at a high risk of SMM progression. The model imaging of the future should be an all-in-one strategy offering high diagnostic performance for bone marrow abnormalities and low-volume bone lesions, as well as allowing monitoring by minimizing radiation exposure and the need for contrast agents. PRACTICAL RECOMMENDATIONS Newer imaging techniques need to be validated in prospective clinical trials assessing the SMM to multiple myeloma transition, with the aim of enabling appropriate management decisions. Efforts are also needed to improve the costs and availability of whole-body MRI and/or FDG PET/CT, in order to facilitate their widespread adoption as first-line detection modalities. Future clinical trials of therapeutic agents using earlier detection strategies will have to be carefully designed and take into consideration the risk of lead-time and length-time biases, which might falsely demonstrate longer overall survival. The English full text version of this article is available at SpringerLink (under "Supplemental").
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D'Anastasi M, Grandl S, Reiser MF, Baur-Melnyk A. [Radiological diagnostics of multiple myeloma]. Radiologe 2015; 54:556-63. [PMID: 24927658 DOI: 10.1007/s00117-013-2628-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CLINICAL/METHODICAL ISSUE Robust and reliable imaging methods are required to estimate the skeletal tumor load in multiple myeloma, as well as for the diagnosis of extraskeletal manifestations. Imaging also plays an essential role in the assessment of fracture risk and of vertebral fractures. STANDARD RADIOLOGICAL METHODS The conventional skeletal survey has been the gold standard in the imaging of multiple myeloma for many years. METHODICAL INNOVATIONS Other modalities which have been investigated and are in use are whole-body computed tomography (WBCT), 18F-fluorodeoxyglucose positron emission tomography computed tomography (FDG PET-CT) and whole-body magnetic resonance imaging (WBMRI). These techniques are able to depict both mineralized bone and the bone marrow with a high sensitivity for myeloma lesions. PERFORMANCE Several studies have shown that cross-sectional imaging is superior to the skeletal survey in the detection of myeloma lesions and WBMRI has been shown to be significantly more sensitive than WBCT for the detection of focal myeloma lesions as well as for diffuse infiltration. The FDG PET-CT technique has a sensitivity comparable to WBMRI. ACHIEVEMENTS Due to the higher sensitivity in the detection of myeloma lesions WBCT and WBMRI should replace the skeletal survey. PRACTICAL RECOMMENDATIONS A WBCT should be performed if there is suspicion of multiple myeloma. If no focal lesions are found WBMRI or at least MRI of the spine and pelvis should be additionally performed if available. If WBMRI has been initially performed and focal lesions are present, an additional WBCT may be performed to assess the extent of bone destruction and fracture risk. In cases of monoclonal gammopathy of undetermined significance (MGUS), solitary and smoldering myeloma, a WBMRI, if available, should be performed in addition to WBCT.
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Affiliation(s)
- M D'Anastasi
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
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Ahn IE, Mailankody S, Korde N, Landgren O. Dilemmas in treating smoldering multiple myeloma. J Clin Oncol 2014; 33:115-23. [PMID: 25422486 DOI: 10.1200/jco.2014.56.4351] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Novel therapies hold promise for high-risk smoldering multiple myeloma (SMM). Recent studies suggest that modern combination approaches can be options for high-risk SMM to obtain deep molecular responses with favorable toxicity profiles. Although pioneering treatment trials based on small numbers of patients suggest progression-free and overall survival benefits, application of the data to real-life practice remains to be validated. Therapeutic modulation of disease tempo, disease burden, clonal evolution, and tumor microenvironment in SMM remains to be understood and calls for reliable biomarkers reflective of disease biology. Here, we review studies that open a new management platform for SMM, address ongoing dilemmas in practice and under investigation, and highlight emerging scientific questions in the era of SMM treatment.
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Affiliation(s)
- Inhye E Ahn
- Inhye Ahn and Sham Mailankody, the National Cancer Institute, National Institutes of Health, Bethesda, MD; Neha Korde and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sham Mailankody
- Inhye Ahn and Sham Mailankody, the National Cancer Institute, National Institutes of Health, Bethesda, MD; Neha Korde and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neha Korde
- Inhye Ahn and Sham Mailankody, the National Cancer Institute, National Institutes of Health, Bethesda, MD; Neha Korde and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ola Landgren
- Inhye Ahn and Sham Mailankody, the National Cancer Institute, National Institutes of Health, Bethesda, MD; Neha Korde and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY.
