Predictive role of diffusion‐weighted whole‐body MRI (DW‐MRI) imaging response according to MY‐RADS criteria after autologous stem cell transplantation in patients with multiple myeloma and combined evaluation with MRD assessment by flow cytometry. (15th July 2021)

• Record Type: Journal Article
• Authors: Belotti, Angelo; Ribolla, Rossella; Cancelli, Valeria; Villanacci, Alberta; Angelini, Valentina; Chiarini, Marco; Giustini, Viviana; Facchetti, Giulia V.; Roccaro, Aldo M.; Ferrari, Samantha; Peli, Annalisa; Bottelli, Chiara; Cattaneo, Chiara; Crippa, Claudia; Micilotta, Monica; Frittoli, Barbara; Grazioli, Luigi; Rossi, Giuseppe; Tucci, Alessandra
• Is Part Of: Cancer medicine. Volume 10:Number 17(2021)
• Page Start: 5859
• Page End: 5865
• Publication Date: 2021-07-15
• Subjects: diffusion‐weighted whole‐body MRI -- minimal residual disease -- MRD -- myeloma -- MY‐RADS -- transplant; 616.994005
• DOI: 10.1002/cam4.4136
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: Background: Diffusion‐weighted whole‐body MRI (DW‐MRI) is increasingly used in the management of multiple myeloma (MM) patients, but data regarding the prognostic role of DW‐MRI imaging response after treatment are lacking. The Myeloma Response Assessment and Diagnosis System (MY‐RADS) imaging recommendations recently proposed the criteria for response assessment category (RAC) with a 5‐point scale in order to standardize response assessment after therapy, but this score still needs to be validated. Methods: We investigated the prognostic role of RAC criteria in 64 newly diagnosed MM patients after autologous stem cell transplantation (ASCT), and we combined the results of MY‐RADS with those of minimal residual disease (MRD) assessment by multiparametric flow cytometry (MFC). Results: Superior post‐ASCT PFS and OS were observed in patients with complete imaging response (RAC1), with respect to patients with imaging residual disease (RAC≥2): median PFS not reached (NR) versus 26.5 months, p = 0.0047, HR 0.28 (95% CI: 0.12–0.68); 3‐year post‐ASCT OS 92% versus 69% for RAC1 versus RAC ≥2, respectively, p = 0.047, HR 0.24 (95% CI: 0.06–0.99). Combining MRD and imaging improved prediction of outcome, with double‐negative and double‐positive features defining groups with excellent and dismal PFS, respectively (PFS NR vs. 10.6 months); p = 0.001, HR 0.07 (95%CI: 0.01–0.36). Conclusion: The present study supports the applicability of MY‐RADS recommendations after ASCT; RAC criteria were able to independently stratify patients and to better predict their prognosis and the combined use of DW‐MRI with MFC allowed a more precise evaluation of MRD. Abstract : The present study supports both the applicability and the clinical usefulness of the proposed Myeloma Response Assessment and Diagnosis System (MY‐RADS) recommendations applied to DW‐MRI imaging obtained after first‐line treatment of MM including ASCT. MY‐RADS RAC criteria were able to independently stratify patients and to better predict their outcome and their prognosis. DW‐MRI proved to be a powerful tool for the assessment of residual bone disease by functional imaging: it complemented bone marrow flow cytometry and may, therefore, represent a step forward in the clinical management of the increasing number of MM patients achieving CR with the novel treatment approaches.