Case series: MRD negativity assessment using ¹¹C-Acetate PET with 3-weekly daratumumab-based quadruplet induction in newly diagnosed multiple myeloma

Abstract

Complete response (CR) is an important favorable factor for survival in multiple myeloma (MM). However, CR patients continue to relapse, especially in the presence of minimal residual disease (MRD). Bone marrow (BM) MRD is predictive of progression-free survival (PFS) in MM. However, myeloma outside the BM aspiration site may result in subsequent relapse despite MRD-negativity. Therefore, positron emission tomography-computed tomography (PET-CT) based on F-fluorodeoxyglucose (FDG) is a complementary tool to monitor residual disease in MM. However, FDG may miss myeloma lesions that are not FDG-avid. On the other hand, 11C-Acetate (ACT) has been found to be a more sensitive and specific tracer than FDG in MM. Recently, the addition of daratumumab to bortezomib, thalidomide, dexamethasone (VTd) or bortezomib, lenalidomide, dexamethasone (VRd) backbone has been proven to improve outcomes. Herein, we report three newly-diagnosed MM patients achieving deep responses with imaging CR using ACT PET in addition to conventional immunofixation CR and MRD-negative CR after a 3-weekly daratumumab-based quadruplet induction regimen.

Prognostic factors in 448 newly diagnosed multiple myeloma receiving bortezomib-based induction: impact of ASCT, transplant refusal and high-risk MM

“…Addition of a CD38 antibody has been shown to yield a higher rate of MRD negativity CR that translated into superior PFS [ 30 – 32 ]. Indeed, triple negative CR including immunofixation, MRD and acetate positron emission tomography negative CR maybe the next goal and definition of CR in MM treatment [ 33 ]. Moreover, to enhance the rate of deep response in non-transplant candidates, incorporation of CD38 antibody has been shown to render a higher rate of MRD negative CR that translated into superior PFS and OS than the control arm [ 34 ].…”

Prognostic Factors in 448 Newly Diagnosed Multiple Myeloma Receiving Bortezomib-based Induction: Impact of ASCT, Transplant Refusal and High-Risk MM

“…Addition of a CD38 antibody has been shown to yield a higher rate of MRD negativity CR that translated into superior PFS (29)(30)(31). Indeed, triple negative CR including immuno xation, MRD and acetate positron emission tomography negative CR maybe the next goal and de nition of CR in MM treatment (32). Moreover, to enhance the rate of deep response in non-transplant candidates, incorporation of CD38 antibody has been shown to render a higher rate of MRD negative CR that translated into superior PFS and OS than the control arm (33).…”

Functional Imaging in the Evaluation of Treatment Response in Multiple Myeloma: The Role of PET-CT and MRI

“…Choline is an indicator of the synthesis of plasma membrane, and it can be labelled with 11 C and 18 F, becoming more sensitive than 18 F-FDG [26,27]. Indeed, acetate is converted in acetyl-CoA in Krebs' cycle, producing energy for cells and it is also considered more sensitive than 18 F-FDG [28,29]. Amino acid tracers are used by plasma cells in the synthesis of new proteins, such as immunoglobulins, and they can be more specific biomarkers of active MM.…”