Elena Zamagni1, Cristina Nanni2, Luca Dozza1, Thomas Carlier3, Clément Bailly3, Paola Tacchetti1, Annibale Versari4, Stephane Chauvie5, Andrea Gallamini6, Barbara Gamberi7, Denis Caillot8, Francesca Patriarca9, Margaret Macro10, Mario Boccadoro11, Laurent Garderet12, Simona Barbato1, Stefano Fanti2, Aurore Perrot13, Francesca Gay11, Peter Sonneveld14, Lionel Karlin15, Michele Cavo1, Caroline Bodet-Milin3, Philippe Moreau16, Françoise Kraeber-Bodéré3. 1. "Seragnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy. 2. Nuclear Medicine, L'Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi, Bologna, Italy. 3. Nuclear Medicine Department, Nantes University Hospital, CRCINA INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France. 4. Nuclear Medicine, AUSL-IRCSS of Reggio Emilia, Reggio Emilia, Italy. 5. Medical Physics Unit, Santa Croce e Carle Hospital, Cuneo, Italy. 6. Research and Innovation Department, Antoine Lacassagne Cancer Center, Nice, France. 7. Hematology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy. 8. Hematology Department, University Hospital, Dijon, France. 9. Hematology, Dipartimento di Area Medica, Udine University, Udine, Italy. 10. Hematology Department, University Hospital, Caen, France. 11. Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy. 12. Hematology Department, University Hospital, Pitié Salpétriere, Paris, France. 13. Hematology Department, University Hospital, Nancy, France. 14. Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. 15. Hematology Department, University Hospital, Lyon, France. 16. Hematology Department, University Hospital, Nantes, France.
Abstract
PURPOSE: 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is currently the standard technique to define minimal residual disease (MRD) status outside the bone marrow (BM) in patients with multiple myeloma (MM). This study aimed to define criteria for PET complete metabolic response after therapy, jointly analyzing a subgroup of newly diagnosed transplantation-eligible patients with MM enrolled in two independent European randomized phase III trials (IFM/DFCI2009 and EMN02/HO95). PATIENTS AND METHODS: Two hundred twenty-eight patients were observed for a median of 62.9 months. By study design, PET/CT scans were performed at baseline and before starting maintenance (premaintenance [PM]). The five-point Deauville scale (DS) was applied to describe BM (BM score [BMS]) and focal lesion (FL; FL score [FS]) uptake and tested a posteriori in uni- and multivariable analyses for their impact on clinical outcomes. RESULTS: At baseline, 78% of patients had FLs (11% extramedullary), 80% with an FS ≥ 4. All patients had BM diffuse uptake (35.5% with BMS ≥ 4). At PM, 31% of patients had visually detectable FLs (2% extramedullary), 24% and 67.7% of them with an FS of 3 and ≥ 4, respectively. At PM, 98% of patients retained residual BM diffuse uptake, which was significantly lower than at baseline (mainly between BMS 2 and 3, BMS was ≥ 4 in only 8.7% of patients). By both uni- and multivariable analysis, FS and BMS < 4 were associated with prolonged progression-free survival (PFS) and overall survival (OS) at PM (OS: hazard ratio [HR], 0.6 and 0.47, respectively; PFS: HR, 0.36 and 0.24, respectively). CONCLUSION: FL and BM FDG uptake lower than the liver background after therapy was an independent predictor for improved PFS and OS and can be proposed as the standardized criterion of PET complete metabolic response, confirming the value of the DS for patients with MM.
