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Rajkumar SV. Multiple myeloma: 2024 update on diagnosis, risk-stratification, and management. Am J Hematol 2024; 99:1802-1824. [PMID: 38943315 PMCID: PMC11404783 DOI: 10.1002/ajh.27422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 06/11/2024] [Indexed: 07/01/2024]
Abstract
DISEASE OVERVIEW Multiple myeloma accounts for approximately 10% of hematologic malignancies. DIAGNOSIS The diagnosis requires ≥10% clonal bone marrow plasma cells or a biopsy proven plasmacytoma plus evidence of one or more multiple myeloma defining events (MDE): CRAB (hypercalcemia, renal failure, anemia, or lytic bone lesions) attributable to the plasma cell disorder, bone marrow clonal plasmacytosis ≥60%, serum involved/uninvolved free light chain (FLC) ratio ≥100 (provided involved FLC is ≥100 mg/L and urine monoclonal protein is ≥200 mg/24 h), or >1 focal lesion on magnetic resonance imaging. RISK STRATIFICATION The presence of del(17p), t(4;14), t(14;16), t(14;20), gain 1q, del 1p, or p53 mutation is considered high-risk multiple myeloma. Presence of any two high risk factors is considered double-hit myeloma; three or more high risk factors is triple-hit myeloma. RISK-ADAPTED INITIAL THERAPY In patients who are candidates for autologous stem cell transplantation, induction therapy consists of anti-CD38 monoclonal antibody plus bortezomib, lenalidomide, dexamethasone (VRd) followed by autologous stem cell transplantation (ASCT). Selected standard risk patients can delay transplant until first relapse. Frail patients who not candidates for transplant are treated with VRd for approximately 8-12 cycles followed by maintenance or alternatively with daratumumab, lenalidomide, dexamethasone (DRd) until progression. MAINTENANCE THERAPY Standard risk patients need lenalidomide maintenance, while bortezomib plus lenalidomide maintenance is needed for high-risk myeloma. MANAGEMENT OF RELAPSED DISEASE A triplet regimen is usually needed at relapse, with the choice of regimen varying with each successive relapse. Chimeric antigen receptor T (CAR-T) cell therapy and bispecific antibodies are additional options.
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Nanni C, Deroose CM, Balogova S, Lapa C, Withofs N, Subesinghe M, Jamet B, Zamagni E, Ippolito D, Delforge M, Kraeber-Bodéré F. EANM guidelines on the use of [ 18F]FDG PET/CT in diagnosis, staging, prognostication, therapy assessment, and restaging of plasma cell disorders. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06858-9. [PMID: 39207486 DOI: 10.1007/s00259-024-06858-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/21/2024] [Indexed: 09/04/2024]
Abstract
We provide updated guidance and standards for the indication, acquisition, and interpretation of [18F]FDG PET/CT for plasma cell disorders. Procedures and characteristics are reported and different scenarios for the clinical use of [18F]FDG PET/CT are discussed. This document provides clinicians and technicians with the best available evidence to support the implementation of [18F]FDG PET/CT imaging in routine practice and future research.
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Affiliation(s)
- Cristina Nanni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Christophe M Deroose
- Nuclear Medicine, University Hospitals (UZ) Leuven, 3000, Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Sona Balogova
- Nuclear Medicine, Comenius University, Bratislava, Slovakia
- Médecine Nucléaire, Hôpital Tenon, GH AP.SU, Paris, France
| | - Constantin Lapa
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Nadia Withofs
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liege, Liege, Belgium
- GIGA-CRC in Vivo Imaging, University of Liege, Liege, Belgium
| | - Manil Subesinghe
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Bastien Jamet
- Médecine Nucléaire, CHU Nantes, F-44000, Nantes, France
| | - Elena Zamagni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Bologna, Italy.
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.
| | - Davide Ippolito
- Department of Diagnostic Radiology, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, Italy
- University of Milano-Bicocca, School of Medicine, Via Cadore 33, 20090, Monza, Italy
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Liu Y, Huang W, Yang Y, Cai W, Sun Z. Recent advances in imaging and artificial intelligence (AI) for quantitative assessment of multiple myeloma. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2024; 14:208-229. [PMID: 39309415 PMCID: PMC11411189 DOI: 10.62347/nllv9295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/18/2024] [Indexed: 09/25/2024]
Abstract
Multiple myeloma (MM) is a malignant blood disease, but there have been significant improvements in the prognosis due to advancements in quantitative assessment and targeted therapy in recent years. The quantitative assessment of MM bone marrow infiltration and prognosis prediction is influenced by imaging and artificial intelligence (AI) quantitative parameters. At present, the primary imaging methods include computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). These methods are now crucial for diagnosing MM and evaluating myeloma cell infiltration, extramedullary disease, treatment effectiveness, and prognosis. Furthermore, the utilization of AI, specifically incorporating machine learning and radiomics, shows great potential in the field of diagnosing MM and distinguishing between MM and lytic metastases. This review discusses the advancements in imaging methods, including CT, MRI, and PET/CT, as well as AI for quantitatively assessing MM. We have summarized the key concepts, advantages, limitations, and diagnostic performance of each technology. Finally, we discussed the challenges related to clinical implementation and presented our views on advancing this field, with the aim of providing guidance for future research.
