Positron emission tomography-computed tomography in the diagnostic evaluation of smoldering multiple myeloma: identification of patients needing therapy.
We studied 188 patients with a suspected smoldering multiple myeloma (MM) who had undergone a positron emission tomography-computed tomography (PET-CT) scan as part of their clinical evaluation. PET-CT was positive (clinical radiologist interpretation of increased bone uptake and/or evidence of lytic bone destruction) in 74 patients and negative in 114 patients. Of these, 25 patients with a positive PET-CT and 97 patients with a negative PET-CT were observed without therapy and formed the study cohort (n=122). The probability of progression to MM within 2 years was 75% in patients with a positive PET-CT observed without therapy compared with 30% in patients with a negative PET-CT; median time to progression was 21 months versus 60 months, respectively, P=0.0008. Of 25 patients with a positive PET-CT, the probability of progression was 87% at 2 years in those with evidence of underlying osteolysis (n=16) and 61% in patients with abnormal PET-CT uptake but no evidence of osteolysis (n=9). Patients with positive PET-CT and evidence of underlying osteolysis have a high risk of progression to MM within 2 years when observed without therapy. These observations support recent changes to imaging requirements in the International Myeloma Working Group updated diagnostic criteria for MM.
Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
B
B
Siontis
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
S
S
Kumar
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
A
A
Dispenzieri
Division of Endocrinology, Mayo Clinic, Rochester, MN, USA.
M T
MT
Drake
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
M Q
MQ
Lacy
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
F
F
Buadi
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
D
D
Dingli
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
P
P
Kapoor
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
W
W
Gonsalves
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
M A
MA
Gertz
Division of Hematology, Mayo Clinic, Rochester, MN, USA.
S V
SV
Rajkumar
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000401:mortality; D049268:Positron-Emission Tomography; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed