F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma.
F18-fluorodeoxyglucose positron emission tomography (FDG-PET) is a powerful tool to investigate the role of tumor metabolic activity and its suppression by therapy for cancer survival. As part of Total Therapy 3 for newly diagnosed multiple myeloma, metastatic bone survey, magnetic resonance imaging, and FDG-PET scanning were evaluated in 239 untreated patients. All 3 imaging techniques showed correlations with prognostically relevant baseline parameters: the number of focal lesions (FLs), especially when FDG-avid by PET-computed tomography, was positively linked to high levels of beta-2-microglobulin, C-reactive protein, and lactate dehydrogenase; among gene expression profiling parameters, high-risk and proliferation-related parameters were positively and low-bone-disease molecular subtype inversely correlated with FL. The presence of more than 3 FDG-avid FLs, related to fundamental features of myeloma biology and genomics, was the leading independent parameter associated with inferior overall and event-free survival. Complete FDG suppression in FL before first transplantation conferred significantly better outcomes and was only opposed by gene expression profiling-defined high-risk status, which together accounted for approximately 50% of survival variability (R(2) test). Our results provide a rationale for testing the hypothesis that myeloma survival can be improved by altering treatment in patients in whom FDG suppression cannot be achieved after induction therapy.
Bartel
Twyla B
TB
Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
Haessler
Jeff
J
Brown
Tracy L Y
TL
Shaughnessy
John D
JD
van Rhee
Frits
F
Anaissie
Elias
E
Alpe
Terri
T
Angtuaco
Edgardo
E
Walker
Ronald
R
Epstein
Joshua
J
Crowley
John
J
Barlogie
Bart
B
D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000556:secondary / Q000628:therapy; D002097:C-Reactive Protein / Q000032:analysis; D049109:Cell Proliferation; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage*; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D009101:Multiple Myeloma / Q000097:blood / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D009362:Neoplasm Metastasis; D049268:Positron-Emission Tomography / Q000379:methods*; D011859:Radiography; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D012307:Risk Factors; D015996:Survival Rate; D001613:beta 2-Microglobulin / Q000097:blood
D019275:Radiopharmaceuticals; D001613:beta 2-Microglobulin; D019788:Fluorodeoxyglucose F18; D002097:C-Reactive Protein; D007770:L-Lactate Dehydrogenase