Prospective Evaluation of Magnetic Resonance Imaging and [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography at Diagnosis and Before Maintenance Therapy in Symptomatic Patients With Multiple Myeloma Included in the IFM/DFCI 2009 Trial: Results of the IMAJEM Study

Abstract

Purpose Magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) are important imaging techniques in multiple myeloma (MM). We conducted a prospective trial in patients with MM aimed at comparing MRI and PET-CT with respect to the detection of bone lesions at diagnosis and the prognostic value of the techniques. Patients and Methods One hundred thirty-four patients received a combination of lenalidomide, bortezomib, and dexamethasone (RVD) with or without autologous stem-cell transplantation, followed by lenalidomide maintenance. PET-CT and MRI were performed at diagnosis, after three cycles of RVD, and before maintenance therapy. The primary end point was the detection of bone lesions at diagnosis by MRI versus PET-CT. Secondary end points included the prognostic impact of MRI and PET-CT regarding progression-free (PFS) and overall survival (OS). Results At diagnosis, MRI results were positive in 127 of 134 patients (95%), and PET-CT results were positive in 122 of 134 patients (91%; P = .33). Normalization of MRI after three cycles of RVD and before maintenance was not predictive of PFS or OS. PET-CT became normal after three cycles of RVD in 32% of the patients with a positive evaluation at baseline, and PFS was improved in this group (30-month PFS, 78.7% v 56.8%, respectively). PET-CT normalization before maintenance was described in 62% of the patients who were positive at baseline. This was associated with better PFS and OS. Extramedullary disease at diagnosis was an independent prognostic factor for PFS and OS, whereas PET-CT normalization before maintenance was an independent prognostic factor for PFS. Conclusion There is no difference in the detection of bone lesions at diagnosis when comparing PET-CT and MRI. PET-CT is a powerful tool to evaluate the prognosis of de novo myeloma.

Integration of Novel Agents into the Care of Patients with Multiple Myeloma

“…However, four-year survival was similar (83% vs. 81%; HR 1.2; CI 0.7–1.8), and there were more deaths (54 vs. 48) and second primary malignancies (6 vs.1) in the early transplant group. Correlative studies showed that MRD-negativity by flow cytometry or next-generation sequencing (51), as well as by magnetic resonance imaging or positron emission tomography (52), was generally associated with a better PFS, and in some cases with a better OS.…”

PET Imaging for Initial Staging and Therapy Assessment in Multiple Myeloma Patients

“…Finally, the French IMAJEM [18] study confirmed the superiority of FDG-PET as opposed to MRI in the therapeutic evaluation of patients with MM in front-line therapy. This work prospectively compared the value of MRI and FDG-PET realized at diagnosis, after three cycles of induction chemotherapy and before maintenance therapy, in a series of 134 patients treated in the Intergroupe Francophone du Myelome/Dana–Farber Cancer Institute (IFM/DFCI) 2009 clinical trial.…”

“…The French IMAgerie JEune Myélome (IMAJEM) study has compared FDG-PET and MRI performed at baseline in patients with symptomatic MM, showing comparable results with both techniques, detecting abnormalities in more than 90% of the patients [18]. FDG-PET also allows for the detection of additional medullary lesions or EMD in regions unexplored by MRI.…”

The Role of Minimal Residual Disease Testing in Myeloma Treatment Selection and Drug Development: Current Value and Future Applications

“…In several prior studies, post-treatment FDG-PET/CT negativity was defined according to a range of heterogeneous criteria, which included the lack of any increased FDG uptake, decreased metabolism of the tumor below different cut offs of Standard Uptake Value (SUV), or the absence of metabolically active focal lesions. Nevertheless, all these studies consistently showed positive outcomes related to negative FDG-PET/CT scans in previously untreated patients after completion of therapy, either before or after autologous stem-cell transplantation (ASCT), or even in the absence of high-dose therapy and subsequent ASCT (15,(36)(37)(38)(39)(40). Whether or not FDG-PET/CT can detect MRD after highly effective newer therapies will be addressed in future clinical trials.…”