18F-FDG PET/CT focal, but not osteolytic, lesions predict the progression of smoldering myeloma to active disease.
Identification of patient sub-groups with smoldering multiple myeloma (SMM) at high risk of progression to active disease (MM) is an important goal. 18F-FDG PET/CT (positron emission tomography (PET) integrated with computed tomography (PET/CT) using glucose labelled with the positron-emitting radionuclide (18)F) allows for assessing early skeletal involvement. Identification of osteolytic lesions by this technique has recently been incorporated into the updated International Myeloma Working Group criteria for MM diagnosis. However, no data are available regarding the impact of focal lesions (FLs) without underlying osteolysis on time to progression (TTP) to MM. We hence prospectively studied a cohort of 120 SMM patients with PET/CT. PET/CT was positive in 16% of patients (1 FL: 8, 2 FLs: 3, >3 FLs: 6, diffuse bone marrow involvement: 2). With a median follow-up of 2.2 years, 38% of patients progressed to MM, in a median time of 4 years, including 21% with skeletal involvement. The risk of progression of those with positive PET/CT was 3.00 (95% confidence interval 1.58-5.69, P=0.001), with a median TTP of 1.1 versus 4.5 years for PET/CT-negative patients. The probability of progression within 2 years was 58% for positive versus 33% for negative patients. In conclusion, PET/CT positivity significantly increased the risk of progression of SMM to MM. PET/CT could become a new tool to define high-risk SMM.
'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
E
E
Zamagni
Institute of Nuclear Medicine, Bologna University School of Medicine, Bologna, Italy.
C
C
Nanni
Myeloma Unit, Division of Hematology, University of Turin, Torino, Italy.
F
F
Gay
'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
A
A
Pezzi
Hematologic Clinic, Department of Clinical and Morphological Research, Udine University, Udine, Italy.
F
F
Patriarca
Institute of Nuclear Medicine, Department of Imaging, University of Turin, Torino, Italy.
M
M
Bellò
Institute of Nuclear Medicine, Bologna University School of Medicine, Bologna, Italy.
I
I
Rambaldi
'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
P
P
Tacchetti
Department of Hematology and Oncology, University of Heidelberg, Heidelberg, Germany.
J
J
Hillengass
Hematology Unit, Department of Oncology, Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy.
B
B
Gamberi
'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
L
L
Pantani
Myeloma Unit, Division of Hematology, University of Turin, Torino, Italy.
V
V
Magarotto
Institute of Nuclear Medicine, Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy.
A
A
Versari
Hematology Clinic, AOU Ospedali Riuniti di Ancona, Ancona, Italy.
M
M
Offidani
'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
B
B
Zannetti
Hematologic Clinic, Department of Clinical and Morphological Research, Udine University, Udine, Italy.
F
F
Carobolante
Institute of Nuclear Medicine, Department of Imaging, University of Turin, Torino, Italy.
M
M
Balma
Hematology Unit, IRCCS Referral Cancer Centre of Basilicata, Rionero in Vulture, Italy.
P
P
Musto
Institute of Nuclear Medicine, S. Maria della Misericordia Hospital, Udine, Italy.
M
M
Rensi
'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
K
K
Mancuso
Department of Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany.
A
A
Dimitrakopoulou-Strauss
Medical Physics Department, Santa Croce and Carlo Hospital, Cuneo, Italy.
S
S
Chauviè
'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
S
S
Rocchi
Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
N
N
Fard
'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
G
G
Marzocchi
Unit of Nuclear Medicine, IRCCS Referral Cancer Centre of Basilicata, Rionero in Vulture, Italy.
G
G
Storto
Institute of Nuclear Medicine, Bologna University School of Medicine, Bologna, Italy.
P
P
Ghedini
Myeloma Unit, Division of Hematology, University of Turin, Torino, Italy.
A
A
Palumbo
Institute of Nuclear Medicine, Bologna University School of Medicine, Bologna, Italy.
S
S
Fanti
'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
M
M
Cavo
D000368:Aged; D018450:Disease Progression; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009101:Multiple Myeloma / Q000000981:diagnostic imaging*; D010014:Osteolysis / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18