18F-FDG PET/CT focal, but not osteolytic, lesions predict the progression of smoldering myeloma to active disease

Zamagni, Elena; Nanni, Cristina; Pezzi, Annalisa; Patriarca, Francesca; Bellò, Marilena; Rambaldi, Ilaria; Tacchetti, Paola; Hillengaß, Jens; Gamberi, Barbara; Pantani, Lucia; Magarotto, Valeria; Versari, Annibale; Offidani, Massimo; Zannetti, Beatrice Anna; Carobolante, Francesca; Balma, Michele; Musto, Pellegrino; Rensi, Marco; Mancuso, Katia; Dimitrakopoulou-Strauß, Antonia; Chauvie, Stéphane; Rocchi, Serena; Fard, Nassim; Marzocchi, Giulia; Storto, Giovanni; Ghedini, Pietro; Palumbo, Antônio; Fanti, Stefano; Cavo, Michèle

doi:10.1038/leu.2015.291

Cited by 126 publications

(103 citation statements)

References 36 publications

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“…Standardization is also required for the use and implication of positron emission tomography (PET)/computed tomography (CT). In their study on 120 patients with SMM, the Bologna group reported that PET/CT identified either focal lesions or a diffuse infiltration in 19 (16%) patients [23]. Patients presenting small osteolytic lesions were excluded from the study.…”

Section: Imaging Studiesmentioning

confidence: 99%

The Changing Landscape of Smoldering Multiple Myeloma: A European Perspective

et al. 2016

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Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell disorder and bridges monoclonal gammopathy of undetermined significance to multiple myeloma (MM), based on higher levels of circulating monoclonal immunoglobulin and bone marrow plasmocytosis without end-organ damage. Until a Spanish study reported fewer MM-related events and better overall survival among patients with high-risk SMM treated with lenalidomide and dexamethasone, prior studies had failed to show improved survival with earlier intervention, although a reduction in skeletal-related events (without any impact on disease progression) has been described with bisphosphonate use. Risk factors have now been defined, and a subset of ultra-high-risk patients have been reclassified by the International Myeloma Working Group as MM, and thus will require optimal MM treatment, based on biomarkers that identify patients with a >80% risk of progression. The number of these redefined patients is small (∼10%), but important to unravel, because their risk of progression to overt MM is substantial (≥80% within 2 years). Patients with a high-risk cytogenetic profile are not yet considered for early treatment, because groups are heterogeneous and risk factors other than cytogenetics are deemed to weight higher. Because patients with ultra-high-risk SMM are now considered as MM and may be treated as such, concerns exist that earlier therapy may increase the risk of selecting resistant clones and induce side effects and costs. Therefore, an even more accurate identification of patients who would benefit from interventions needs to be performed, and clinical judgment and careful discussion of pros and cons of treatment initiation need to be undertaken. For the majority of SMM patients, the standard of care remains observation until development of symptomatic MM occurs, encouraging participation in ongoing and upcoming SMM/early MM clinical trials, as well as consideration of bisphosphonate use in patients with early bone loss.

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Section: Imaging Studiesmentioning

confidence: 99%

The Changing Landscape of Smoldering Multiple Myeloma: A European Perspective

et al. 2016

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“…Risk of progression to symptomatic MM within 2 years was 58-61% [57,58]. Risk progression in light-chain SMM is approximately 5% per year during the first 5 years and decreases thereafter [23].…”

Section: % Of Totalmentioning

confidence: 96%

“…Risk of progression at 7 years (%) hypermetabolism without underlying osteolysis on PET-CT (8-16% of the patients with SMM) have a higher probability of progression, compared to patients without these abnormalities [57,58]. Risk of progression to symptomatic MM within 2 years was 58-61% [57,58].…”

Section: % Of Totalmentioning

confidence: 99%

Diagnosis, risk stratification and management of monoclonal gammopathy of undetermined significance and smoldering multiple myeloma

Donk

Mutis

Poddighe

et al. 2016

Int J Lab Hematology

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KeywordsMonoclonal gammopathy of undetermined significance, smoldering multiple myeloma, multiple myeloma, diagnosis, management, treatment S U M M A RYMonoclonal gammopathy of undetermined significance (MGUS) is one of the most common premalignant disorders. IgG and IgA MGUS are precursor conditions of multiple myeloma (MM), whereas light-chain MGUS is a precursor condition of light-chain MM. Smoldering MM (SMM) is a precursor condition with higher tumor burden and higher risk of progression to symptomatic MM compared to MGUS. Assessment of the risk of progression of patients with asymptomatic monoclonal gammopathies is based on various factors including clonal burden, as well as biological characteristics, such as cytogenetic abnormalities and light-chain production. Several models have been constructed that are useful in daily practice for predicting risk of progression of MGUS or SMM. Importantly, the plasma cell clone may occasionally be responsible for severe organ damage through the production of a M-protein which deposits in tissues or has autoantibody activity. These disorders are rare and often require therapy directed at eradication of the underlying clone. Importantly, recent studies have shown that asymptomatic patients with a bone marrow plasma cell percentage ≥60%, free light-chain ratio ≥100, or >1 focal lesion on MRI (myeloma-defining events) have a 80% risk of developing symptomatic MM within 2 years. These patients are now considered to have MM requiring therapy, similar to patients with symptomatic disease. In this review, we provide an overview of the new diagnostic criteria of the monoclonal gammopathies and discuss risk of progression to active MM. We also provide recommendations for the management of patients with MGUS and SMM including risk-adapted follow-up.

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“…Kornélia Kajȧry and Dr. Zsuzsa Molnár publish their research article entitled "The role of 18F-FDG PET/CT before and after the treatment of multiple myeloma: Our clinical experience" in this issue of AMOR (page [20][21][22][23][24][25][26][27][28][29][30] ung cancer is responsible for millions of death worldwide each year and it is the second most common cancer in both men and women. According to the American Cancer Society, lung cancer is responsible for about 1 in 4 cancer deaths and 14% of all new cases.…”

Section: Dr Kajȧry With a Patient (Photo Credits: Dr Kornélia Kajȧry)mentioning

confidence: 99%