Magnetic Resonance Imaging in Multiple Myeloma: Diagnostic and Clinical Implications

Walker, Ronald C.; Barlogie, Bart; Haessler, Jeffrey; Tricot, Guido; Anaissie, Elias; Shaughnessy, John D.; Epstein, Joshua; Hemert, Rudy Van; Eren, Erdem; Hoering, Antje; Crowley, John; Ferris, Ernest J.; Hollmig, Klaus; Rhee, Frits van; Zangari, Maurizio; Pineda‐Roman, Mauricio; Mohiuddin, Abid; Yaccoby, Shmuel; Sawyer, Jeffrey R.; Angtuaco, Edgardo J.

doi:10.1200/jco.2006.08.5803

Cited by 370 publications

(278 citation statements)

References 23 publications

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“…We and others have previously described that diffuse MRI pattern correlates with shorter survival when conventional chemotherapy or novel agent-based regimens are used as first line therapy in symptomatic myeloma [4,5,15]. The Arkansas group showed that the presence of more than seven focal lesions on whole body MRI is also an independent prognostic factor for OS in patients who received thalidomide-based first line therapy [16]. In this study, we showed that patients with diffuse MRI patterns have almost two-fold longer median OS with the use of novel agent-based therapies upfront compared to conventional treatment.…”

Section: Mri Patterns and Cytogenetic Abnormalitiesmentioning

confidence: 95%

Diffuse pattern of bone marrow involvement on magnetic resonance imaging is associated with high risk cytogenetics and poor outcome in newly diagnosed, symptomatic patients with multiple myeloma: A single center experience on 228 patients

et al. 2012

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Magnetic Resonance Imaging (MRI) and specific cytogenetic abnormalities offer important prognostic information for myeloma patients. However, limited data are available about the association between cytogenetic abnormalities and MRI patterns of marrow infiltration. To address this issue, we analyzed 228 consecutive newly diagnosed, symptomatic patients who were diagnosed and treated in a single center. On bone marrow MR images, 95 (41%) patients had diffuse, 94 (41%) had focal, 35 (15%) were normal, and 4 (1.7%) patients had variegated pattern of marrow infiltration. High risk cytogenetics were more commonly observed with diffuse MRI pattern (50% vs. 31% in focal and normal patterns). Patients with diffuse MRI pattern had poorer survival compared to others and responded better to novel agent-based therapies than to conventional chemotherapy (objective response: 88% vs. 46%, P < 0.001). There was a significant improvement of patients' survival with a diffuse MRI pattern when treated upfront with novel agents compared to conventional chemotherapy (47 vs. 24 months; P < 0.001). Diffuse MRI pattern along with ISS-3 and high risk cytogenetics could identify a very high risk group of patients with extremely poor median survival (21 months) and an only 35% probability of 3-year OS. Our study shows that symptomatic myeloma patients with a diffuse MRI pattern at diagnosis very often show high risk cytogenetic abnormalities and are benefiting from upfront novel agent-based therapies. Diffuse MRI pattern in combination with high risk cytogenetics and ISS-3 can identify a subset of myeloma patients with very poor prognosis who may need innovative treatment strategies and possibly more aggressive therapies. Am. J. Hematol. 87:861-864, 2012. V

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Section: Mri Patterns and Cytogenetic Abnormalitiesmentioning

confidence: 95%

Diffuse pattern of bone marrow involvement on magnetic resonance imaging is associated with high risk cytogenetics and poor outcome in newly diagnosed, symptomatic patients with multiple myeloma: A single center experience on 228 patients

et al. 2012

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“…88 An alternative explanation might be that these focal lesions, which may be the first site of recurrence, contain cells that are nonsecretory (possibly myeloma stem cells). Therefore, a more precise approach of the CR status might require an imaging technique (magnetic resonance imagery or positron emission tomography-computed tomography scan) in addition to serologic, cytologic, and possibly immunophenotypic analysis.…”

Section: Which Level Of Response Is Necessary?mentioning

confidence: 99%

The role of complete response in multiple myeloma

Harousseau

Attal

Avet-Loiseau

2009

Blood

209

148

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In multiple myeloma (MM), the impact of complete response (CR) could be shown only after introduction of high-dose therapy plus autologous stem cell transplantation (ASCT). In the context of ASCT, achieving CR (negative immunofixation and normal bone marrow) or at least very good partial response is associated with longer progression-free survival and in most studies longer survival. With novel agents, high CR rates are achieved and this prognostic impact of CR is being shown as well, both in relapsed and in newly diagnosed MM. However the benefit of CR achievement depends on the type of treatment and is not identical for all patients. In elderly patients, treatments inducing more CR may be more toxic. Although CR achievement is necessary in patients with poor-risk disease, it might not be as critical for long survival in more indolent MM. CR achievement is not the only objective of treatment because it is possible to further improve the depth of response and the outcome by continuing treatment after CR achievement. Finally, there are several levels of CR and in the future it will be necessary to confirm the prognostic impact of immunophenotypic or molecular CR or of CR defined by imaging procedures. (Blood. 2009;114: 3139-3146)

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“…16 Such focal lesions harbor viable tumor cells as shown by 18-fluorodeoxyglucose avidity on PET-CT scanning as well as on cytogenetic and GEP examinations of samples procured from focal lesions under CT guidance. MRI-defined focal lesions, often representing the first site of disease recurrence, can resolve in up to 60% of patients, with a median lag time behind onset of clinical CR of 24 months.…”

Section: Figurementioning

confidence: 99%

Making progress in treating multiple myeloma with total therapies: issue of complete remission and more

et al. 2008

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Magnetic Resonance Imaging in Multiple Myeloma: Diagnostic and Clinical Implications

Cited by 370 publications

References 23 publications

Diffuse pattern of bone marrow involvement on magnetic resonance imaging is associated with high risk cytogenetics and poor outcome in newly diagnosed, symptomatic patients with multiple myeloma: A single center experience on 228 patients

Diffuse pattern of bone marrow involvement on magnetic resonance imaging is associated with high risk cytogenetics and poor outcome in newly diagnosed, symptomatic patients with multiple myeloma: A single center experience on 228 patients

The role of complete response in multiple myeloma

Making progress in treating multiple myeloma with total therapies: issue of complete remission and more

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