PURPOSE:18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is currently the standard technique to define minimal residual disease (MRD) status outside the bone marrow (BM) in patients with multiple myeloma (MM). This study aimed to define criteria for PET complete metabolic response after therapy, jointly analyzing a subgroup of newly diagnosed transplantation-eligible patients with MM enrolled in two independent European randomized phase III trials (IFM/DFCI2009 and EMN02/HO95). PATIENTS AND METHODS: Two hundred twenty-eight patients were observed for a median of 62.9 months. By study design, PET/CT scans were performed at baseline and before starting maintenance (premaintenance [PM]). The five-point Deauville scale (DS) was applied to describe BM (BM score [BMS]) and focal lesion (FL; FL score [FS]) uptake and tested a posteriori in uni- and multivariable analyses for their impact on clinical outcomes. RESULTS: At baseline, 78% of patients had FLs (11% extramedullary), 80% with an FS ≥ 4. All patients had BM diffuse uptake (35.5% with BMS ≥ 4). At PM, 31% of patients had visually detectable FLs (2% extramedullary), 24% and 67.7% of them with an FS of 3 and ≥ 4, respectively. At PM, 98% of patients retained residual BM diffuse uptake, which was significantly lower than at baseline (mainly between BMS 2 and 3, BMS was ≥ 4 in only 8.7% of patients). By both uni- and multivariable analysis, FS and BMS < 4 were associated with prolonged progression-free survival (PFS) and overall survival (OS) at PM (OS: hazard ratio [HR], 0.6 and 0.47, respectively; PFS: HR, 0.36 and 0.24, respectively). CONCLUSION:FL and BM FDG uptake lower than the liver background after therapy was an independent predictor for improved PFS and OS and can be proposed as the standardized criterion of PET complete metabolic response, confirming the value of the DS for patients with MM.
Authors: Rita Alaggio; Catalina Amador; Ioannis Anagnostopoulos; Ayoma D Attygalle; Iguaracyra Barreto de Oliveira Araujo; Emilio Berti; Govind Bhagat; Anita Maria Borges; Daniel Boyer; Mariarita Calaminici; Amy Chadburn; John K C Chan; Wah Cheuk; Wee-Joo Chng; John K Choi; Shih-Sung Chuang; Sarah E Coupland; Magdalena Czader; Sandeep S Dave; Daphne de Jong; Ming-Qing Du; Kojo S Elenitoba-Johnson; Judith Ferry; Julia Geyer; Dita Gratzinger; Joan Guitart; Sumeet Gujral; Marian Harris; Christine J Harrison; Sylvia Hartmann; Andreas Hochhaus; Patty M Jansen; Kennosuke Karube; Werner Kempf; Joseph Khoury; Hiroshi Kimura; Wolfram Klapper; Alexandra E Kovach; Shaji Kumar; Alexander J Lazar; Stefano Lazzi; Lorenzo Leoncini; Nelson Leung; Vasiliki Leventaki; Xiao-Qiu Li; Megan S Lim; Wei-Ping Liu; Abner Louissaint; Andrea Marcogliese; L Jeffrey Medeiros; Michael Michal; Roberto N Miranda; Christina Mitteldorf; Santiago Montes-Moreno; William Morice; Valentina Nardi; Kikkeri N Naresh; Yasodha Natkunam; Siok-Bian Ng; Ilske Oschlies; German Ott; Marie Parrens; Melissa Pulitzer; S Vincent Rajkumar; Andrew C Rawstron; Karen Rech; Andreas Rosenwald; Jonathan Said; Clémentine Sarkozy; Shahin Sayed; Caner Saygin; Anna Schuh; William Sewell; Reiner Siebert; Aliyah R Sohani; Reuben Tooze; Alexandra Traverse-Glehen; Francisco Vega; Beatrice Vergier; Ashutosh D Wechalekar; Brent Wood; Luc Xerri; Wenbin Xiao Journal: Leukemia Date: 2022-06-22 Impact factor: 12.883
Authors: Marcella Kaddoura; David Dingli; Francis K Buadi; Martha Q Lacy; Morie A Gertz; Angela Dispenzieri; Prashant Kapoor; Lisa Hwa; Amie Fonder; Miriam Hobbs; Suzanne Hayman; John Lust; Nelson Leung; Ronald S Go; Yi Lin; Wilson Gonsalves; Taxiarchis Kourelis; Rahma Warsame; Robert A Kyle; Stephen M Broski; Vincent Rajkumar; Shaji Kumar Journal: Blood Adv Date: 2021-07-13
Authors: Martin Stork; Sabina Sevcikova; Jiri Minarik; Petra Krhovska; Jakub Radocha; Lenka Pospisilova; Lucie Brozova; Jiri Jarkovsky; Ivan Spicka; Jan Straub; Petr Pavlicek; Alexandra Jungova; Tomas Jelinek; Viera Sandecka; Vladimir Maisnar; Roman Hajek; Ludek Pour Journal: Br J Haematol Date: 2021-11-02 Impact factor: 8.615