title: A magnetic resonance imaging-based prognostic scoring system to predict outcome in transplant-eligible patients with multiple myeloma.
abstract: Diffuse and focal bone marrow infiltration patterns detected by magnetic resonance imaging have been shown to be of prognostic significance in all stages of monoclonal plasma cell disorders and have, therefore, been incorporated into the definition of the disease. The aim of this retrospective analysis was to develop a rapidly evaluable prognostic scoring system, incorporating the most significant information acquired from magnetic resonance imaging. Therefore, the impact of bone marrow infiltration patterns on progression-free and overall survival in 161 transplant-eligible myeloma patients was evaluated. Compared to salt and pepper/minimal diffuse infiltration, moderate/severe diffuse infiltration had a negative prognostic impact on both progression-free survival (P<0.001) and overall survival (P=0.003). More than 25 focal lesions on whole-body magnetic resonance imaging or more than seven on axial magnetic resonance imaging were associated with an adverse prognosis (progression-free survival: P=0.001/0.003 and overall survival: P=0.04/0.02). A magnetic resonance imaging-based prognostic scoring system, combining grouped diffuse and focal infiltration patterns, was formulated and is applicable to whole-body as well as axial magnetic resonance imaging. The score identified high-risk patients with median progression-free and overall survival of 23.4 and 55.9 months, respectively (whole-body-based). Multivariate analyses demonstrated that the magnetic resonance imaging-based prognostic score stage III (high-risk) and adverse cytogenetics are independent prognostic factors for both progression-free and overall survival (whole-body-based, progression-free survival: hazard ratio=3.65, P<0.001; overall survival: hazard ratio=5.19, P=0.005). In conclusion, we suggest a magnetic resonance imaging-based prognostic scoring system which is a robust, easy to assess and interpret parameter summarizing significant magnetic resonance imaging findings in transplant-eligible patients with multiple myeloma.
authors: Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.
authors: Elias K
authors: EK
authors: Mai
authors: Division of Biostatistics, German Cancer Research Center, Heidelberg, Heidelberg, Germany.
authors: Thomas
authors: T
authors: Hielscher
authors: Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.
authors: Jost K
authors: JK
authors: Kloth
authors: Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.
authors: Maximilian
authors: M
authors: Merz
authors: Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.
authors: Sofia
authors: S
authors: Shah
authors: Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.
authors: Marc S
authors: MS
authors: Raab
authors: Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.
authors: Michaela
authors: M
authors: Hillengass
authors: Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.
authors: Barbara
authors: B
authors: Wagner
authors: Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany.
authors: Anna
authors: A
authors: Jauch
authors: Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.
authors: Dirk
authors: D
authors: Hose
authors: Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.
authors: Marc-André
authors: MA
authors: Weber
authors: Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
authors: Stefan
authors: S
authors: Delorme
authors: Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany.
authors: Hartmut
authors: H
authors: Goldschmidt
authors: Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany jens.hillengass@med.uni-heidelberg.de.
authors: Jens
authors: J
authors: Hillengass
mesh_terms: D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000378:metabolism / Q000473:pathology; D016026:Bone Marrow Transplantation / Q000401:mortality* / Q000639:trends; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome