scholarly journals Development of a new risk stratification system for patients with newly diagnosed multiple myeloma using R-ISS and 18F-FDG PET/CT

2021 ◽  
Vol 11 (12) ◽  
Author(s):  
Hee Jeong Cho ◽  
Sung-Hoon Jung ◽  
Jae-Cheol Jo ◽  
Yoo Jin Lee ◽  
Sang Eun Yoon ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Risk Stratification ◽  
Fdg Pet ◽  
Survival Rates ◽  
Newly Diagnosed ◽  
Focal Lesions ◽  
Pet Ct ◽  
Stratification System ◽  
Fdg Pet Ct ◽  
Risk Stratification System

AbstractIn multiple myeloma (MM), a high number of focal lesions (FL) detected using positron emission tomography/computed tomography (PET/CT) was found to be associated with adverse prognosis. To design a new risk stratification system that combines the Revised International Staging System (R-ISS) with FL, we analyzed the data of 380 patients with newly diagnosed MM (NDMM) who underwent 18F-fluorodeoxyglucose (18F-FDG) PET/CT upon diagnosis. The K-adaptive partitioning algorithm was adopted to define subgroups with homogeneous survival. The combined R-ISS with PET/CT classified NDMM patients into four groups: R-ISS/PET stage I (n = 31; R-ISS I with FL ≤ 3), stage II (n = 156; R-ISS I with FL > 3 and R-ISS II with FL ≤ 3), stage III (n = 162; R-ISS II with FL > 3 and R-ISS III with FL ≤ 3), and stage IV (n = 31; R-ISS III with FL > 3). The 2-year overall survival rates for stages I, II, III, and IV were 96.7%, 89.8%, 74.7%, and 50.3%. The 2-year progression-free survival rates were 84.1%, 64.7%, 40.8%, and 17.1%, respectively. The new R-ISS/PET was successfully validated in an external cohort. This new system had a remarkable prognostic power for estimating the survival outcomes of patients with NDMM. This system helps discriminate patients with a good prognosis from those with a poor prognosis more precisely.

scholarly journals A Novel Validated Recurrence Stratification System Based on 18F-FDG PET/CT Radiomics to Guide Surveillance After Resection of Pancreatic Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Miaoyan Wei ◽  
Bingxin Gu ◽  
Shaoli Song ◽  
Bo Zhang ◽  
Wei Wang ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Risk Stratification ◽  
Cancer Patients ◽  
Fdg Pet ◽  
Resectable Pancreatic Cancer ◽  
Pet Ct ◽  
Stratification System ◽  
Fdg Pet Ct ◽  
Risk Stratification System

objectiveDespite the heterogeneous biology of pancreatic cancer, similar surveillance schemas have been used. Identifying the high recurrence risk population and conducting prompt intervention may improve prognosis and prolong overall survival.MethodsOne hundred fifty-six resectable pancreatic cancer patients who had undergone 18F-FDG PET/CT from January 2013 to December 2018 were retrospectively reviewed. The patients were categorized into a training cohort (n = 109) and a validation cohort (n = 47). LIFEx software was used to extract radiomic features from PET/CT. The risk stratification system was based on predictive factors for recurrence, and the index of prediction accuracy was used to reflect both the discrimination and calibration.ResultsOverall, seven risk factors comprising the rad-score and clinical variables that were significantly correlated with relapse were incorporated into the final risk stratification system. The 1-year recurrence-free survival differed significantly among the low-, intermediate-, and high-risk groups (85.5, 24.0, and 9.1%, respectively; p < 0.0001). The C-index of the risk stratification system in the development cohort was 0.890 (95% CI, 0.835–0.945).ConclusionThe 18F-FDG PET/CT-based radiomic features and clinicopathological factors demonstrated good performance in predicting recurrence after pancreatectomy in pancreatic cancer patients, providing a strong recommendation for an adequate adjuvant therapy course in all patients. The high-risk recurrence population should proceed with closer follow-up in a clinical setting.