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Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, Kumar S, Hillengass J, Kastritis E, Richardson P, Landgren O, Paiva B, Dispenzieri A, Weiss B, LeLeu X, Zweegman S, Lonial S, Rosinol L, Zamagni E, Jagannath S, Sezer O, Kristinsson SY, Caers J, Usmani SZ, Lahuerta JJ, Johnsen HE, Beksac M, Cavo M, Goldschmidt H, Terpos E, Kyle RA, Anderson KC, Durie BGM, Miguel JFS. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014; 15:e538-48. [PMID: 25439696 DOI: 10.1016/s1470-2045(14)70442-5] [Citation(s) in RCA: 2743] [Impact Index Per Article: 274.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This International Myeloma Working Group consensus updates the disease definition of multiple myeloma to include validated biomarkers in addition to existing requirements of attributable CRAB features (hypercalcaemia, renal failure, anaemia, and bone lesions). These changes are based on the identification of biomarkers associated with near inevitable development of CRAB features in patients who would otherwise be regarded as having smouldering multiple myeloma. A delay in application of the label of multiple myeloma and postponement of therapy could be detrimental to these patients. In addition to this change, we clarify and update the underlying laboratory and radiographic variables that fulfil the criteria for the presence of myeloma-defining CRAB features, and the histological and monoclonal protein requirements for the disease diagnosis. Finally, we provide specific metrics that new biomarkers should meet for inclusion in the disease definition. The International Myeloma Working Group recommends the implementation of these criteria in routine practice and in future clinical trials, and recommends that future studies analyse any differences in outcome that might occur as a result of the new disease definition.
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Affiliation(s)
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Giampaolo Merlini
- Amyloidosis Center, University Hospital Policlinico San Matteo, Pavia, Italy
| | | | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jens Hillengass
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece
| | | | - Ola Landgren
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bruno Paiva
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain
| | | | - Brendan Weiss
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | - Elena Zamagni
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | | | | | - Jo Caers
- Department of Hematology, CHU de Liege, Liege, Belgium
| | - Saad Z Usmani
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Juan José Lahuerta
- Servicio de Hematología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Hans Erik Johnsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
| | - Meral Beksac
- Ankara University School of Medicine, Ankara, Turkey
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Hartmut Goldschmidt
- Department of Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Evangelos Terpos
- Department of Clinical Therapeutics, University of Athens, School of Medicine, Athens, Greece
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Brian G M Durie
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Jesus F San Miguel
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Pamplona, Spain
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Monoclonal Gammopathy of Undetermined Significance and Smoldering Multiple Myeloma. Hematol Oncol Clin North Am 2014; 28:775-90. [DOI: 10.1016/j.hoc.2014.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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36
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The prognostic importance of the presence of more than one focal lesion in spine MRI of patients with asymptomatic (smoldering) multiple myeloma. Leukemia 2014; 28:2402-3. [DOI: 10.1038/leu.2014.230] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Kloth JK, Hillengass J, Listl K, Kilk K, Hielscher T, Landgren O, Delorme S, Goldschmidt H, Kauczor HU, Weber MA. Appearance of monoclonal plasma cell diseases in whole-body magnetic resonance imaging and correlation with parameters of disease activity. Int J Cancer 2014; 135:2380-6. [DOI: 10.1002/ijc.28877] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/20/2014] [Indexed: 01/25/2023]
Affiliation(s)
- Jost K. Kloth
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
- Department of Radiology; German Cancer Research Center (dkfz); Heidelberg Germany
| | - Jens Hillengass
- Department of Radiology; German Cancer Research Center (dkfz); Heidelberg Germany
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Karin Listl
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
| | - Kerstin Kilk
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
| | - Thomas Hielscher
- Department of Biostatistics; German Cancer Research Center (dkfz); Heidelberg Germany
| | - Ola Landgren
- Multiple Myeloma Section; National Cancer Institute, Nationl Institutes of Health; Bethesda MD
| | - Stefan Delorme
- Department of Radiology; German Cancer Research Center (dkfz); Heidelberg Germany
| | - Hartmut Goldschmidt
- Department of Internal Medicine V; University of Heidelberg; Heidelberg Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology; University of Heidelberg; Heidelberg Germany
- Department of Radiology; German Cancer Research Center (dkfz); Heidelberg Germany
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Caers J, Withofs N, Hillengass J, Simoni P, Zamagni E, Hustinx R, Beguin Y. The role of positron emission tomography-computed tomography and magnetic resonance imaging in diagnosis and follow up of multiple myeloma. Haematologica 2014; 99:629-37. [PMID: 24688111 PMCID: PMC3971072 DOI: 10.3324/haematol.2013.091918] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 11/29/2013] [Indexed: 12/25/2022] Open
Abstract
Multiple myeloma is the second most common hematologic malignancy and occurs most commonly in elderly patients. Almost all multiple myeloma patients develop bone lesions in the course of their disease or have evidence of bone loss at initial diagnosis. Whole-body conventional radiography remains the gold standard in the diagnostic evaluation, but computed tomography, magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography are increasingly used as complementary techniques in the detection of bone lesions. Moreover, the number of lesions detected and the presence of extramedullary disease give strong prognostic information. These new techniques may help to assess treatment response in solitary plasmacytoma or in multiple myeloma. In this article, we review recent data on the different imaging techniques used at diagnosis and in the assessment of treatment response, and discuss some current issues.
