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Abstract
Purpose: To assess the prognostic value of interim 18F-fluorodeoxyglucose (FDG)-PET analysis using decrease in maximum standardized uptake value (SUVmax) versus visual analysis in patients with multiple myeloma.Patients and Methods: We evaluated the prognostic value of FDG-PET after three cycles of lenalidomide, bortezomib, and dexamethasone (RVD) in patients with FDG-avid multiple myeloma included in the French prospective multicenter IMAJEM study. All images were centrally reviewed and interpreted using visual criteria and maximal standardized uptake value reduction (ΔSUVmax). Known prognostic factors, such as the revised International Staging System and biochemical response after three cycles of chemotherapy, were also evaluated.Results: In the multivariate analysis, only ΔSUVmax [P < 0.001, HR = 5.56; 95% confidence interval (CI), 1.96-15.81] and biochemical response after three cycles of RVD (P = 0.025, HR = 0.29; 95% CI, 0.1-0.85) appeared as independent prognostic factors, with a more discriminative HR for ΔSUVmax. ΔSUVmax analysis (>-25% vs. ≤-25%) identified patients with improved median progression-free survival (22.6 months and not reached, respectively).Conclusions: ΔSUVmax appears to be a powerful tool for the prediction of long-term outcome in patients with FDG-avid multiple myeloma. Other prospective studies are needed to further validate this prognostic biomarker.

Author information

Bailly C#1,2, Carlier T#1,2, Jamet B2, Eugene T2, Touzeau C1,3, Attal M4, Hulin C5, Facon T6, Leleu X7, Perrot A8, Garderet L9, Macro M10, Caillot D11, Moreau P1,3, Kraeber-Bodéré F1,2,12, Bodet-Milin C13,2.
1
Nantes-Angers Cancer Research Center (CRCINA), University of Nantes, Inserm UMR1232, Nantes, France.
2
Department of Nuclear Medicine, CHU de Nantes, Nantes, France.
3
Department of Hematology, CHU de Nantes, Nantes, France.
4
Department of Hematology, IUCT Oncopole, Toulouse, France.
5
Department of Hematology, CHU Haut Leveque, Pessac, France.
6
Department of Hematology, CHRU Lille, Lille, France.
7
Department of Hematology, CHU de Poitiers, Poitiers, France.
8
Department of Hematology, CHU de Nancy, Nancy, France.
9
Department of Hematology, CHU de St Antoine, Paris, France.
10
Department of Hematology, CHU de Caen, Caen, France.
11
Department of Hematology, CHU de Dijon, Dijon, France.
12
Department of Nuclear Medicine, ICO-René Gauducheau, Saint-Herblain, France.
13
Nantes-Angers Cancer Research Center (CRCINA), University of Nantes, Inserm UMR1232, Nantes, France. caroline.milin@chu-nantes.fr.
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Contributed equally