scholarly journals Clinical Impact of 18f-FDG PET/CT As a Valuable Prognostic Tool for the Newly Diagnosed Multiple Myeloma with Extramedullary Disease

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3142-3142
Author(s):  
Dong Won Baek ◽  
Hee Jeong Cho ◽  
Sang Kyun Sohn ◽  
Sung-Hoon Jung ◽  
Hong chae Moon ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Fdg Pet ◽  
Survival Outcomes ◽  
Newly Diagnosed ◽  
Prognostic Tool ◽  
Pet Ct ◽  
National University ◽  
18F Fdg ◽  
Fdg Pet Ct

Purpose 18F-FDG PET/CT (PET/CT) could be a valuable tool to predict long-term survival outcomes in patients with newly diagnosed multiple myeloma (MM). It has ability to distinguish metabolically active sites such as extramedullary disease (EMD) as well as bone damage with relatively high sensitivity and specificity. In this study, we attempted to evaluate the role of PET-CT as a novel prognostic tool for patients with newly diagnosed MM who have EMD. Patients and Methods This study included 211 patients who were newly diagnosed with multiple myeloma from Kyunpook National University Hospital and Chonnam National University Hwasun Hospital. We retrospectively analyzed the medical records of enrolled patients. PET/CT was performed at the diagnosis and EMD was identified in 36 patients (17.1%). Results With a median follow-up duration of 21.5 months (range 1.4-67.7), the estimated 2-year PFS and OS rates were 46.1% and 79.6%, respectively. The presence of PET/CT positive EMD and high maximum standardized uptake value (SUVmax) on baseline PET/CT were significantly associated with inferior long-term survivals in terms of PFS (p=0.013, p=0.007) and OS (p=0.002, p=0.004). In addition, patients who underwent autologous stem cell transplantation (auto-SCT) showed superior PFS (p=0.005) and OS (p=0.022) in PET/CT positive EMD group. Meanwhile, Revised-International Staging System (R-ISS) successfully predicted the prognosis in this study. When we modified R-ISS with the presence of EMD, survival outcomes of the R-ISS stage III patients who didn't have EMD were similar to R-ISS II, while patients with PET/CT positive EMD showed even worse prognosis than the R-ISS stage III group. In the multivariate survival analysis, the presence of EMD (hazard ratio (HR), 2.397; 95% confidence internal (CI), 1.281-4.483; p=0.006) and auto-SCT (HR, 0.326; 95% CI, 0.194-0.549; p<0.001) were related to PFS, while LDH (HR, 2.56; 95% CI, 1.221-5.366; p=0.013) level and auto-SCT (HR, 0.398; 95% CI, 0.167-0.953; p=0.039) were independent prognostic factors of OS. Conclusion In conclusion, PET/CT positive EMD was a poor prognostic factor in patients with newly diagnosed MM. In addition, PET/CT could be a valuable tool to make better risk-adapted treatment strategies with R-ISS in EMD positive MM patients. Above all, patients with PET/CT positive EMD should be considered auto-SCT to improve long-term survivals. Figure Disclosures No relevant conflicts of interest to declare.

scholarly journals 99mTc-sestamibi SPECT/CT and 18F-FDG-PET/CT have similar performance but different imaging patterns in newly diagnosed multiple myeloma

2020 ◽  
Vol 41 (10) ◽  
pp. 1081-1088
Author(s):  
Camila Mosci ◽  
Fernando V. Pericole ◽  
Gislaine B. Oliveira ◽  
Marcia T. Delamain ◽  
Maria E.S. Takahashi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Fdg Pet ◽  
Newly Diagnosed ◽  
Similar Performance ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
99Mtc Sestamibi

scholarly journals Prognostic Value of FDG-PET/CT Parameters in Patients with Relapse/Refractory Multiple Myeloma before Anti-CD38 Based Therapy

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4323
Author(s):  
Guillemette Fouquet ◽  
Myriam Wartski ◽  
Amina Dechmi ◽  
Lise Willems ◽  
Bénédicte Deau-Fischer ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
High Risk ◽  
Fdg Pet ◽  
Multivariable Analysis ◽  
High Risk Group ◽  
Focal Lesions ◽  
Refractory Multiple Myeloma ◽  
Pet Ct ◽  
Poor Outcomes ◽  
Fdg Pet Ct

