F-18 FDG PET/CT and F-18 FLT PET/CT as predictors of outcome in patients with multiple myeloma. A pilot study. Issue 136 (March 2021)

• Record Type: Journal Article
• Authors: Gallicchio, R.; Nardelli, A.; Calice, G.; Guarini, A.; Guglielmi, G.; Storto, G.
• Is Part Of: European journal of radiology. Issue 136(2021)
• Publication Date: 2021-03
• Subjects: MM multiple myeloma -- BMB bone marrow biopsy -- IMWG International Myeloma Working Group -- MRI magnetic resonance imagin -- FDG fluorine-18-fluorodeoxyglucose -- PET/CT positron emission tomography/computed tomography -- FLT fluorine-18−3-deoxy-3-fluorothymidine -- FLC free light chain -- SUVmax maximum standardized uptake -- DeLBL FLT destructive lytic bone lesion without enough FLT concentration -- EFS event free survival -- VTD Bortezomib (Velcade)-Thalidomide – Dexamethasone -- SMM smoldering multiple myeloma; Multiple myeloma -- Positron emission tomography -- Survival; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2021.109564
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: The aggregate use of PET/CT FDG and FLT in multiple myeloma represents a valuable prognostic indicator in patients at higher risk of undue events. FDG and FLT PET/CT in concert help to identify multiple myeloma patients who might beneficiate from a tailored treatment. To implement both FDG and FLT PET/CT in multiple myeloma has a prognostic impact allowing a more precise risk stratification of patients. Abstract: Objectives: We evaluated the prognostic significance of the combined use of F-18 FDG (FDG) and F-18 FLT (FLT) PET/CT (PET/CT) in patients (pts) with multiple myeloma (MM) suspected relapse after a first line chemotherapy. Methods: twenty-eight patients (57 ± 12 years) underwent both PET/CT scans over 2–4 weeks. Patients were grouped according to imaging results (FDG+/-; FLT+/-) and the findings compared to the event free survival (EFS). Results: five pts had FDG+; FLT+, 8 showed FDG+;FLT-, two had FDG-;FLT + and 13 presented FDG-;FLT-, mostly (87 %) of FDG+;FLT- pts had destructive lytic bone lesions. At Cox regression analysis the FDG PET/CT (HR 4.4, 95 % CI 1.3–15.4, p < 0.05) and FLT PET/CT (HR 5.8, 95 % CI 1.7–19.3, p < 0.01) were predictive of worst prognosis. The Kaplan-Meier analysis showed that FDG and FLT PET/CT independently influenced the survival. FDG-;FLT-patients had better EFS as compared to FDG+; FLT + pts and FDG-;FLT + pts, those of FDG+;FLT- group also had worsened EFS. Conclusions: results from the aggregate use of PET/CT FDG and FLT in MM represent a valuable prognostic indicator for identifying patients at higher risk of undue events and may help to correctly stratify the patients with suspected relapse.