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FDG PET in Multiple Myeloma

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Abstract

The potential of 18Fluoro-deoxyglucose (FDG) positron emission tomography (PET) for the treatment of multiple myeloma has recently been evaluated. FDG-PET is a powerful imaging tool for the detection of bone lesions at initial diagnosis with high sensitivity and specificity values. The presence of extra-medullary lesions affects the prognosis. During therapeutic evaluation, FDG-PET is the reference imaging technique, because it can be performed much earlier than an MRI which lacks specificity. The negativity of FDG-PET before and after autologous stem cell transplantation is an independent favorable prognostic factor, especially for patients with a complete biological response.

In patients with smoldering multiple myeloma, the presence of one or more hyper-metabolic lytic lesions on FDG-PET may be considered as a criterion for initiating therapy. In the event of a suspect solitary plasmacytoma, the completion of a PET-FDG is indicated so as to not disregard other bone or extra-medullary localizations. The challenge of future multi-center prospective studies will be to standardize the interpretation criteria of FDG-PET, especially in the therapeutic evaluation.

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References

  1. Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia. 2009;23:3–9.

    Article  CAS  Google Scholar 

  2. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International myeloma working group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15:538–48.

    Article  Google Scholar 

  3. Dimopoulos M, Hillengass J, Usmani S, et al. Role of magnetic resonance imaging in the Management of Patients with multiple myeloma: a consensus statement. J Clin Oncol. 2015;33:657–64.

    Article  Google Scholar 

  4. Terpos E, Kleber M, Engelhardt M, et al. European myeloma network guidelines for the management of multiple myeloma-related complications. Haematologica. 2015;100(10):1254–66.

    Article  CAS  Google Scholar 

  5. Cavo M, Terpos E, Nanni C, et al. Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the international myeloma working group. Lancet Oncol. 2017;18(4):e206–17.

    Article  Google Scholar 

  6. Dammacco F, Rubini G, Ferrari C, et al. 18F-FDG PET/CT: a review of diagnostic and prognostic features in multiple myeloma and related disorders. Clin Exp Med. 2015;15(1):1–18.

    Article  CAS  Google Scholar 

  7. Weng W-W, Dong M-J, Zhang J, et al. A systematic review of MRI, scintigraphy, FDG-PET and PET/CT for diagnosis of multiple myeloma related bone disease-which is best? Asian Pac J Cancer Prev. 2014;15(22):9879–84.

    Article  Google Scholar 

  8. Lu YY, Chen JH, Lin WY, et al. FDG PET or PET/CT for detecting intramedullary and extramedullary lesions in multiple Myeloma: a systematic review and meta-analysis. Clin Nucl Med. 2012;37(9):833–7.

    Article  Google Scholar 

  9. Walker RC, Brown TL, Jones-Jackson LB, et al. Imaging of multiple myeloma and related plasma cell dyscrasias. J Nucl Med. 2012;53(7):1091–101.

    Article  Google Scholar 

  10. Sager S, Ergul N, Ciftci H, et al. The value of FDG PET/CT in the initial staging and bone marrow involvement of patients with multiple myeloma. Skelet Radiol. 2011;40(7):843–7.

    Article  Google Scholar 

  11. Mesguich C, Fardanesh R, Tanenbaum L, et al. State of the art imaging of multiple myeloma: comparative review of FDG PET/CT imaging in various clinical settings. Eur J Radiol. 2014;83(12):2203–23.

    Article  Google Scholar 

  12. Rasche L, Angtuaco E, McDonald JE, et al. Low expression of hexokinase-2 is associated with false-negative FDG-positron emission tomography in multiple myeloma. Blood. 2017;130(1):30–4.

    Article  CAS  Google Scholar 

  13. Moreau P, Attal M, Caillot D, et al. Prospective evaluation of magnetic resonance imaging and [18F]Fluorodeoxyglucose positron emission tomography-computed tomography at diagnosis and before maintenance therapy in symptomatic patients with multiple myeloma included in the IFM/DFCI 2009 trial: results of the IMAJEM study. J Clin Oncol. 2017;35(25):2911–8.

    Article  CAS  Google Scholar 

  14. Nanni C, Versari A, Chauvie S, et al. Interpretation criteria for FDG PET/CT in multiple myeloma (IMPeTUs): final results. IMPeTUs (Italian myeloma criteria for PET USe). Eur J Nucl Med Mol Imaging. 2018;45(5):712–9.

    Article  Google Scholar 

  15. Van Lammeren-Venema D, Regelink JC, Riphagen II, et al. 8F-fluoro-deoxyglucose positron emission tomography in assessment of myeloma-related bone disease: a systematic review. Cancer. 2012;118(8):1971–81.

    Article  Google Scholar 

  16. Zamagni E, Nanni C, Patriarca F, et al. A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma. Haematologica. 2007;92:50–5.

    Article  Google Scholar 

  17. Fonti R, Salvatore B, Quarantelli M, et al. 18F-FDG PET/CT, 99mTc-MIBI, and MRI in evaluation of patients with multiple myeloma. J Nucl Med. 2008;49:195–200.

    Article  Google Scholar 

  18. Fonti R, Pace L, Cerchione C, Catalano L, Salvatore B, De LS, Pane F, Salvatore M, Del VS. 18F-fdg pet/ct, 99mtc-mibi, and mri in the prediction of outcome of patients with multiple myeloma: a comparative study. Clin Nucl Med. 2015;40(4):303–8.