Although anti-CD38 monoclonal antibodies have improved the prognosis of relapsed/refractory multiple myeloma (RRMM), some patients still experience early relapses with poor outcomes. This present study evaluated the predictive value of FDG PET/CT parameters for RRMM prior to initiating anti-CD38 treatment. We included 38 consecutive RRMM patients who underwent a PET/CT scan treated at our institution at relapse. The median PFS was 12.5 months and the median OS was not reached. 42% of the patients had an initial ISS score of 1, 37% of 2, and 21% of 3. The presence of >3 focal lesions (FLs, n = 19) and the ISS score were associated with inferior PFS (p = 0.0036 and p = 0.0026) and OS (p = 0.025 and p = 0.0098). Patients with >3 FLs had a higher initial ISS score (p = 0.028). In multivariable analysis, the ISS score and >3 FLs were independent prognostic factors for PFS (p = 0.010 and p = 0.025 respectively), and combined they individualized a high-risk group with a median PFS and OS of 3.1 months and 8.5 months respectively vs. not reached for the other patients. The presence of >3 FLs on PET was predictive of survival outcomes in patients with RRMM treated using CD38 targeted therapy. Combined with the initial ISS, an ultra-high-risk RRMM population can thus be identified.

Medullary Abnormalities in Appendicular Skeletons Detected With18F-FDG PET/CT Predict an Unfavorable Prognosis in Newly Diagnosed Multiple Myeloma Patients With High-Risk Factors

2019 ◽  
Vol 213 (4) ◽  
pp. 918-924 ◽  
Author(s):  
Yoshiaki Abe ◽  
Kentaro Narita ◽  
Hiroki Kobayashi ◽  
Akihiro Kitadate ◽  
Masami Takeuchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
High Risk ◽  
Fdg Pet ◽  
Newly Diagnosed ◽  
High Risk Factors ◽  
Pet Ct ◽  
Fdg Pet Ct

Correlation of Suppression of FDG PET Uptake with Serum Free Light Chain Levels - Both FDG PET-CT and Serum Clonal Free Light Chain Response Precede and Predict the Likelihood of Subsequent Complete Remission in Newly Diagnosed Multiple Myeloma.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3493-3493
Author(s):  
Ronald Walker ◽  
Erik Rasmussen ◽  
Federica Cavallo ◽  
Laurie Jones-Jackson ◽  
Elias Anaissie ◽  
...  
Keyword(s):  
Light Chain ◽  
Fdg Pet ◽  
Free Light Chain ◽  
Newly Diagnosed ◽  
Percent Reduction ◽  
Focal Lesions ◽  
Serum Free Light Chain ◽  
Kaplan Meier ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract 18F-labeled Fluorodeoxyglucose Positron Emission Tomography - computed tomography (PET-CT) imaging results from newly diagnosed patients with multiple myeloma (MM) were correlated with serum free light chain (FLC) results from Total Therapy 3 (TT3). Patients had baseline PET-CT scans and serum kappa and lamda FLC analysis at diagnosis and at 2, 14 and 30 days post first cycle of VDTPACE and at pre-transplant 1 of two planned autologous stem cell transplants (TX1), correlating PET-CT response, clonal and nonclonal FCL response, and likelihood of subsequent complete clinical response (CR). Patients were selected with serum clonal FLC levels above the normal range that had been enrolled for sufficient time for a complete response (CR) to be recorded. Correlations between the serum clonal and nonclonal FLC levels and PET-CT response defined by both reduction in number of PET-defined focal lesions (PET-FL) (5 mm or larger areas of circumscribed uptake visually definable above background activity) and reduction in the maximum standardized uptake value normalized to the patients’ lean body mass (max SUV) were performed. Results: Reduction in FLC and PET-FL and max SUV are correlated, as was normalization of clonal FLC levels with likelihood of subsequent CR (Fig 1). The Spearman’s correlation coefficient between percent reduction in clonal FLC and percent reduction in max SUV was 0.04 (n=49, p=0.79) at 2 days post-VDTPACE, 0.32 (n=48, p=0.028) at 30 days post-VDTPACE, and 0.52 (n=33, p=0.002) prior to TX1. The greatest reduction in max SUV occurred by 2 days post-VDTPACE while the maximum reduction in clonal FLC occurred at 30 days post-VDTPACE, indicating that the PET response lead and predicted the FLC response in near “real time.” While normalization of the clonal FLC levels at 30 days was strongly predictive of subsequent CR (p&lt;0.001, n=125), normalization of the non-clonal FLC levels was not (p=0.41, n=124). Conclusion: We conclude that normalization of serum clonal FLC correlates both with improvement in FDG PET-CT scanning in both max SUV and number of PET-defined focal lesions and with likelihood of subsequent CR, though it “lags” behind FDG PET response by nearly a month, with FDG PET following the clinical course in near real time. Figure 1: Kaplan-Meier Analysis Correlating Normalization of Clonal FLC Levels by 30 Days Post Initiation of Treatment with Likelihood of Subsequent Clinical Remission (p=0.0001, n=125). Figure 1:. Kaplan-Meier Analysis Correlating Normalization of Clonal FLC Levels by 30 Days Post Initiation of Treatment with Likelihood of Subsequent Clinical Remission (p=0.0001, n=125).