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Affiliation(s)
- Yongshun Liu
- Department of Nuclear Medicine, Peking University First HospitalBeijing 100034, China
| | - Wenpeng Huang
- Department of Nuclear Medicine, Peking University First HospitalBeijing 100034, China
| | - Yihan Yang
- Department of Nuclear Medicine, Peking University First HospitalBeijing 100034, China
| | - Weibo Cai
- Department of Radiology and Medical Physics, University of Wisconsin-MadisonMadison, WI 53705, USA
| | - Zhaonan Sun
- Department of Medical Imaging, Peking University First HospitalBeijing 100034, China
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Gantana EJ, Musekwa E, Chapanduka ZC. Advances in estimating plasma cells in bone marrow: A comprehensive method review. Afr J Lab Med 2024; 13:2381. [PMID: 39114749 PMCID: PMC11304106 DOI: 10.4102/ajlm.v13i1.2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/25/2024] [Indexed: 08/10/2024] Open
Abstract
The quantitation of plasma cells in bone marrow (BM) is crucial for diagnosing and classifying plasma cell neoplasms. Various methods, including Romanowsky-stained BM aspirates (BMA), immunohistochemistry, flow cytometry, and radiological imaging, have been explored. However, challenges such as patchy infiltration and sample haemodilution can impact the reliability of BM plasma cell percentage estimates. Bone marrow plasma cell percentage varies across methods, with immunohistochemically stained biopsies consistently yielding higher values than Romanowsky-stained BMA or flow cytometry alone. CD138 or MUM1 immunohistochemistry and artificial intelligence image analysis on whole-slide images are emerging as promising tools for accurate plasma cell identification and quantification. Radiological imaging, particularly with advanced technologies like dual-energy computed tomography and radiomics, shows potential for multiple myeloma diagnosis, although standardisation remains a challenge. Molecular techniques, such as allele-specific oligonucleotide quantitative polymerase chain reaction and next-generation sequencing, offer insights into clonality and measurable residual disease. While no consensus exists on a gold standard method for BM plasma cell quantitation, CD138-stained biopsies are favoured for accurate estimation and play a pivotal role in diagnosing and assessing multiple myeloma treatment responses. Combining multiple methods, such as BMA, BM biopsy, and flow cytometry, enhances accuracy of diagnosis and classification of plasma cell neoplasms. The quest for a gold standard requires ongoing research and collaboration to refine existing methods. Furthermore, the rise of digital pathology is anticipated to reshape laboratory medicine and the role of pathologists in the digital era. What this study adds This article adds a comprehensive review and comparison of different methods for plasma cell estimation in the bone marrow, highlighting their strengths and limitations. The goal is to contribute valuable insights that can guide the selection of optimal techniques for accurate plasma cell estimation.
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Affiliation(s)
- Ethan J Gantana
- Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Haematology, National Health Laboratory Service, Cape Town, South Africa
| | - Ernest Musekwa
- Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Haematology, National Health Laboratory Service, Cape Town, South Africa
| | - Zivanai C Chapanduka
- Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Haematology, National Health Laboratory Service, Cape Town, South Africa
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An S, Huang G, Yu X, Liu J, Chen Y. The added diagnostic value of 18 F-FDG PET/CT radiomic analysis in multiple myeloma patients with negative visual analysis. Nucl Med Commun 2024; 45:244-252. [PMID: 38165165 DOI: 10.1097/mnm.0000000000001809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
PURPOSE A small number of patients diagnosed with multiple myeloma (MM) by bone marrow aspiration reported as being disease-free on 18 F-FDG PET/CT. We aim to evaluate the diagnostic value of radiomics approach in patients with MM who were negative by visual analysis. MATERIALS AND METHODS Thirty-three patients judged negative by visual analysis were assigned to the MM group. Contemporaneous 31 disease-free patients served as the control group. 70% of the whole data set was used as training set (23 from MM group and 22 from control group) and 30% as testing set (10 from MM group and 9 from control group). Axial skeleton volumes were automatically segmented and high-dimensional imaging features were extracted from PET and CT. The unsupervised machine learning method was used to filter and reduce the dimensions of the extracted features. Random forest was used to construct the prediction model and then validated with 10-fold cross-validation and evaluated on the independent testing set. RESULTS One thousand seven hundred two quantitative features were extracted from PET and CT. Of those, three first-order and one high-order imaging features were uncorrelated. With the cross-validation on the training group, the sensitivity, specificity, accuracy and area under the curve of random forest were 0.850, 0.792, 0.818 and 0.894, respectively. On the independent testing set, the accuracy of the model was 0.850 and the area under the curve was 0.909. CONCLUSION Radiomic analysis based on 18 F-FDG PET/CT using machine learning model provides a quantitative, objective and efficient mechanism for diagnosing patients with MM who were negative by visual analysis.