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Predictive value of longitudinal whole-body magnetic resonance imaging in patients with smoldering multiple myeloma. Leukemia 2014; 28:1902-8. [DOI: 10.1038/leu.2014.75] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/08/2014] [Accepted: 02/12/2014] [Indexed: 01/21/2023]
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Brioli A, Morgan GJ, Durie B, Zamagni E. The utility of newer imaging techniques as predictors of clinical outcomes in multiple myeloma. Expert Rev Hematol 2014; 7:13-6. [PMID: 24428518 DOI: 10.1586/17474086.2014.873347] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The 14th International Myeloma Workshop Kyoto, Japan, 3-7 April 2013 The International Myeloma Workshop (IMW) is a biannual meeting that gathers experts in multiple myeloma (MM) from all over the world and scientists interested in clinical and biological aspects of myeloma. The 2013 IMW was held in Kyoto, Japan and presented an interesting program with an appealing section on newer imaging techniques as predictor of outcome in asymptomatic and symptomatic MM. During the meeting, the importance of newer functional imaging techniques as new ways of assessing bone disease and the extent of marrow infiltration by myeloma cells was highlighted. This short meeting report will provide a review of new and/or functional imaging techniques, such as magnetic resonance imaging (MRI), both axial and whole body (WB-MRI), dynamic contrast enhanced (DCE) MRI, diffusion weighted imaging (DWI) and PET integrated with computed tomography.
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Affiliation(s)
- Annamaria Brioli
- Centre for Myeloma Research, Division of Molecular Pathology, The Institute of Cancer Research, London, UK
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Dispenzieri A, Stewart AK, Chanan-Khan A, Rajkumar SV, Kyle RA, Fonseca R, Kapoor P, Bergsagel PL, McCurdy A, Gertz MA, Lacy MQ, Lust JA, Russell SJ, Zeldenrust SR, Reeder C, Roy V, Buadi F, Dingli D, Hayman SR, Leung N, Lin Y, Mikhael J, Kumar SK. Smoldering multiple myeloma requiring treatment: time for a new definition? Blood 2013; 122:4172-81. [PMID: 24144641 PMCID: PMC3952477 DOI: 10.1182/blood-2013-08-520890] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 10/07/2013] [Indexed: 11/20/2022] Open
Abstract
Smoldering multiple myeloma (SMM) bridges the gap between monoclonal gammopathy of undetermined significance (a mostly premalignant disorder) and active multiple myeloma (MM). Until recently, no interventional study in patients with SMM showed improved overall survival (OS) with therapy as compared with observation. A report from the PETHEMA-GEM (Programa Español de Tratamientos en Hematologica) group described both fewer myeloma-related events and better OS among patients with high-risk SMM who were treated with lenalidomide and dexamethasone. This unique study prompted us to review current knowledge about SMM and address the following questions: (1) Are there patients currently defined as SMM who should be treated routinely? (2) Should the definitions of SMM and MM be reconsidered? (3) Has the time come when not treating is more dangerous than treating? (4) Could unintended medical harm result from overzealous intervention? Our conclusion is that those patients with the highest-risk SMM (extreme bone marrow plasmacytosis, extremely abnormal serum immunoglobulin free light chain ratio, and multiple bone lesions detected only by modern imaging) should be reclassified as active MM so that they can receive MM-appropriate therapy and the paradigm of careful observation for patients with SMM can be preserved.
