Lumbar bone marrow microcirculation measurements from dynamic contrast-enhanced magnetic resonance imaging is a predictor of event-free survival in progressive multiple myeloma.
OBJECTIVE
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with high temporal resolution enables the detection of microcirculation variables amplitude A and exchange rate constant k(ep). In this study, the prognostic value of the DCE-MRI variables for overall survival and event-free survival in patients with progressive multiple myeloma was investigated.


METHODS
Between 1999 and 2001, 65 patients with progressive or relapse of multiple myeloma requiring therapy were investigated with DCE-MRI of the lumbar spine before start of therapy. The contrast uptake was quantified using a two-compartment model with the output variables amplitude A and exchange rate constant k(ep) reflecting bone marrow microcirculation. The estimated median follow-up was 56 months. Event-free survival and overall survival were investigated for DCE-MRI variables and for established prognosis variables (beta(2)-microglobulin, lactate dehydrogenase, albumin, and age).


RESULTS
Using a multivariate Cox regression model, beta(2)-microglobulin and amplitude A of DCE-MRI were identified as statistically significant prognostic variable of event-free survival with Ps of 0.01 and 0.02, respectively. A statistical correlation of DCE-MRI variables with overall survival could not be found. The multivariate analysis of beta(2)-microglobulin, age, lactate dehydrogenase, and albumin revealed beta(2)-microglobulin as statistically significant prognostic factor for overall survival in this group of patients (P < 0.001).


CONCLUSIONS
This analysis identifies contrast-enhanced DCE-MRI variable amplitude A reflecting increased bone marrow microcirculation and angiogenesis as a novel and possibly useful prognostic factor in patients with multiple myeloma. Prospective studies are currently done to further investigate this functional variable for prognosis and stratification of myeloma patients.
Hillengass
Jens
J
Department of Hematology, Oncology, and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Jens.Hillengass@med.uni-heidelberg.de
Wasser
Klaus
K
Delorme
Stefan
S
Kiessling
Fabian
F
Zechmann
Christian
C
Benner
Axel
A
Kauczor
Hans-Ulrich
HU
Ho
Anthony D
AD
Goldschmidt
Hartmut
H
Moehler
Thomas M
TM
D000368:Aged; D001854:Bone Marrow Cells / Q000378:metabolism*; D003287:Contrast Media / Q000494:pharmacology*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007700:Kinetics; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality* / Q000473:pathology*; D015999:Multivariate Analysis; D011379:Prognosis; D013997:Time Factors; D016896:Treatment Outcome
D003287:Contrast Media