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Affiliation(s)
- Shuxian An
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Mohyuddin GR, Chakraborty R, Cliff ERS, Derman BA. Clinician preferences on treatment of smoldering myeloma: a cross-sectional survey. EClinicalMedicine 2023; 65:102272. [PMID: 38046471 PMCID: PMC10689285 DOI: 10.1016/j.eclinm.2023.102272] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 12/05/2023] Open
Abstract
Background Smoldering myeloma (SMM) is an asymptomatic precursor condition to multiple myeloma (MM) with a variable risk of progression. The management of high-risk SMM (HR-SMM) remains controversial, particularly with changes in diagnostic criteria that led to reclassifying of some patients with SMM to MM. This study aimed to assess clinician preferences for whether to treat patients with HR-SMM and/or patients with MM diagnosed solely by SLiM criteria (free light chain ratio >100, bone marrow plasma cell percentage >60, greater than two focal marrow lesions on MRI) through an electronic survey. Methods This was a cross-sectional survey of clinicians, conducted via an anonymous online REDCap survey from May 16th to July 5th, 2023. The survey included questions on demographics, SMM surveillance practices, and management preferences for two clinical scenarios (HR-SMM and MM based solely on the free light chain ratio >100 criterion). Data was analysed descriptively via Microsoft Excel. Findings A total of 146 clinicians completed the full survey, with 92% recommending against routine treatment for a patient with HR-SMM based on a single time point assessment, instead preferring active surveillance. For patients with MM diagnosed solely on the basis of a free light chain ratio >100, 61% recommended active treatment, while 37% recommended active surveillance. The most common reasons recommending against treatment of HR-SMM were toxicity, lack of demonstrated overall survival benefit, and low MM-defining event rates in clinical trials. Interpretation The survey indicates that most clinicians recommend against routine treatment for HR-SMM. Active surveillance is the prevailing standard of care and it is therefore an appropriate control arm in future SMM trials. More randomised trials are needed to determine if early treatment of modern-era SMM offers a net benefit to patients. Funding None.
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Affiliation(s)
| | - Rajshekhar Chakraborty
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, USA
| | - Edward R. Scheffer Cliff
- Program on Regulation, Therapeutics and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, USA
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Chakraborty R, Hillengass J, Lentzsch S. How do we image patients with multiple myeloma and precursor states? Br J Haematol 2023; 203:536-545. [PMID: 37217164 DOI: 10.1111/bjh.18880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/24/2023]
Abstract
Advances in morphological and functional imaging have led to superior detection of early bone disease, bone marrow infiltration, paramedullary and extramedullary involvement in multiple myeloma. The two functional imaging modalities that are most widely used and standardized are 18F-fluorodeoxyglucose-Positron emission tomography/computed tomography (FDG PET/CT) and whole-body magnetic resonance imaging with diffusion-weighted imaging (WB DW-MRI). Both prospective and retrospective studies have demonstrated that WB DW-MRI is more sensitive than PET/CT in the detection of baseline tumour burden and to assess response after therapy. In patients with smouldering multiple myeloma, WB DW-MRI is now the preferred imaging modality to rule out two or more unequivocal lesions which would be considered a myeloma-defining event by the updated international myeloma working group (IMWG) criteria. In addition to sensitive detection of baseline tumour burden, both PET/CT and WB DW-MRI have been successfully used for monitoring response to therapy and provide information that is complementary to IMWG response assessment and bone marrow minimal residual disease. In this article, we present 3 vignettes illustrating how we approach the use of modern imaging in the management of patients with multiple myeloma and precursor states, with a specific focus on recent data that have emerged since the publication of the IMWG consensus guideline on imaging. We have utilized data from prospective and retrospective studies to provide a rationale for our approach to imaging in these clinical scenarios and highlighted knowledge gaps requiring future investigation.
