Multiple Myeloma Guidelines and Their Recent Updates: Implications for Imaging

Abstract

Background In 2014, the diagnostic criteria for multiple myeloma were updated, leading to revised recommendations for imaging modalities and definition of therapy response. This review provides an overview of the current definitions of monoclonal plasma cell disease, diagnostic options, and changes relevant to radiologists. Method A pubmed search regarding the multiple myeloma guidelines was conducted, and results were filtered considering publications of international associations and expert reviews. Recommendations by the International Myeloma Working Group (IMWG), the National Comprehensive Cancer Network (NCCN, USA), the European Society for Medical Oncology (ESMO), and the European Myeloma Network are acknowledged. Results and Conclusion Conventional skeletal survey is to be replaced by cross-sectional imaging techniques. For initial diagnostics of bone lesions or bone marrow involvement defining multiple myeloma, whole-body low-dose CT and whole-body MRI are recommended. Two or more focal bone marrow lesions suspicious for myeloma on MRI will now define symptomatic disease even in the case of intact mineralized bone. Follow-up imaging is not clearly specified so far. New guidelines concerning the definitions of minimal residual disease include the assessment of focal lesions before and after treatment using 18F-FDG-PET/CT, with the potential to redefine the role of PET/CT in the diagnostics of multiple myeloma. Key points: Citation Format

Standardization of sampling and sample preparation for analysis of human monocyte subsets in peripheral blood

“…The prognostic impact differs even between trisomies; trisomy 21 impairs but trisomy 3 and 5 seem to improve overall survival. Guidelines for skeletal evaluation by imaging are also given [339,340]. Although several studies suggest the analysis of gene expression profiles in malignant plasma cells -37can be used for prognostic subclassification possibly in combination with the Revised-ISS [341][342][343], the guidelines do not recommend the use of this parameter for the diagnosis or monitoring of myeloma patients in routine clinical practice.…”

Deep Learning-Based CT Imaging in Diagnosing Myeloma and Its Prognosis Evaluation

“…It suggested that the adjusted U-Net model had better segmentation effects on the CT image of multiple myeloma. Image processing is an integral part in the detection of lesion area [ 18 ]. The deep learning-based model needs to classify the target areas after the recognition and positioning [ 19 ].…”

Whole-body magnetic resonance imaging (WBMRI) versus whole-body computed tomography (WBCT) for myeloma imaging and staging

“…Their cross-sectional dimension and the assessment of growth or shrinkage with either technique are two aspects included in the standard IMWG response criteria defining a partial response and a minimal response [ 13 ]. FDG-PET-CT has alternatively become established for the evaluation of extraosseous disease, since it is more sensitive than CT due to the uptake of FDG in these lesions and because it yields morphological, biochemical and functional information [ 18 , 25 , 33 ].…”