Aim of the study The aim of this study was to analyse the diagnostic accuracy of “18 F-fluoro-ethyl-tyrosine ( 18 F-FET) PET/CT tracer in multiple myeloma. Material and methods The analysed group included: patients with newly diagnosed active myeloma (eight patients); in very good partial remission or complete remission (VGPR or CR) after treatment (nine patients); and with active disease after relapse (15 patients). Results In patients with newly diagnosed myeloma, 64 lesions were found using CT and 83 lesions using 18 F-FET. In six patients, the number of lesions using CT and 18 F-FET was the same, and two had more lesions with the 18 F-FET than with the CT. Patients in VGPR or CR had no FET-positive lesions. Fourteen out of 15 patients with active relapsed myeloma had 47 FET-positive lesions, CT assessment of the same group showed 282 lesions. In one patient with relapse soft tissue mass was found with 18 F-FET but not with CT. Conclusions 18 F-FET can be a promising alternative to 18 F-FDG PET/CT for myeloma-related bone disease diagnosis.

Monoclonal gammopathy of unknown significance (MGUS) is a benign condition that carries a risk of progression to haematological malignancy. It is accepted that MGUS should not be treated until progression to multiple myeloma or another lymphoid malignancy. Recently, growing evidence has started to show that even small monoclonal clones can be responsible for renal impairment. Long-term observation of patients with monoclonal gammopathy and abnormal renal function showed that this condition can significantly affect renal and overall survival. Patients with monoclonal gammopathy with renal impairment have also higher risk of relapse after kidney transplantation. Among patients with monoclonal gammopathy of unknown significance there is a group of defined monoclonal component-related diseases, which includes:light-chain amyloidosis, monoclonal immunoglobulin deposition disease, crystal-storing histiocytosis, cryoglobulinaemias, and some others. They can be diagnosed on the base of clinical features and on histological examination. In patients with monoclonal protein and deposition of fragments or whole particle of monoclonal immunoglobulin with distinct localisation and substructural organisation can be found.The treatment strategy is targeting of B cell clones, which requires administration of chemotherapeutics or other medications that are used for the treatment of lymphoid malignancy or myeloma. The choice of therapeutic agent should take into account the current kidney status. Treatment of renal disease should not differ from other patients with similar conditions not related to monoclonal protein. The expert opinion is that the presence of monoclonal gammapathy is not a contraindication to kidney transplantation.

Background Although the introduction of novel agents improved the survival outcomes in patients with multiple myeloma (MM), some patients died within one year (early mortality, EM) following diagnosis. In this study, we evaluated the EM rate, and investigated the risk factors associated with EM in MM patients. Aims In this study we investigated risk factors associated with EM in MM patients initially treated with novel-agent containing regimen. Methods We conducted a multicenter (15 Polish sites) retrospective study a cohort of symptomatic MM pts diagnosed between October 2006 and November 2019 and living < 365 days (d) after diagnosis. All pts were dead at the time of the analysis. Data were collected from medical registries and databases. Mortality rate and cause at 2, 6, and 12 months following diagnosis was evaluated. Clinical staging was performed using the International Staging System (ISS). Response to treatment was evaluated according to the International Myeloma Working Group (IMWG) consensus criteria (2016). Statistical analysis was performed using R-studio v.1.3.959. and significant levels were set at p<0.05. Results Of the 197 pts were included in the study, 112 (57%) male and the median age at diagnosis was 69 y (41-91). The MM type of 100 patients (52%) was Immunoglobulin (Ig) G, 24% of patients was IgA, 15% of patients had light chain disease, and 3% of patients IgM or IgD. At diagnosis, renal impairment (RI) was present in 43%, extramedullary disease (EMD) in 15% of the pts; 15% were in stage I, 10% in stage II, 60% in stage III (ISS) and 15% not done. Fluorescent in situ hybridization analysis was performed in 59 pts, 69% presenting high-risk cytogenetic abnormalities (HRC) [t(4;14), t(14;16), t(14;20) or del17p]. 54% pts were >2 comorbidities at diagnosis. Heart disease was presented at diagnosis in 57% pts and diabetes in 22% pts. First-line treatment (1stL), 41% of the pts patients were bortezomib-based (Bor) regimens, 25% Bor with thalidomide (VT)-based, 22% IMiD-based and 13% others. Response evaluation showed an overall response rate (ORR) of 44% (3% CR; 14% VGPR; 27% PR). 46% pts survived < 2 months, 29%; 2-6 months and 25%: 6-12 month. Median time until death was 2.5 month; 31% of pts died directly from progression disease (PD), and 69% from other causes [infection in 66%, cardiovascular complications in 27%, RI in 8%]. In our study, age > 65 y (HR 1.67; 95% CI 1.24-2.26; p=0.0007), and >75 y (HR 1.5; 95% CI 1.10-2.03; p=0.0087), >2 comorbidities (p=0.002), heart disease (HR 2.12; 95% CI 1.57-2.85; p < 0.0001), RI (HR 0.7; 95% CI 0.53-0.95; p=0.029), dependence of dialysis (HR 1.50; 95% CI 1.05-2.14; p=0.029) were associated with increased risk of death. Mortality predictive value showed HRC (p=0.05), lactate dehydrogenase levels (HR 0.65; 95% CI 0.38-1.1; p=0.002), and >PR (HR 0.30; 95% CI 0.21-0.43; p<0.0001). Moreover, sex, hypertension, diabetes, type of MM, extramedullary disease, ISS stage, hemoglobin level, count of platelets didn't show a mortality predictive value. Conclusions IMWG response criteria are not adequate to predict short-term outcome in the era of novel agents. Infections and refractory disease were the leading contributors to early death in our pts cohort. These data may provide new opportunities to define patient-adapted treatment strategies in order to decrease EM and improve overall survival in MM. Disclosures Wrobel: BMS/Celgene: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria; Roche: Research Funding; Janssen: Honoraria. Robak:Abbvie, Pharmacyclics, Gilead, GlaxoSmithKline, Novartis, Janssen, F. Hoffmann-La Roche, Acerta, AstraZeneca, BioGene, UCB: Research Funding; F. Hoffmann-La Roche, Abbvie, Pharmacyclics, Novartis, Janssen, Acerta, AstraZeneca, BioGene, UCB, Sandoz: Honoraria. Robak:Bristol Meyers Squibb: Research Funding; Roche: Consultancy, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding; Novartis: Honoraria, Research Funding; Takeda: Consultancy; GSK: Research Funding; UTX-TGR: Research Funding; Acerta: Research Funding; BioGene: Honoraria, Research Funding; Morphosys: Research Funding; Janssen: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding; Octapharma: Honoraria; AbbVie: Consultancy, Honoraria, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding; Medical University of Lodz: Current Employment; UCB: Honoraria, Research Funding; Pfizer: Research Funding; Momenta: Consultancy; Sandoz: Consultancy, Honoraria; Pharmacyclics LLC, an AbbVie Company: Honoraria, Research Funding; AstraZeneca: Honoraria, Research Funding.

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