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Abstract

Purpose Magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) are important imaging techniques in multiple myeloma (MM). We conducted a prospective trial in patients with MM aimed at comparing MRI and PET-CT with respect to the detection of bone lesions at diagnosis and the prognostic value of the techniques. Patients and Methods One hundred thirty-four patients received a combination of lenalidomide, bortezomib, and dexamethasone (RVD) with or without autologous stem-cell transplantation, followed by lenalidomide maintenance. PET-CT and MRI were performed at diagnosis, after three cycles of RVD, and before maintenance therapy. The primary end point was the detection of bone lesions at diagnosis by MRI versus PET-CT. Secondary end points included the prognostic impact of MRI and PET-CT regarding progression-free (PFS) and overall survival (OS). Results At diagnosis, MRI results were positive in 127 of 134 patients (95%), and PET-CT results were positive in 122 of 134 patients (91%; P = .33). Normalization of MRI after three cycles of RVD and before maintenance was not predictive of PFS or OS. PET-CT became normal after three cycles of RVD in 32% of the patients with a positive evaluation at baseline, and PFS was improved in this group (30-month PFS, 78.7% v 56.8%, respectively). PET-CT normalization before maintenance was described in 62% of the patients who were positive at baseline. This was associated with better PFS and OS. Extramedullary disease at diagnosis was an independent prognostic factor for PFS and OS, whereas PET-CT normalization before maintenance was an independent prognostic factor for PFS. Conclusion There is no difference in the detection of bone lesions at diagnosis when comparing PET-CT and MRI. PET-CT is a powerful tool to evaluate the prognosis of de novo myeloma. 

Author information​

Moreau P1, Attal M1, Caillot D1, Macro M1, Karlin L1, Garderet L1, Facon T1, Benboubker L1, Escoffre-Barbe M1, Stoppa AM1, Laribi K1, Hulin C1, Perrot A1, Marit G1, Eveillard JR1, Caillon F1, Bodet-Milin C1, Pegourie B1, Dorvaux V1, Chaleteix C1, Anderson K1, Richardson P1, Munshi NC1, Avet-Loiseau H1, Gaultier A1, Nguyen JM1, Dupas B1, Frampas E1, Kraeber-Bodere F1.

1 Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA.