title: Assessment of Total Lesion Glycolysis by18F FDG PET/CT Significantly Improves Prognostic Value of GEP and ISS in Myeloma.
abstract: Purpose:Fluorine-18 fluorodeoxyglucose positron emission tomography with CT attenuation correction (18F-FDG PET/CT) is useful in the detection and enumeration of focal lesions and in semiquantitative characterization of metabolic activity (glycolytic phenotype) by calculation of glucose uptake. Total lesion glycolysis (TLG) and metabolic tumor volume (MTV) have the potential to improve the value of this approach and enhance the prognostic value of disease burden measures. This study aims to determine whether TLG and MTV are associated with progression-free survival (PFS) and overall survival (OS), and whether they improve risk assessments such as International Staging System (ISS) stage and GEP70 risk.Experimental Design:192 patients underwent whole body PET/CT in the Total Therapy 3A (TT3A) trial and were evaluated using three-dimensional region-of-interest analysis with TLG, MTV, and standard measurement parameters derived for all focal lesions with peak SUV above the background red marrow signal.Results:In multivariate analysis, baseline TLG > 620 g and MTV > 210 cm3remained a significant factor of poor PFS and OS after adjusting for baseline myeloma variables. Combined with the GEP70 risk score, TLG > 205 g identifies a high-risk-behaving subgroup with poor expected survival. In addition, TLG > 205 g accurately divides ISS stage II patients into two subgroups with similar outcomes to ISS stage I and ISS stage III, respectively.Conclusions:TLG and MTV have significant survival implications at baseline and offer a more precise quantitation of the glycolytic phenotype of active disease. These measures can be assessed more readily than before using FDA-approved software and should be standardized and incorporated into clinical trials moving forward.Clin Cancer Res; 23(8); 1981-7. ©2016 AACR.
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: James E
authors.initials: JE
authors.lastname: McDonald
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Marcus M
authors.initials: MM
authors.lastname: Kessler
authors.affiliation: College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Gardner
authors.affiliation: Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Amy F
authors.initials: AF
authors.lastname: Buros
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: James A
authors.initials: JA
authors.lastname: Ntambi
authors.affiliation: Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Sarah
authors.initials: S
authors.lastname: Waheed
authors.affiliation: Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Frits
authors.initials: F
authors.lastname: van Rhee
authors.affiliation: Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zangari
authors.affiliation: Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Heuck
authors.affiliation: Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Nathan
authors.initials: N
authors.lastname: Petty
authors.affiliation: Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Carolina
authors.initials: C
authors.lastname: Schinke
authors.affiliation: Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Sharmilan
authors.initials: S
authors.lastname: Thanendrarajan
authors.affiliation: Cancer Research and Biostatistics, Seattle, Washington.
authors.forename: Alan
authors.initials: A
authors.lastname: Mitchell
authors.affiliation: Cancer Research and Biostatistics, Seattle, Washington.
authors.forename: Antje
authors.initials: A
authors.lastname: Hoering
authors.affiliation: Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Bart
authors.initials: B
authors.lastname: Barlogie
authors.affiliation: Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Morgan
authors.affiliation: Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas. fedavies@uams.edu.
authors.forename: Faith E
authors.initials: FE
authors.lastname: Davies
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D019788:Fluorodeoxyglucose F18; D006019:Glycolysis; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18