title: Combining FDG-PET/CT with laboratory data yields superior results for prediction of relapse in multiple myeloma.
abstract: OBJECTIVE
  The precise role of positron emission tomography (PET/CT) for predicting relapse/progression in multiple myeloma remains uncertain. We compared the predictive values of PET/CT, concurrent laboratory testing (labs), and their combination in prediction of 12-month progression, as determined by current International Myeloma Working Group (IMWG) criteria.
  
  
  METHODS
  PET/CT and labs (serum chemistry, β2-microglobulin, immunofixation, bone marrow biopsy, serum free light chains) were reviewed, and date of relapse/progression was determined by IMWG criteria.
  
  
  RESULTS
  The median time from therapy to PET/CT imaging was 12.0 months (1.0-110) and median time to progression (TTP) was 29.8 months (1.6-130+). Overall survival and survival-without-progression at last follow-up were 84% and 49%, respectively. Sensitivity of PET/CT for predicting relapse/progression was lower than that of labs (0.67 vs. 0.89, ns), but PET/CT was more specific (0.89 vs. 0.79, ns). When labs and PET/CT data were combined, a positive result for either test was 89% sensitive and a positive result for both tests was 100% specific for predicting 12-month progression of disease. Kaplan-Meier analysis showed significantly greater TTP for those with a negative vs. positive PET/CT (P = 0.0005), negative vs. positive labs (P < 0.0001), and both tests negative vs. both tests positive (P < 0.0001).
  
  
  CONCLUSIONS
  Combining PET/CT with laboratory data improves the accuracy of prediction of relapse/progression within 12 months compared with each test alone. Thus, integration of PET/CT into myeloma follow-up is recommended, and the impact of this approach on management should be explored.
authors.affiliation: The Division of Nuclear Medicine and The Bone Marrow Transplant Program, The Mount Sinai Medical Center, New York,NY 10029, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Elliott
authors.forename: Steven
authors.initials: S
authors.lastname: Peti
authors.forename: Keren
authors.initials: K
authors.lastname: Osman
authors.forename: Eileen
authors.initials: E
authors.lastname: Scigliano
authors.forename: David
authors.initials: D
authors.lastname: Lee
authors.forename: Luis
authors.initials: L
authors.lastname: Isola
authors.forename: Lale
authors.initials: L
authors.lastname: Kostakoglu
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D009194:Myeloma Proteins / Q000378:metabolism; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D001613:beta 2-Microglobulin / Q000097:blood
chemical_list: D009194:Myeloma Proteins; D019275:Radiopharmaceuticals; D001613:beta 2-Microglobulin; D019788:Fluorodeoxyglucose F18