scholarly journals Glucose Metabolism Quantified by SUVmax on Baseline FDG-PET/CT Predicts Survival in Newly Diagnosed Multiple Myeloma Patients: Combined Harmonized Analysis of Two Prospective Phase III Trials

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2532
Author(s):  
Anne-Victoire Michaud-Robert ◽  
Elena Zamagni ◽  
Thomas Carlier ◽  
Clément Bailly ◽  
Bastien Jamet ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Fdg Pet ◽  
Plasma Cells ◽  
Standardized Uptake Value ◽  
Phase Iii ◽  
High Morbidity ◽  
Newly Diagnosed ◽  
Pet Ct ◽  
Phase Iii Trials ◽  
Fdg Pet Ct

Background: Multiple myeloma is a hematological neoplasm characterized by a clonal proliferation of malignant plasma cells in the bone marrow, and is associated with high morbidity and mortality and variable survival. Positron emission tomography combined with computed tomography using 18F-deoxyfluoroglucose (FDG-PET/CT) is a promising technique for initial staging of symptomatic multiple myeloma patients. The objective of this study was to assess the prognostic value of this technique at baseline in symptomatic multiple myeloma patients included in two large European prospective studies (French and Italian). Methods: We retrospectively performed a combined harmonized analysis of 227 newly diagnosed transplant eligible multiple myeloma patients from two separate phase III trials. All images were centrally reviewed and analyzed using visual criteria and maximal standardized uptake value. An ad-hoc approach (called modified Combat) was applied to harmonize the data and then remove the “country effect” in order to strengthen the reliability of the final conclusions. Results: Using a multivariate analysis including treatment arm, R-ISS score, presence of extra-medullary disease and bone SUVmax, only bone SUVmax (p = 0.016) was an independent prognosis factor with an OS threshold of 7.1. For PFS, treatment arm and presence of extra-medullary disease were both independent prognosis biomarkers (p = 0.022 and 0.006 respectively). Conclusions: Our results show that bone SUVmax is a simple and reliable biomarker to analyze FDG-PET/CT at baseline that strongly correlates with a poorer prognosis for MM patients.

scholarly journals Evaluation of Whole-Body MRI (WB-MRI) in Smoldering Multiple Myeloma (SMM)

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 19-20
Author(s):  
Elizabeth Hill ◽  
Baris Turkbey ◽  
Evrim Turkbey ◽  
Candis Morrison ◽  
Peter Choyke ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Fdg Pet ◽  
High Sensitivity ◽  
Focal Lesions ◽  
Pet Ct ◽  
18F Fdg ◽  
Whole Spine ◽  
Fdg Pet Ct ◽  
Spine Mri