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Tageja N, Manasanch EE, Korde N, Kwok M, Mailankody S, Bhutani M, Roschewski M, Landgren O. Smoldering multiple myeloma: present position and potential promises. Eur J Haematol 2013; 92:1-12. [PMID: 24112232 DOI: 10.1111/ejh.12205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 12/24/2022]
Abstract
Since smoldering multiple myeloma (SMM) was first described over three decades ago based on a case series of six patients, its definition and our understanding of the entity have evolved considerably. The risk of progression to symptomatic myeloma (MM) varies greatly among individuals diagnosed with myeloma precursor disease. Epidemiologic, molecular, flow cytometric and radiological techniques have demonstrated that this transformation to MM from precursor states is not sudden but rather a continuous overlapping series of events with evidence of end-organ damage that could manifest in the earliest stages of disease. Contemporary antimyeloma therapies can yield rapid, deep, and durable responses with manageable toxicities, and molecular-cell-based measures are now available to rule out minimal residual disease. With this information, clinical studies with correlative measures can now be developed to test the fundamental hypothesis that intervention in early myeloma may provide a measurable clinical benefit to patients by either delaying progression or eradicating plasma cell clones.
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Affiliation(s)
- Nishant Tageja
- Multiple Myeloma Section, Metabolism Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Terpos E, Morgan G, Dimopoulos MA, Drake MT, Lentzsch S, Raje N, Sezer O, García-Sanz R, Shimizu K, Turesson I, Reiman T, Jurczyszyn A, Merlini G, Spencer A, Leleu X, Cavo M, Munshi N, Rajkumar SV, Durie BGM, Roodman GD. International Myeloma Working Group recommendations for the treatment of multiple myeloma-related bone disease. J Clin Oncol 2013; 31:2347-57. [PMID: 23690408 DOI: 10.1200/jco.2012.47.7901] [Citation(s) in RCA: 235] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The aim of the International Myeloma Working Group was to develop practice recommendations for the management of multiple myeloma (MM) -related bone disease. METHODOLOGY An interdisciplinary panel of clinical experts on MM and myeloma bone disease developed recommendations based on published data through August 2012. Expert consensus was used to propose additional recommendations in situations where there were insufficient published data. Levels of evidence and grades of recommendations were assigned and approved by panel members. RECOMMENDATIONS Bisphosphonates (BPs) should be considered in all patients with MM receiving first-line antimyeloma therapy, regardless of presence of osteolytic bone lesions on conventional radiography. However, it is unknown if BPs offer any advantage in patients with no bone disease assessed by magnetic resonance imaging or positron emission tomography/computed tomography. Intravenous (IV) zoledronic acid (ZOL) or pamidronate (PAM) is recommended for preventing skeletal-related events in patients with MM. ZOL is preferred over oral clodronate in newly diagnosed patients with MM because of its potential antimyeloma effects and survival benefits. BPs should be administered every 3 to 4 weeks IV during initial therapy. ZOL or PAM should be continued in patients with active disease and should be resumed after disease relapse, if discontinued in patients achieving complete or very good partial response. BPs are well tolerated, but preventive strategies must be instituted to avoid renal toxicity or osteonecrosis of the jaw. Kyphoplasty should be considered for symptomatic vertebral compression fractures. Low-dose radiation therapy can be used for palliation of uncontrolled pain, impending pathologic fracture, or spinal cord compression. Orthopedic consultation should be sought for long-bone fractures, spinal cord compression, and vertebral column instability.
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece.
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Regelink JC, Minnema MC, Terpos E, Kamphuis MH, Raijmakers PG, Pieters-van den Bos IC, Heggelman BGF, Nievelstein RJ, Otten RHJ, van Lammeren-Venema D, Zijlstra JM, Arens AIJ, de Rooy JW, Hoekstra OS, Raymakers R, Sonneveld P, Ostelo RW, Zweegman S. Comparison of modern and conventional imaging techniques in establishing multiple myeloma-related bone disease: a systematic review. Br J Haematol 2013; 162:50-61. [PMID: 23617231 DOI: 10.1111/bjh.12346] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/26/2013] [Indexed: 01/17/2023]
Abstract
This systematic review of studies compared magnetic resonance imaging (MRI), (18) F-fluorodeoxyglucose positron emission tomography (FDG-PET), FDG-PET with computerized tomography (PET-CT) and CT with whole body X-Ray (WBXR) or (whole body) CT in order to provide evidence-based diagnostic guidelines in multiple myeloma bone disease. A comprehensive search of 3 bibliographic databases was performed; methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria (score 1-14). Data from 32 directly comparative studies were extracted. The mean QUADAS score was 7·1 (3-11), with quality hampered mainly by a poor description of selection and execution criteria. All index tests had a higher detection rate when compared to WBXR, with up to 80% more lesions detected by the newer imaging techniques; MRI (1·12-1·82) CT (1·04-1·33), PET (1·00-1·58) and PET-CT (1·27-1·45). However, the modern imaging techniques detected fewer lesions in the skull and ribs. In a direct comparison CT and MRI performed equally with respect to detection rate and sensitivity. This systematic review supports the International Myeloma Working Group guidelines, which recommend that WBCT can replace WBXR. In our opinion, the equal performance of MRI also indicates that it is a valuable alternative. As lesions of the skull and ribs are underdiagnosed by modern imaging techniques we advise additional X-rays of these regions. The consequences of this approach are discussed.
