PET-CT Scans May Be Useful in Predicting Prognosis in Patients With Newly Diagnosed Multiple Myeloma

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PET-CT scans can reveal abnormalities such as bony lesions and extramedullary disease in patients with multiple myeloma.
PET-CT scans can reveal abnormalities such as bony lesions and extramedullary disease in patients with multiple myeloma.

According to a retrospective review of medical records of patients with newly diagnosed multiple myeloma, positron emission tomography-computed tomography (PET-CT) can be an important tool for determining burden of disease and might provide prognostic information. Results from this study were published in the American Journal of Hematology.

Researchers examined medical records of 313 patients with newly diagnosed multiple myeloma who were treated at the Mayo Clinic in Rochester, Minnesota, between April 2005 and June 2017. These patients received PET-CT scans within 60 days of diagnosis and prior to initiation of any treatment regimen. The researchers noted that PET-CT can reveal bony lesions, determine burden of disease, and identify extramedullary disease (EMD) in patients with multiple myeloma.

Approximately 75% of patients (234/313) had focal lesions, with 58% having 3 or more focal lesions. More than 1 in 10 patients (12%) had EMD, and 65% of patients had myelomatous lytic lesions documented.

The median maximum standardized uptake value for all patients was 5.9 (range, 1.5-48.3). The median overall survival (OS) for patients with 3 or more FLs was 57.8 months compared with 103.6 months for patients with fewer than 3 FLs (P =.003). The median OS for patients with EMD was 45.5 months compared with 71.8 months for patients without EMD (P =.004). Different SUVmax cutoffs did not predict progression-free survival or OS.

Twenty-five percent of patients received a combination of a proteasome inhibitor and immunomodulatory agent; 32% received a proteasome inhibitor-based regimen; 36% received an immunomodulatory agent-based regimen; and 1% received an alkylator-based regimen for treatment. No significant associations between induction regimen and total number of FLs or induction regimen and EMD status occurred.

A total of 43% of patients (n = 129) underwent autologous stem cell transplant, with no significant differences due to the number of FLs (P =.48) or the presence of EMD (P =1.0) in the patients.

“Our data highlight the nature of the PET-CT abnormalities in patients with multiple myeloma [and] clarify the prognostic impact of these abnormalities,” the researchers concluded. “We have now shown a close association between PET-CT findings and traditional markers of disease activity.”

Reference

1. Aljama MA, Sidiqi MH, Buadi FK, et al. Utility and prognostic value of 18F-FDG positron emission tomography-computed tomography scans in patients with newly diagnosed multiple myeloma [published online September 8, 2018]. Am J Hematol. doi: 10.1002/ajh.25279

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