Prognostic significance of tumor burden assessed by whole-body magnetic resonance imaging in multiple myeloma patients treated with allogeneic stem cell transplantation

Abstract

Allogeneic stem cell transplantation is a therapeutic option under dispute but nonetheless chosen with increasing frequency for patients suffering from multiple myeloma in Europe. To study possible predictors of survival, 79 patients were investigated using whole-body magnetic resonance imaging to assess the visible tumor burden before and after allogeneic stem cell transplantation. Statistical analysis of clinical and imaging parameters included Cox regression models and distribution of survival time estimates (Kaplan-Meier method). Log rank test was used to determine the prognostic impact of the presence of focal lesions on survival. A higher tumor burden according to the lesion count was associated with a shorter overall survival (univariable/multivariable Cox regression: 1st magnetic resonance imaging P=0.028/P=0.048; 2nd magnetic resonance imaging P=0.008/P=0.024). Focal infiltration pattern itself seemed to be an additional adverse prognostic factor for overall survival (2nd MRI P=0.048), although no definite cut-off could be defined. Kaplan-Meier estimates at 60 months of follow up show a significant difference (Log rank P=0.04) for overall survival rates between patients with focal infiltration (32%) and those without (75%). Since this subgroup of patients may benefit from maintenance therapy, adoptive immunotherapy, or local interventions, whole-body imaging is an appropriate and highly recommendable diagnostic approach for detection of prognostically relevant lesions before and after treatment.

Diffusion-Weighted MRI—The Way Forward for MRI in Myeloma?

“…In fact, the presence of more than three residual focal lesions after induction and any residual focal lesions after high dose chemotherapy were significantly adverse prognostic factors. The same group was also able to show that residual lesions on conventional MRI are a negative prognostic factor, which was confirmed by other research groups, and in patients after allogeneic stem cell transplantation [19,20]. However, a comparison of whole body PET/CT and conventional spinal MRI, the latter limited due to availability of whole body MRI, by the Intergroupe Francophone du Myélome, showed that PET/CT more reliably predicted outcomes [21].…”

Imaging and bone marrow assessments improve minimal residual disease prediction in multiple myeloma

“…In these contexts, it would seem prudent to complement bone marrow MRD assessment with other techniques, that could detect heterogeneous bone marrow involvement or EMD. Imaging techniques such as magnetic resonance imaging (MRI) or positron emission tomography‐computed tomography (PET‐CT) have demonstrated their prognostic value for progression‐free survival (PFS) and overall survival (OS) in this framework.…”

The association of blood ctDNA levels to mutations of marker genes in colorectal cancer

“…Therefore, because mutations in ctDNA have an association with ctDNA level, then, we can infer the tumor burden or tumor size from gene mutations in ctDNA, and even the survival time for prognosis. The large tumor burden and high ctDNA level indicate shorter overall survival 19–21 . We found the association between gene mutations and ctDNA levels provides new insight into ctDNA study.…”