title: PET/CT Improves the Definition of Complete Response and Allows to Detect Otherwise Unidentifiable Skeletal Progression in Multiple Myeloma.
abstract: OBJECTIVE
  To evaluate the role of 18F-FDG PET/CT in 282 symptomatic multiple myeloma patients treated up-front between 2002 and 2012.
  
  
  METHODS
  All patients were studied by PET/CT at baseline, during posttreatment follow-up, and at the time of relapse. Their median duration of follow-up was 67 months.
  
  
  RESULTS
  Forty-two percent of the patients at diagnosis had >3 focal lesions, and in 50% SUVmax was >4.2; extramedullary disease was present in 5%. On multivariate analysis, ISS stage 3, SUVmax >4.2, and failure to achieve best complete response (CR) were the leading factors independently associated with shorter progression-free survival (PFS) and overall survival (OS). These 3 variables were used to construct a prognostic scoring system based on the number of risk factors. After treatment, PET/CT negativity (PET-neg) was observed in 70% of patients, whereas conventionally defined CR was achieved in 53%. Attainment of PET-neg favorably influenced PFS and OS. PET-neg was an independent predictor of prolonged PFS and OS for patients with conventionally defined CR. Sixty-three percent of patients experienced relapse or progression; in 12%, skeletal progression was exclusively detected by systematic PET/CT performed during follow-up. A multivariate analysis revealed that persistence of SUVmax >4.2 following first-line treatment was independently associated with exclusive PET/CT progression.
  
  
  CONCLUSIONS
  PET/CT combined with ISS stage and achievement or not of CR on first-line therapy sorted patients into different prognostic groups. PET/CT led to a more careful evaluation of CR. Finally, in patients with persistent high glucose metabolism after first-line treatment, PET/CT can be recommended during follow-up, to screen for otherwise unidentifiable progression.
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy. e.zamagni@unibo.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Zamagni
authors.affiliation: Institute of Nuclear Medicine, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Nanni
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Mancuso
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Tacchetti
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Pezzi
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Pantani
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Zannetti
authors.affiliation: Institute of Nuclear Medicine, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Rambaldi
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Brioli
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Rocchi
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Terragna
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Martello
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Marzocchi
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Borsi
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Rizzello
authors.affiliation: Institute of Nuclear Medicine, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
authors.affiliation: "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Cavo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18