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Abstract

PURPOSE:

To evaluate the role of 18F-FDG PET/CT in 282 symptomatic multiple myeloma patients treated up-front between 2002 and 2012.

EXPERIMENTAL DESIGN:

All patients were studied by PET/CT at baseline, during posttreatment follow-up, and at the time of relapse. Their median duration of follow-up was 67 months.

RESULTS:

Forty-two percent of the patients at diagnosis had >3 focal lesions, and in 50% SUVmax was >4.2; extramedullary disease was present in 5%. On multivariate analysis, ISS stage 3, SUVmax >4.2, and failure to achieve best complete response (CR) were the leading factors independently associated with shorter progression-free survival (PFS) and overall survival (OS). These 3 variables were used to construct a prognostic scoring system based on the number of risk factors. After treatment, PET/CT negativity (PET-neg) was observed in 70% of patients, whereas conventionally defined CR was achieved in 53%. Attainment of PET-neg favorably influenced PFS and OS. PET-neg was an independent predictor of prolonged PFS and OS for patients with conventionally defined CR. Sixty-three percent of patients experienced relapse or progression; in 12%, skeletal progression was exclusively detected by systematic PET/CT performed during follow-up. A multivariate analysis revealed that persistence of SUVmax >4.2 following first-line treatment was independently associated with exclusive PET/CT progression.

CONCLUSIONS:

PET/CT combined with ISS stage and achievement or not of CR on first-line therapy sorted patients into different prognostic groups. PET/CT led to a more careful evaluation of CR. Finally, in patients with persistent high glucose metabolism after first-line treatment, PET/CT can be recommended during follow-up, to screen for otherwise unidentifiable progression.  

Author information

Zamagni E1, Nanni C2, Mancuso K3, Tacchetti P3, Pezzi A3, Pantani L3, Zannetti B3, Rambaldi I2, Brioli A3, Rocchi S3, Terragna C3, Martello M3, Marzocchi G3, Borsi E3, Rizzello I3, Fanti S2, Cavo M3.

1"Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy. e.zamagni@unibo.it.

2Institute of Nuclear Medicine, Bologna University School of Medicine, Bologna, Italy.

3"Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.