Application of PET/CT in treatment response evaluation and recurrence prediction in patients with newly-diagnosed multiple myeloma

Abstract

Multiple myeloma (MM) causes osteolytic lesions which can be detected by 18F-fluorodeoxyglucose positron emission tomography/Computed tomography (18F-FDG PET/CT). We prospectively involve 96 Newly diagnosed MM to take PET/CT scan at scheduled treatment time (figure 1), and 18F-FDG uptake of lesion was measured by SUVmax and T/Mmax. All MM patients took bortezomib based chemotherapy as induction and received ASCT and maintenance. All clinical features were analyzed with the PET/CT image changes, and some relationships between treatment response and FDG uptakes changes were found: Osteolytic lesions of MM uptakes higher FDG than healthy volunteers, and this trend is more obvious in extramedullary lesions. Compared to X-ray, PET/CT was more sensitive both in discoering bone as well as extramedullary lesions. In newly diagnosed MM, several adverse clinical factors were related to high FDG uptakes of bone lesions. Bone lesion FDG uptakes of MM with P53 mutation or with hypodiploidy and complex karyotype were also higher than those without such changes. In treatment response, PET/CT showed higher sensitivity in detecting tumor residual disease than immunofixation electrophoresis. But in relapse prediction, it might show false positive disease recurrences and the imaging changes might be influenced by infections and hemoglobulin levels. Conclusion: PET/CT is sensitive in discovering meduallary and extrameduallary lesions of MM, and the 18F-FDG uptake of lesions are related with clinical indictors and biological features of plasma cells. In evaluating treatment response and survival, PET/CT showed its superiority. But in predicting relapse or refractory, it may show false positive results.

[18F](2S,4R)-4-Fluoroglutamine as a New Positron Emission Tomography Tracer in Myeloma

“…Indeed, independently from response, Bortezomib increased [ 18 F]FDG uptake and volume of distribution, whereas [ 18 F]4-FGln parameters were more closely associated with the response, suggesting that [ 18 F]4-FGln based PET scan reliably delineates tumor sensitivity to the drug. In line with our observations, it has been reported that [ 18 F]FDG uptake may persist in MM patients who achieved complete response to Bortezomib (37). The drug has been reported to stimulate aerobic glycolysis, thus possibly indicating that changes in tumor volume are masked by increased glycolytic flux (38)(39)(40).…”

The Role of 18F-FDG-PET/CT Scan in the Management of Multiple Myeloma

“…They also revealed the correlation between FDG uptake and some prognostically relevant laboratory parameters such as β2M and CRP [35]. As well the correlation between SUVmax in bone lesions and clinical parameters related to tumor burden such as high M protein, plasma cell >20% in bone marrow, β2M>3.5mg/dl, hypercalcemia at the onset of disease, and increased LDH was reported by Li et al [36].…”

Relationship Between Fluorine-18 Fluorodeoxyglucose PET/CT Uptake and the Plasma Cell Infiltration Rate in the Bone Marrow of Patients With Multiple Myeloma

“…Previous studies reported a correlation between FDG uptake by BM and PC in ltration [12,20,28,29,[42][43][44][45], while others showed that FDG uptake correlated with b2m [28,29] and CRP (29) and negatively correlated with Hb and HT [29] as well as Alb [28].…”