title: The role of positron emission tomography with 18F-fluorodeoxyglucose integrated with computed tomography in the evaluation of patients with multiple myeloma undergoing allogeneic stem cell transplantation.
abstract: Positron emission tomography (PET) integrated with computed tomography (PET/CT) has been reported to be useful for screening myelomatous lesions at diagnosis in patients with multiple myeloma (MM) and for monitoring response to autologous stem cell transplantation (auto-SCT). The aim of the study was to evaluate the prognostic significance of PET/CT in MM patients who received allogeneic stem cell transplantation (allo-SCT). Patients who underwent upfront auto-SCT followed by allo-SCT, either as consolidation or salvage treatment, were studied with PET/CT before and/or within 6 months after allo-SCT. The number, the maximum standard uptake value (SUV), and the location (medullary or extramedullary) of focal lesions (FLs) were recorded and investigated as predictors of progression-free survival (PFS) and overall survival (OS) by univariate and multivariate analyses. Fifty-four patients had a PET/CT scan before allo-SCT. Of these, 22 patients (41%) had a negative PET/CT scan, 11 patients (20%) showed 1 to 3 FLs, and 21 patients (39%) had either a diffuse bone marrow involvement or more than 3 FLs. SUV was >4.2 in 21 patients (39%) and extramedullary disease (EMD) was present in 6 patients (11%). Multivariate analysis of prognostic factors before allo-SCT showed that persistence of EMD at transplantation was an independent predictor of poor PFS, whereas OS was negatively influenced by unrelated donor and SUV > 4.2. Fifty-nine patients had a PET/CT scan within 6 months after allo-SCT. Multivariate analysis of post-treatment variables showed that persistence of EMD and failure to obtain complete response or very good partial response after allo-SCT were strongly associated with shorter PFS and OS. Of the 46 patients with evaluable PET/CT scans both before and 6 months after allo-SCT, the 23 patients who maintained or reached a PET complete remission showed a significantly prolonged PFS and OS compared with the 23 patients with persistence of any PET positivity (2-year PFS: 51% versus 25%, P = .03; 2-year OS: 81% versus 47%, P = .001). This study indicates that PET/CT imaging before and after allo-SCT is significantly associated with the outcome, suggesting the utility of this technique for MM staging before allo-SCT and for response monitoring after the transplantation.
authors.affiliation: Hematology, DISM, University of Udine, Italy. Electronic address: patriarca.francesca@aoud.sanita.fvg.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.affiliation: Hematology, DISM, University of Udine, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Carobolante
authors.affiliation: Hematology Institute, University of Bologna, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Zamagni
authors.affiliation: Division of Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Montefusco
authors.affiliation: Department of Molecular Biotechnology and Health Science, Hematology, University of Torino, Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.affiliation: Institute of Nuclear Medicine, Azienda Ospedaliera-Universitaria, Udine, Italy.
authors.forename: Emanuaela
authors.initials: E
authors.lastname: Englaro
authors.affiliation: Institute of Nuclear Medicine, Policlinico S.Orsola Malpighi, Bologna, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Nanni
authors.affiliation: Institute of Nuclear Medicine, Azienda Ospedaliera-Universitaria, Udine, Italy.
authors.forename: Onelio
authors.initials: O
authors.lastname: Geatti
authors.affiliation: Institute of Statistics, DISM, University of Udine, Italy.
authors.forename: Miriam
authors.initials: M
authors.lastname: Isola
authors.affiliation: Hematology, DISM, University of Udine, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sperotto
authors.affiliation: Hematology, DISM, University of Udine, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Buttignol
authors.affiliation: Hematology, DISM, University of Udine, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Stocchi
authors.affiliation: Chair of Hematology, University of Milano, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Corradini
authors.affiliation: Hematology Institute, University of Bologna, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
authors.affiliation: Hematology, DISM, University of Udine, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Fanin
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D019788:Fluorodeoxyglucose F18; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D049268:Positron-Emission Tomography; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D035781:Siblings; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D061349:Unrelated Donors
chemical_list: D000970:Antineoplastic Agents; D019653:Myeloablative Agonists; D019788:Fluorodeoxyglucose F18
keywords: Allogeneic stem cell transplantation; Multiple myeloma; Positron emission tomography/computed tomography; Prognostic factors; Response monitoring