    Article  Google Scholar 

  19. Salaun P-Y, Gastinne T, Frampas E, et al. FDG-positron-emission tomography for staging and therapeutic assessment in patients with plasmacytoma. Haematologica. 2008;93(8):1269–71.

    Article  Google Scholar 

  20. Fouquet G, Guidez S, Herbaux C, et al. Impact of initial FDG-PET/CT and serum-free light chain on transformation of conventionally defined solitary plasmacytoma to multiple myeloma. Clin Cancer Res. 2014;20(12):3254–60.

    Article  CAS  Google Scholar 

  21. Siontis B, Kumar S, Dispenzieri A, et al. Positron emission tomography-computed tomography in the diagnostic evaluation of smoldering multiple myeloma: identification of patients needing therapy. Blood. 2015;5:e364. https://doi.org/10.1038/bcj.2015.87.

    Article  CAS  Google Scholar 

  22. Zamagni E, Nanni C, Gay F, et al. 18F-FDG PET/CT focal, but not osteolytic, lesions predict the progression of smoldering myeloma to active disease. Leukemia. 2016;30(2):417–22.

    Article  CAS  Google Scholar 

  23. Bartel TB, Haessler J, Brown TL, et al. F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma. Blood. 2009;114(10):2068–76.

    Article  CAS  Google Scholar 

  24. Zamagni E, Patriarca F, Nanni C, et al. Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation. [Erratum appears in Blood. 2012 Sep 13;120(11):2349]. Blood. 2011;118(23):5989–95.

    Article  CAS  Google Scholar 

  25. Haznedar R, Aki SZ, Akdemir OU, et al. Value of 18F-fluorodeoxyglucose uptake in positron emission tomography/computed tomography in predicting survival in multiple myeloma. Eur J Nucl Med Mol Imaging. 2011;38(6):1046–53.

    Article  CAS  Google Scholar 

  26. Park S, Lee SJ, Chang WJ, et al. Positive correlation between baseline PET or PET/CT findings and clinical parameters in multiple myeloma patients. Acta Haematol. 2014;131(4):193–9.

    Article  Google Scholar 

  27. Fonti R, Larobina M, Del Vecchio S, et al. Metabolic tumor volume assessed by 18F-FDG PET/CT for the prediction of outcome in patients with multiple myeloma. J Nucl Med. 2012;53(12):1829–35.

    Article  CAS  Google Scholar 

  28. McDonald JE, Kessler MM, Gardner MW, et al. Assessment of Total lesion glycolysis by 18F FDG PET/CT significantly improves prognostic value of GEP and ISS in myeloma. Clin Cancer Res. 2017;23(8):1981–7.

    Article  CAS  Google Scholar 

  29. Carlier T, Bailly C, Leforestier R, et al. Prognostic added value of PET textural features at diagnosis in symptomatic multiple myeloma. Oral Communication SNM 2017.

    Google Scholar 

  30. Kumar S, Paiva B, Anderson KC, et al. International myeloma working group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol. 2016;17(8):e328–46.

    Article  Google Scholar 

  31. Usmani SZ, Mitchell A, Waheed S, et al. Prognostic implications of serial 18-fluoro-deoxyglucose emission tomography in multiple myeloma treated with total therapy 3. Blood. 2013;121(10):1819–23.

    Article  CAS  Google Scholar 

  32. Zamagni E, Nanni C, Mancuso K, et al. PET/CT improves the definition of complete response and allows to detect otherwise unidentifiable skeletal progression in multiple myeloma. Clin Cancer Res. 2015;21(19):4384–90.

    Article  CAS  Google Scholar 

  33. Bailly C, Carlier T, Jamet B, et al. Interim PET analysis in first line therapy of multiple myeloma: Prognostic value of ΔSUVmax in the FDG-avid patients of the IMAJEM study. Clin Cancer Res. 2018.

    Google Scholar 

  34. Nanni C, Zamagni E, Celli M, et al. The value of 18F-FDG PET/CT after autologous stem cell transplantation (ASCT) in patients affected by multiple myeloma (MM): experience with 77 patients. Clin Nucl Med. 2013;38(2):e74–9.

    Article  Google Scholar 

  35. Derlin T, Weber C, Habermann CR, et al. 18F-FDG PET/CT for detection and localization of residual or recurrent disease in patients with multiple myeloma after stem cell transplantation. Eur J Nucl Med Mol Imaging. 2012;39(3):493–500.

    Article  Google Scholar 

  36. Lapa C, Lückerath K, Malzahn U, et al. 18 FDG-PET/CT for prognostic stratification of patients with multiple myeloma relapse after stem cell transplantation. Oncotarget. 2014;5(17):7381–91.

    Article  Google Scholar 

  37. Jamet B, Bailly C, Carlier T, et al. Added prognostic value of FDG-PET/CT in relapsing multiple myeloma patients. Leuk Lymphoma. 2018:1–4.

    Google Scholar 

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Acknowledgments

“This work has been supported in part by grants from the French National Agency for Research called “Investissements d’Avenir” IRON Labex n° ANR-11-LABX-0018-01 and ArronaxPlus Equipex n° ANR-11-EQPX-0004, and by a grant INCa-DGOS-Inserm_12558 (SIRIC ILIAD).”

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Jamet, B. et al. (2019). FDG PET in Multiple Myeloma. In: Nanni, C., Fanti, S., Zanoni, L. (eds) Molecular Imaging in Multiple Myeloma. Springer, Cham. https://doi.org/10.1007/978-3-030-19019-4_3

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  • DOI: https://doi.org/10.1007/978-3-030-19019-4_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-19018-7

  • Online ISBN: 978-3-030-19019-4

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