Journal Article

Prognostic value of 18FFDG-PET/CT in multiple myeloma patients before and after allogeneic hematopoietic cell transplantation

Hofmann, Susanne, Bunjes, Donald, Speer, Martin, Lückerath, Katharina, Schmid, Jan-Stefan, Buck, Andreas K., Lapa, Constantin, Knop, Stefan, Samnick, Samuel, Stolzenburg, Antje, Beer, Ambros J., Kneer, Katharina, Grigoleit, Götz Ulrich, Einsele, Hermann

2018

Overview

Purpose Despite improved treatment options, multiple myeloma (MM) remains an incurable disease. The aim of this study was to investigate the prognostic value of positron emission tomography/computed tomography (PET/CT) using 18 F-2’-deoxy-2’-fluorodeoxyglucose ([ 18 F]FDG) in MM patients shortly before and ~100 days after allogeneic hematopoietic cell transplantation (allo-HCT). Methods In this retrospective analysis, we evaluated [ 18 F]FDG-PET/CT-scans of 45 heavily pre-treated MM patients before and 27 patients after scheduled allo-HCT. All scans were qualitatively and semi-quantitatively assessed for the presence of active disease. Serological response was recorded according to International Myeloma Working Group (IMWG) criteria. Progression-free (PFS) and overall survival (OS) were correlated with different PET/CT-derived parameters, such as presence, number and maximum standardized uptake value (SUV max ) of focal myeloma lesions. The impact of extramedullary disease on patient outcome was also assessed. Results PET/CT negativity -prior to or following allo-HCT- was a favorable prognostic factor for progression-free and overall survival (both, PFS and OS: pre-HSCT p  < 0.001, post-HCT p  < 0.005). High FDG-uptake (SUV max  > 6.5) revealed a significantly shortened survival compared to patients with a lower SUV max (<6.5) (OS, 5.0 ± 1.1 m vs. not reached - longest 122.0 m; p  < 0.001). Moreover, our data prove that a higher number (>3) of focal lesions (pre-HCT: both PFS and OS: p  < 0.001; post-HCT PFS: p  < 0.001, OS: p  = 0.139) as well as the presence of extramedullary disease serve as adverse prognostic factors prior to and after allo-HCT. At response assessment after allo-HCT, [ 18 F]FDG-PET/CT had a complementary value in prognostication in addition to IMWG criteria alone. Conclusion [ 18 F]FDG-PET/CT before and shortly after allogeneic HCT is a powerful predictor for progression-free and overall survival in MM patients.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Adult / Aged / Cardiology / Computed tomography / Cytogenetic Analysis / Emission analysis / Female / Fluorine isotopes / Fluorodeoxyglucose F18 / Hematopoietic Stem Cell Transplantation / Humans / Imaging / Lesions / Male / Medical prognosis / Medicine / Medicine & Public Health / Middle Aged / Multiple myeloma / Multiple Myeloma - diagnostic imaging / Multiple Myeloma - genetics / Multiple Myeloma - therapy / Nuclear Medicine / Oncology / Original Article / Orthopedics / Patients / Positron emission / Positron emission tomography / Positron Emission Tomography Computed Tomography / Prognosis / Radiology / Retrospective Studies / Stem cell transplantation / Stem cells / Survival / Tomography / Transplantation / Transplantation, Homologous