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Affiliation(s)
- Josien C Regelink
- Department of Haematology, VU University Medical Centre, Amsterdam, The Netherlands.
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Tosi P. Diagnosis and treatment of bone disease in multiple myeloma: spotlight on spinal involvement. SCIENTIFICA 2013; 2013:104546. [PMID: 24381787 PMCID: PMC3870870 DOI: 10.1155/2013/104546] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 11/14/2013] [Indexed: 05/07/2023]
Abstract
Bone disease is observed in almost 80% of newly diagnosed symptomatic multiple myeloma patients, and spine is the bone site that is more frequently affected by myeloma-induced osteoporosis, osteolyses, or compression fractures. In almost 20% of the cases, spinal cord compression may occur; diagnosis and treatment must be carried out rapidly in order to avoid a permanent sensitive or motor defect. Although whole body skeletal X-ray is considered mandatory for multiple myeloma staging, magnetic resonance imaging is presently considered the most appropriate diagnostic technique for the evaluation of vertebral alterations, as it allows to detect not only the exact morphology of the lesions, but also the pattern of bone marrow infiltration by the disease. Multiple treatment modalities can be used to manage multiple myeloma-related vertebral lesions. Surgery or radiotherapy is mainly employed in case of spinal cord compression, impending fractures, or intractable pain. Percutaneous vertebroplasty or balloon kyphoplasty can reduce local pain in a significant fraction of treated patients, without interfering with subsequent therapeutic programs. Systemic antimyeloma therapy with conventional chemotherapy or, more appropriately, with combinations of conventional chemotherapy and compounds acting on both neoplastic plasma cells and bone marrow microenvironment must be soon initiated in order to reduce bone resorption and, possibly, promote bone formation. Bisphosphonates should also be used in combination with antimyeloma therapy as they reduce bone resorption and prolong patients survival. A multidisciplinary approach is thus needed in order to properly manage spinal involvement in multiple myeloma.
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Affiliation(s)
- Patrizia Tosi
- Hematology Unit, Department of Oncology and Hematology, Infermi Hospital, Viale Settembrini 2, 47100 Rimini, Italy
- *Patrizia Tosi:
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47
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Extensive bone marrow infiltration and abnormal free light chain ratio identifies patients with asymptomatic myeloma at high risk for progression to symptomatic disease. Leukemia 2012. [DOI: 10.1038/leu.2012.309] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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49
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Zamagni E, Cavo M. The role of imaging techniques in the management of multiple myeloma. Br J Haematol 2012; 159:499-513. [PMID: 22881361 DOI: 10.1111/bjh.12007] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Bone disease is the major feature of multiple myeloma (MM). Imaging is required for correct staging, in the follow-up after treatment and, as recently highlighted, is predictor of prognosis. In the near future, whole-body X-Ray may be replaced by more sensitive techniques, such as whole-body low-dose computerized tomography (CT). Magnetic resonance imaging (MRI) is the gold standard method for assessing bone marrow infiltration of the spine, predicting the risk of vertebral fracture and distinguishing between benign and malignant osteoporosis. Positron emission tomography (PET) with CT (PET/CT) provides important information about the extent of whole-body disease, including soft tissue masses, and is the best tool to distinguish between active or inactive disease after therapy. Both MRI and PET/CT are predictors of clinical outcome. A prospective use of these newer imaging techniques in both clinical trials and clinical practice may help optimize MM management in the near future.
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Affiliation(s)
- Elena Zamagni
- Seràgnoli Institute of Haematology, Bologna University School of Medicine, Bologna, Italy.
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50
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Walker RC, Brown TL, Jones-Jackson LB, De Blanche L, Bartel T. Imaging of Multiple Myeloma and Related Plasma Cell Dyscrasias. J Nucl Med 2012; 53:1091-101. [DOI: 10.2967/jnumed.111.098830] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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