Introduction Whole-body magnetic resonance imaging (WB-MRI), including multiplanar multisequence technique with diffusion weighted images, is a novel imaging technique being evaluated for patients with multiple myeloma (MM). WB-MRI is ideal for this population due to its high sensitivity for bone marrow signal changes and full anatomic coverage from vertex to mid-thighs. It is well established that patients with unequivocal focal lesions on MRI have worse outcomes. Currently the IMWG recommends that all patients with smoldering multiple myeloma (SMM) undergo WB-MRI (or whole spine MRI if WB-MRI is not available) to rule out two or more focal lesions which would classify the patient as having symptomatic myeloma requiring treatment. There is a clear benefit of using MRI for the detection of early focal myeloma lesions however less is known about findings in the SMM population. Detection of subtle findings such as one small focal lesion or heterogeneous bone marrow in WB-MRI has unknown clinical significance that needs to be further evaluated. This study aimed to evaluate the sensitivity of WB-MRI compared to other highly sensitive functional imaging modalities in patients with SMM both at baseline and after treatment. Methods Imaging of patients with WB-MRI performed at the National Institutes of Health Clinical Center Myeloma Program were reviewed and compared to whole spine MRI and 18F-FDG PET/CT completed at the same timepoint. The majority of patients were being evaluated for enrollment on clinical trials. Patients had undergone a WB-MRI with a 3-Tesla system either as a baseline study, after completion of induction treatment, or during follow up determined by the time DWI became available at our institution. The imaging protocol included sagittalT1 weighted (W) and Short tau inversion recovery (STIR) for spine and coronal, axial T1W and axial T2 TSE pulse sequences. The functional component included diffusion weighted imaging in the axial plane (b=0 and 900sec/mm2). Radiological interpretation was performed by two readers using myeloma response assessment and diagnosis system (My-RADS) {Messiou, 2019 #340}. WB-MRIs were categorized as positive if focal lesions or diffuse/heterogenous pattern of bone marrow infiltration were present. Similarly, 18F-FDG PET/CTs and whole spine MRIs were classified as positive if focal lesions or diffuse/heterogenous pattern of bone marrow were present. Results A total of 34 patients with SMM and 5 patients with relapsed refractory multiple myeloma (RRMM) had sequential WB-MRI and 18F-FDG PET/CT. Figure 1 summarizes the radiological data of the SMM population. Eleven of these patients had PET/CT, whole spine MRI, and WB-MRI at baseline. Twenty-five patients had PET/CT and WB-MRI completed after at least 8 cycles of treatment. Thirteen patients had consistently negative imaging at baseline, 7 of which also had negative imaging after treatment, while 2 patients were found to have new lesions seen on WB-MRI after treatment. Six patients had resolution of positive imaging seen at baseline after treatment. Among the 17 patients with a positive WB-MRI, 12 (71%; 95% CI 47% - 87%) had a negative correlating PET/CT. Among 5 patients with positive PET/CT at the same time point as a WB-MRI, only 1 (20%; 95% CI 2% - 64%) correlated to a negative WB-MRI. Figure 2 depicts findings from patients with RRMM for comparison. All imaging modalities showed multiple focal findings in all 5 patients. Conclusions This study depicts the high sensitivity of WB-MRI in the SMM population. Such a high sensitivity is especially needed in SMM and early myeloma when disease burden is lower and the decision for treatment is being considered. In comparison to the RRMM population where all three imaging modalities easily detect multiple focal lesions, WB-MRI tends to identify myeloma involvement in the SMM patients more than the other imaging techniques. This suggests the importance of utilizing WB-MRI when diagnosing SMM. In the SMM population, the prognostic significance of lesions that are discrepant between MRI and FDG PET/CT is not yet known. Further follow up is needed to evaluate any difference in hard endpoints such as progression free survival between patients with positive findings described by WB-MRI. Disclosures No relevant conflicts of interest to declare.

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