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Affiliation(s)
| | - Jens Hillengass
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Suzanne Lentzsch
- Columbia University Irving Medical Center, New York, New York, USA
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Hildenbrand N, Klein A, Maier-Hein K, Wennmann M, Delorme S, Goldschmidt H, Hillengass J. Identification of focal lesion characteristics in MRI which indicate presence of corresponding osteolytic lesion in CT in patients with multiple myeloma. Bone 2023; 175:116857. [PMID: 37487861 DOI: 10.1016/j.bone.2023.116857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE The presence of bone marrow focal lesions and osteolytic lesions in patients with multiple myeloma (MM) is of high prognostic significance for their individual outcome. It is not known yet why some focal lesions seen in MRI, reflecting localized bone marrow infiltration of myeloma cells, remain non-lytic, whereas others are associated with destruction of mineralized bone. In this study, we analyzed MRI characteristics of manually segmented focal lesions in MM patients to identify possible features that might discriminate lytic and non-lytic lesions. METHOD The initial cohort included a total of 140 patients with different stages of MM who had undergone both whole-body MRI and whole-body low-dose CT within 30 days, and of which 29 satisfied the inclusion criteria for this study. Focal lesions in MRI and corresponding osteolytic areas in CT were segmented manually. Analysis of the lesions included volume, location and first order texture features analysis. RESULTS There were significantly more lytic lesions in the axial skeleton than in the appendicular skeleton (p = 0.037). Out of 926 focal lesions in the axial skeleton seen on MRI, 544 (59.3 %) were osteolytic. Analysis of volume and first order texture features showed differences in texture and volume between focal lesions in MRI with and without local bone destruction in CT, but these findings were not statistically significant. CONCLUSIONS Neither morphological imaging characteristics like size and location nor first order texture features could predict whether focal lesions seen in MRI would exhibit corresponding bone destruction in CT. Studies performing biopsies of such lesions are ongoing.
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Affiliation(s)
- Nina Hildenbrand
- Department of Orthopedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
| | - André Klein
- Information Technology, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA.
| | - Klaus Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg, Germany; Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Markus Wennmann
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg, Germany.
| | - Stefan Delorme
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg, Germany.
| | - Hartmut Goldschmidt
- Internal Medicine V and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.
| | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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Kim DK, Jung JY, Kim H, Lee S, Lee SY, Lee S, Park SS, Min CK. Development of a Semiquantitative Whole-Body MRI Scoring System for Multiple Myeloma. Radiology 2023; 308:e230667. [PMID: 37668524 DOI: 10.1148/radiol.230667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Background In patients with multiple myeloma (MM), the serum marker β2-microglobulin does not always accurately reflect tumor load. In contrast, whole-body (WB) MRI has shown high sensitivity for detecting bone lesions. Purpose To develop and validate a semiquantitative WB MRI scoring system for newly diagnosed MM and to compare it with the International Staging System (ISS) and Revised ISS (R-ISS). Materials and Methods This study included two retrospective groups (group 1, July 2015 to September 2021; group 2, February 2020 to September 2021) and one prospective group (group 3, October 2021 to February 2022) of patients with newly diagnosed MM. A new scoring system for MM was developed using spine MRI scans in group 1 and WB MRI scans in group 2 that integrated three features: (a) background marrow pattern, (b) number of focal bone lesions, and (c) presence of extramedullary or paramedullary lesions. The summed total score ranged from zero to nine. The interobserver agreement for each feature was assessed using Fleiss or Cohen weighted κ. WB MRI total scores in group 3 were compared across ISS and R-ISS stages using two-way analysis of variance. Results Groups 1, 2, and 3 included 103 patients (mean age, 62.1 years ± 9.1 [SD]; 60 men), 36 patients (mean age 65.4 years ± 11.3 [SD]; 19 women), and 39 participants (mean age, 62.0 years ± 11.7 [SD]; 20 men), respectively. The interobserver agreements for the three features composing the scoring system were substantial (κ range, 0.69-0.80). WB MRI total score increased with increasing ISS stage (mean score for ISS 1, 2, and 3 was 2.2, 4.2, and 5.8, respectively; P = .009) and R-ISS stage (mean score for R-ISS 1, 2, and 3 was 2.1, 3.8, and 5.9, respectively; P = .005). Conclusion The developed WB MRI scoring system for MM demonstrated substantial observer agreement and corresponded well with ISS and R-ISS stages. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Dragan and Messiou in this issue.
