title: Magnetic resonance imaging pattern of bone marrow involvement as a new predictive parameter of disease progression in newly diagnosed patients with multiple myeloma eligible for autologous stem cell transplantation.
abstract: We investigated the prognostic value of the magnetic resonance imaging (MRI) pattern of bone marrow involvement in patients with multiple myeloma (MM) eligible for autologous stem cell transplantation (ASCT). 126 patients with untreated MM indicated for ASCT underwent spine MRI and cytogenetic analysis at diagnosis. All patients received ASCT after induction therapy of VAD (vincristine, doxorubicin, dexamethasone; n = 55) or a thalidomide-based regimen (TCD; n = 71). Thalidomide maintenance therapy was performed in 68 patients. The MRI pattern was normal in 27, focal in 47, and diffuse/variegated in 52 patients. Patients with the diffuse/variegated pattern showed significantly higher stage (P = 0·038), higher β-2 microglobulin level (P = 0·001) and severe anaemia (P = 0·015). However, the cytogenetics were not different among the MRI patterns (P = 0·890). Progression-free survival (PFS) was lower in the diffuse/variegated pattern (P = 0·002) than other patterns, but not overall survival (OS) (P = 0·058). Thalidomide maintenance therapy was correlated only with PFS (P = 0·001). High-risk cytogenetics were associated with both poorer PFS (P < 0·001) and OS (P = 0·003). In a multivariate analysis, the diffuse/variegated MRI pattern was an independent predictor of disease progression (Hazard Ratio, 1·922; 95% confidence interval, 1·185-3·118; P = 0·008). The diffuse/variegated MRI pattern is a novel prognostic factor for disease progression in MM patients eligible for ASCT.
authors.affiliation: Department of Haematology-Oncology, Pusan National University Hospital Medical Research Institute, Busan, Korea.
authors.forename: Moo-Kon
authors.initials: MK
authors.lastname: Song
authors.forename: Joo-Seop
authors.initials: JS
authors.lastname: Chung
authors.forename: Je-Jung
authors.initials: JJ
authors.lastname: Lee
authors.forename: Chang-Ki
authors.initials: CK
authors.lastname: Min
authors.forename: Jae-Sook
authors.initials: JS
authors.lastname: Ahn
authors.forename: Sang-Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Dong-Yeop
authors.initials: DY
authors.lastname: Shin
authors.forename: Sung-Hwa
authors.initials: SH
authors.lastname: Bae
authors.forename: Junshik
authors.initials: J
authors.lastname: Hong
authors.forename: Gyeong-Won
authors.initials: GW
authors.lastname: Lee
authors.forename: In-Sook
authors.initials: IS
authors.lastname: Lee
authors.forename: Ho-Jin
authors.initials: HJ
authors.lastname: Shin
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology*; D002869:Chromosome Aberrations; D018450:Disease Progression; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D060828:Induction Chemotherapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: cytogenetics; magnetic resonance imaging; multiple myeloma