title: Value of 18F-fluorodeoxyglucose uptake in positron emission tomography/computed tomography in predicting survival in multiple myeloma.
abstract: OBJECTIVE
  We assessed the role of the maximum standardized uptake value (SUV(max)) of bone marrow and the extramedullary lesion with the highest SUV(max) in positron emission tomography/computed tomography (PET/CT) of newly diagnosed multiple myeloma (MM) patients in predicting overall survival (OS).
  
  
  METHODS
  A total of 61 newly diagnosed patients (55 MM and 6 plasmacytoma) were enrolled in the study [37 men and 24 women with a median age of 57 years (range 28-80 years)]. The SUV(max) of bone marrow and the extramedullary lesion in PET/CT was correlated with the levels of β(2)-microglobulin, C-reactive protein (CRP), albumin, creatinine, per cent of bone marrow plasma cells, serum free light chain (FLC) ratio, International Staging System (ISS) score and Durie-Salmon stage.
  
  
  RESULTS
  The extramedullary lesion with the highest SUV(max) showed significant correlation with bone marrow fluorodeoxyglucose (FDG) uptake (p = 0.027) and near significant correlation with ISS (p = 0.048). Bone marrow SUV(max) correlated significantly with the per cent of bone marrow plasma cell count (p = 0.024), CRP (p = 0.012) and ISS (p = 0.013). In stage III MM the mean values of SUV(max) in extramedullary lesions were significantly higher than stages I and II (6.23 ± 6.32 vs 2.85 ± 3.44, p = 0.023). The serum FLC ratio did not show any correlation with SUV(max) of lesions and bone marrow (p > 0.05). Forty-four MM patients with FDG-positive lesions in PET/CT showed inferior 5-year estimated survival (61.73%) when compared to 11 patients without FDG-positive lesions, all of whom were alive (p = 0.01). In multivariate analysis an extramedullary lesion with the highest SUV(max) was the only independent predictor of OS (p = 0.03).
  
  
  CONCLUSIONS
  PET/CT allows identification of high-risk myeloma patients, and extramedullary lesions with the highest SUV(max) independently predict inferior OS.
authors.affiliation: Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey. rhaznedar@yahoo.com
authors.forename: Rauf
authors.initials: R
authors.lastname: Haznedar
authors.forename: Sahika Z
authors.initials: SZ
authors.lastname: Akı
authors.forename: Ozgür U
authors.initials: OU
authors.lastname: Akdemir
authors.forename: Zübeyde N
authors.initials: ZN
authors.lastname: Ozkurt
authors.forename: Ozcan
authors.initials: O
authors.lastname: Ceneli
authors.forename: Münci
authors.initials: M
authors.lastname: Yağcı
authors.forename: Gulsan T
authors.initials: GT
authors.lastname: Sucak
authors.forename: Mustafa
authors.initials: M
authors.lastname: Unlü
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001692:Biological Transport; D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000378:metabolism; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism*; D049268:Positron-Emission Tomography; D011379:Prognosis; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18