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Affiliation(s)
- Dong Kyun Kim
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Joon-Yong Jung
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Hyeonseon Kim
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Sungwon Lee
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - So-Yeon Lee
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Seungeun Lee
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Sung-Soo Park
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Chang-Ki Min
- From the Departments of Radiology (D.K.K., J.Y.J., H.K., Sungwon Lee, S.Y.L., Seungeun Lee) and Hematology (S.S.P., C.K.M.), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
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Medina-Herrera A, Sarasquete ME, Jiménez C, Puig N, García-Sanz R. Minimal Residual Disease in Multiple Myeloma: Past, Present, and Future. Cancers (Basel) 2023; 15:3687. [PMID: 37509348 PMCID: PMC10377959 DOI: 10.3390/cancers15143687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Responses to treatment have improved over the last decades for patients with multiple myeloma. This is a consequence of the introduction of new drugs that have been successfully combined in different clinical contexts: newly diagnosed, transplant-eligible or ineligible patients, as well as in the relapsed/refractory setting. However, a great proportion of patients continue to relapse, even those achieving complete response, which underlines the need for updated response criteria. In 2014, the international myeloma working group established new levels of response, prompting the evaluation of minimal residual disease (MRD) for those patients already in complete or stringent complete response as defined by conventional serological assessments: the absence of tumor plasma cells in 100,000 total cells or more define molecular and immunophenotypic responses by next-generation sequencing and flow cytometry, respectively. In this review, we describe all the potential methods that may be used for MRD detection based on the evidence found in the literature, paying special attention to their advantages and pitfalls from a critical perspective.
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Affiliation(s)
- Alejandro Medina-Herrera
- Departament of Hematology, University Hospital of Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - María Eugenia Sarasquete
- Departament of Hematology, University Hospital of Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - Cristina Jiménez
- Departament of Hematology, University Hospital of Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - Noemí Puig
- Departament of Hematology, University Hospital of Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
| | - Ramón García-Sanz
- Departament of Hematology, University Hospital of Salamanca (HUSA/IBSAL), CIBERONC, CIC-IBMCC (USAL-CSIC), 37007 Salamanca, Spain
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Gundesen MT, Asmussen JT, Schjesvold F, Vangsted AJ, Helleberg C, Haukås E, Silkjær T, Teodorescu EM, Jensen BA, Slørdahl TS, Nahi H, Waage A, Abildgaard N, Lund T. Potential value of pre-planned imaging of bone disease in multiple myeloma. Blood Cancer J 2023; 13:105. [PMID: 37419876 PMCID: PMC10328913 DOI: 10.1038/s41408-023-00880-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/09/2023] Open
Affiliation(s)
- Michael T Gundesen
- Department of Hematology, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Jon Thor Asmussen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Department of Hematology, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Centre for B-Cell Malignancies, University of Oslo, Oslo, Norway
| | | | | | - Einar Haukås
- Department of Blood and cancer diseases, Stavanger University Hospital, Stavanger, Norway
| | - Trine Silkjær
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bo Amdi Jensen
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Tobias S Slørdahl
- Department of Hematology, St. Olavs Hospital - Trondheim University Hospital, and Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Anders Waage
- Department of Hematology, St. Olavs Hospital - Trondheim University Hospital, and Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Niels Abildgaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Lund
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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12
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Zhong H, Huang D, Wu J, Chen X, Chen Y, Huang C. 18F‑FDG PET/CT based radiomics features improve prediction of prognosis: multiple machine learning algorithms and multimodality applications for multiple myeloma. BMC Med Imaging 2023; 23:87. [PMID: 37370013 DOI: 10.1186/s12880-023-01033-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE Multiple myeloma (MM), the second most hematological malignancy, have been studied extensively in the prognosis of the clinical parameters, however there are only a few studies have discussed the role of dual modalities and multiple algorithms of 18F-FDG (18F-fluorodeoxyglucose) PET/CT based radiomics signatures for prognosis in MM patients. We hope to deeply mine the utility of raiomics data in the prognosis of MM. METHODS We extensively explored the predictive ability and clinical decision-making ability of different combination image data of PET, CT, clinical parameters and six machine learning algorithms, Cox proportional hazards model (Cox), linear gradient boosting models based on Cox's partial likelihood (GB-Cox), Cox model by likelihood based boosting (CoxBoost), generalized boosted regression modelling (GBM), random forests for survival model (RFS) and support vector regression for censored data model (SVCR). And the model evaluation methods include Harrell concordance index, time dependent receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). RESULTS We finally confirmed 5 PET based features, and 4 CT based features, as well as 6 clinical derived features significantly related to progression free survival (PFS) and we included them in the model construction. In various modalities combinations, RSF and GBM algorithms significantly improved the accuracy and clinical net benefit of predicting prognosis compared with other algorithms. For all combinations of various modalities based models, single-modality PET based prognostic models' performance was outperformed baseline clinical parameters based models, while the performance of models of PET and CT combined with clinical parameters was significantly improved in various algorithms. CONCLUSION 18F‑FDG PET/CT based radiomics models implemented with machine learning algorithms can significantly improve the clinical prediction of progress and increased clinical benefits providing prospects for clinical prognostic stratification for precision treatment as well as new research areas.
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Affiliation(s)
- Haoshu Zhong
- Department of Hematology, the Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China
- Stem Cell Laboratory, The Clinical Research Institute, Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China
| | - Delong Huang
- Southwest Medical University, Luzhou City, Sichuan, China
| | - Junhao Wu
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xiaomin Chen
- Department of Hematology, the Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China
- Stem Cell Laboratory, The Clinical Research Institute, Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China
| | - Yue Chen
- Department of Nuclear Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China
| | - Chunlan Huang
- Department of Hematology, the Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China.
- Stem Cell Laboratory, The Clinical Research Institute, Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan, China.
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13
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Milara E, Alonso R, Masseing L, Seiffert AP, Gómez-Grande A, Gómez EJ, Martínez-López J, Sánchez-González P. Radiomics analysis of bone marrow biopsy locations in [ 18F]FDG PET/CT images for measurable residual disease assessment in multiple myeloma. Phys Eng Sci Med 2023; 46:903-913. [PMID: 37155114 DOI: 10.1007/s13246-023-01265-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
The combination of visual assessment of whole body [18F]FDG PET images and evaluation of bone marrow samples by Multiparameter Flow Cytometry (MFC) or Next-Generation Sequencing (NGS) is currently the most common clinical practice for the detection of Measurable Residual Disease (MRD) in Multiple Myeloma (MM) patients. In this study, radiomic features extracted from the bone marrow biopsy locations are analyzed and compared to those extracted from the whole bone marrow in order to study the representativeness of these biopsy locations in the image-based MRD assessment. Whole body [18F]FDG PET of 39 patients with newly diagnosed MM were included in the database, and visually evaluated by experts in nuclear medicine. A methodology for the segmentation of biopsy sites from PET images, including sternum and posterior iliac crest, and their subsequent quantification is proposed. First, starting from the bone marrow segmentation, a segmentation of the biopsy sites is performed. Then, segmentations are quantified extracting SUV metrics and radiomic features from the [18F]FDG PET images and are evaluated by Mann-Whitney U-tests as valuable features differentiating PET+/PET- and MFC+ /MFC- groups. Moreover, correlation between whole bone marrow and biopsy sites is studied by Spearman ρ rank. Classification performance of the radiomics features is evaluated applying seven machine learning algorithms. Statistical analyses reveal that some images features are significant in PET+/PET- differentiation, such as SUVmax, Gray Level Non-Uniformity or Entropy, especially with a balanced database where 16 of the features show a p value < 0.001. Correlation analyses between whole bone marrow and biopsy sites results in significant and acceptable coefficients, with 11 of the variables reaching a correlation coefficient greater than 0.7, with a maximum of 0.853. Machine learning algorithms demonstrate high performances in PET+/PET- classification reaching a maximum AUC of 0.974, but not for MFC+/MFC- classification. The results demonstrate the representativeness of sample sites as well as the effectiveness of extracted features (SUV metrics and radiomic features) from the [18F]FDG PET images in MRD assessment in MM patients.
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Affiliation(s)
- Eva Milara
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040, Madrid, Spain
| | - Rafael Alonso
- Department of Hematology and Instituto de Investigación Sanitaria (imas12), Hospital Universitario, 12 de Octubre, 28041, Madrid, Spain
- Clinical Research Hematology Unit, Centro Nacional de Investigaciones Oncológicas (CNIO), 28029, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Lena Masseing
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040, Madrid, Spain
| | - Alexander P Seiffert
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040, Madrid, Spain
| | - Adolfo Gómez-Grande
- Facultad de Medicina, Universidad Complutense de Madrid, 28040, Madrid, Spain
- Department of Nuclear Medicine, Hospital Universitario, 12 de Octubre, 28041, Madrid, Spain
| | - Enrique J Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040, Madrid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Joaquín Martínez-López
- Department of Hematology and Instituto de Investigación Sanitaria (imas12), Hospital Universitario, 12 de Octubre, 28041, Madrid, Spain
- Clinical Research Hematology Unit, Centro Nacional de Investigaciones Oncológicas (CNIO), 28029, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, 28029, Madrid, Spain.
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14
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Osterhoff G, Kreinest M, Kuhnt T, Pohlenz C, Müller-Broich J, Röllig C, Teipel R, Scheyerer MJ, Schnake KJ, Spiegl UJA, Disch AC. Management of Pathological Thoracolumbar Vertebral Fractures in Patients With Multiple Myeloma: Multidisciplinary Recommendations. Global Spine J 2023; 13:85S-93S. [PMID: 37084345 PMCID: PMC10177308 DOI: 10.1177/21925682221143732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
STUDY DESIGN Mutlidisciplinary consensus recommendations for patients suffering from multiple myeloma (MM) involvement of the spinal column by the Spine Section of the German Association of Orthopaedic and Trauma Surgeons. OBJECTIVE To provide a comprehensive multidisciplinary diagnostic and therapeutic approach and to summarize the current literature on the management of pathological thoracolumbar vertebral fractures in patients with multiple myeloma. METHODS Multidisciplinary recommendations using a classical consensus process provided by radiation oncologists, medical oncologists, orthopaedic- and trauma surgeons. A narrative literature review of the current diagnostic and treatment strategies was conducted. RESULTS Treatment decision has to be driven by a multidisciplinary team of oncologists, radiotherapists and spine surgeons. When considering surgery in MM patients, differing factors compared to other secondary spinal lesions have to be included into the decision process: probable neurological deterioration, the stage of the disease and prognosis, patient's general condition, localization and number of the lesions as well as patient's own wishes or expectations. Aiming to improve quality of life, the major goal of surgical treatment is to preserve mobility by reducing pain, secure neurological function and stability. CONCLUSION The goal of surgery is primarily to improve quality of life by restoring stability and neurological function. Interventions with an increased risk of complications due to MM-associated immunodeficiency must be avoided whenever feasible to allow early systemic treatment. Hence, treatment decisions should be based on a multidisciplinary team that considers patient's constitution and prognosis.
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Affiliation(s)
- Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | | | - Thomas Kuhnt
- Department of Imaging and Radiation Medicine, Clinic of Radiooncology, University of Leipzig, Leipzig, Germany
| | - Claudia Pohlenz
- Department of Imaging and Radiation Medicine, Clinic of Radiooncology, University of Leipzig, Leipzig, Germany
| | | | - Christoph Röllig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Raphael Teipel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Max J Scheyerer
- Department of Orthopaedics and Trauma Surgery, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Klaus John Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Ulrich J A Spiegl
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Alexander C Disch
- University Comprehensive Spine Center, University Center for Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany
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15
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Hõim SE, Fitzgerald E, Mapletoft E, Purzycka K. Computed tomographic findings in dogs with multiple myeloma. Vet Med Sci 2023; 9:660-669. [PMID: 36625231 PMCID: PMC10029888 DOI: 10.1002/vms3.1019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Computed tomography (CT) is considered the first-line imaging modality for human patients with suspected multiple myeloma (MM). Recently the diagnostic criteria for human MM have been updated. OBJECTIVES To describe and provide a baseline of the CT features and distribution of osseous lesions in dogs diagnosed with MM and to describe the change of initial osseous lesions after the start of treatment in a subset of dogs. METHODS Single-centre, retrospective, descriptive, case series. Dogs were included when they met the updated MM criteria and if a staging CT was performed at the time of diagnosis and prior to initiation of treatment. When available, change of osseous lesions was assessed on serial imaging studies. RESULTS Thirteen dogs met the inclusion criteria. All dogs had involvement of the axial skeleton and 9/13 (69%) had concurrent involvement of the appendicular skeleton. Large (≥1 cm), lytic, 'punched out' or expansile bony lesions and regions of permeative lysis were most common and mainly affected the vertebral column. Discrete intramedullary soft tissue attenuating lesions of the proximal appendicular skeleton were observed in 8/13 dogs (61%) and bilateral involvement of both humeri and femurs was seen in 4/9 dogs (44%). A subset of dogs underwent serial imaging and progressive replacement of the contrast-enhancing lesions with fat attenuating tissue was observed for all dogs, corresponding with clinical improvement. CONCLUSIONS This case series provides a baseline knowledge of the initial and follow-up CT features in dogs diagnosed with MM based on updated criteria.
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Affiliation(s)
- Sven-Erik Hõim
- Diagnostic Imaging Department, Anderson Moores Veterinary Specialists Part of Linnaeus Veterinary Limited, The Granary, Bunstead Barns, Poles Ln, Winchester, UK
| | | | - Emma Mapletoft
- Diagnostic Imaging Department, Queen Mother Hospital for Animals, Royal Veterinary College, North Mymms, Hertfordshire, UK
| | - Katarzyna Purzycka
- Oncology Department, Lumbry Park Veterinary Specialists, Alton, Hampshire, UK
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16
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Vicentini JRT, Bredella MA. Whole body imaging in musculoskeletal oncology: when, why, and how. Skeletal Radiol 2023; 52:281-295. [PMID: 35809098 DOI: 10.1007/s00256-022-04112-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/03/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023]
Abstract
The use of whole-body imaging has become increasingly popular in oncology due to the possibility of evaluating total tumor burden with a single imaging study. This is particularly helpful in cases of widespread disease where dedicated regional imaging would make the evaluation more expensive, time consuming, and prone to more risks. Different techniques can be used, including whole-body MRI, whole-body CT, and PET-CT. Common indications include surveillance of cancer predisposing syndromes, evaluation of osseous metastases and clonal plasma cell disorders such as multiple myeloma, and evaluation of soft tissue lesions, including peripheral nerve sheath tumors. This review focuses on advanced whole-body imaging techniques and their main uses in musculoskeletal oncology.
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Affiliation(s)
- Joao R T Vicentini
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, YAW 6, Boston, MA, 02114, USA.
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, YAW 6, Boston, MA, 02114, USA
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17
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Son AY, Chung HW. [Imaging for Multiple Myeloma according to the Recent International Myeloma Working Group Guidelines: Analysis of Image Acquisition Techniques and Response Evaluation in Whole-Body MRI according to MY-RADS]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:150-169. [PMID: 36818702 PMCID: PMC9935955 DOI: 10.3348/jksr.2021.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/16/2022] [Accepted: 02/12/2022] [Indexed: 11/15/2022]
Abstract
Multiple myeloma (MM) is a malignant hematologic disease caused by the proliferation of clonal plasma cells in the bone marrow, and its incidence is increasing in Korea. With the development of treatments for MM, the need for early diagnosis and treatment has emerged. In recent years, the International Myeloma Working Group (IMWG) has been constantly revising the laboratory and radiological diagnostic criteria for MM. In addition, as whole-body MRI (WBMR) has been increasing used in the diagnosis and treatment response evaluation of patients with MM, the Myeloma Response Assessment and Diagnosis System (MY-RADS) was created to standardize WBMR image acquisition techniques, image interpretation, and response evaluation methods. Radiologists need to have a detailed knowledge of the features of MM for accurate diagnosis. Thus, in this review article, we describe the imaging method for MM according to the latest IMWG guidelines as well as the image acquisition and response evaluation technique for WBMR according to MY-RADS.
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Affiliation(s)
- A Yeon Son
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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18
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Santoni A, Simoncelli M, Franceschini M, Ciofini S, Fredducci S, Caroni F, Sammartano V, Bocchia M, Gozzetti A. Functional Imaging in the Evaluation of Treatment Response in Multiple Myeloma: The Role of PET-CT and MRI. J Pers Med 2022; 12:jpm12111885. [PMID: 36579605 PMCID: PMC9696713 DOI: 10.3390/jpm12111885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
Bone disease is among the defining characteristics of symptomatic Multiple Myeloma (MM). Imaging techniques such as fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) and magnetic resonance imaging (MRI) can identify plasma cell proliferation and quantify disease activity. This function renders these imaging tools as suitable not only for diagnosis, but also for the assessment of bone disease after treatment of MM patients. The aim of this article is to review FDG PET/CT and MRI and their applications, with a focus on their role in treatment response evaluation. MRI emerges as the technique with the highest sensitivity in lesions' detection and PET/CT as the technique with a major impact on prognosis. Their comparison yields different results concerning the best tool to evaluate treatment response. The inhomogeneity of the data suggests the need to address limitations related to these tools with the employment of new techniques and the potential for a complementary use of both PET/CT and MRI to refine the sensitivity and achieve the standards for minimal residual disease (MRD) evaluation.
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19
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Pop VS, Tomoaia G, Parvu A. Modern imaging techniques for monitoring patients with multiple myeloma. Med Pharm Rep 2022; 95:377-384. [PMID: 36506611 PMCID: PMC9694753 DOI: 10.15386/mpr-2215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/12/2021] [Accepted: 12/30/2021] [Indexed: 12/15/2022] Open
Abstract
Bone disease is a serious problem for many patients, often causing pathological bone fractures. A spinal collapse is a condition that affects the quality of life. It is the most frequent feature of multiple myeloma (MM), used in establishing the diagnosis and the need to start treatment. Because of these complications, imaging plays a vital role in the diagnosis and workup of myeloma patients. For many years, conventional radiography has been considered the gold standard for detecting bone lesions. The main reasons are the wide availability, low cost, the relatively low radiation dose and the ability of this imaging method to cover the entire bone system. Because of its incapacity to evaluate the response to therapy, more sophisticated techniques such as whole-body low-dose computed tomography (WBLDCT), whole-body magnetic resonance imaging, and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) are used. In this review, some of the advantages, indications and applications of the three techniques in managing patients with MM will be discussed. The European Myeloma Network guidelines have recommended WBLDCT as the imaging modality of choice for the initial assessment of MM-related lytic bone lesions. Magnetic resonance imaging is the gold-standard imaging modality for the detection of bone marrow involvement. One of the modern imaging methods and PET/CT can provide valuable prognostic data and is the preferred technique for assessing response to therapy.
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Affiliation(s)
- Vlad Stefan Pop
- Hematology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Hematology Department, “Prof. Dr. Ioan Chiricuta” Oncological Institute, Cluj-Napoca, Romania
| | - Gheorghe Tomoaia
- Orthopedics and Traumatology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania,Academy of Romanian Scientists, Bucharest, Romania
| | - Andrada Parvu
- Hematology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Hematology Department, “Prof. Dr. Ioan Chiricuta” Oncological Institute, Cluj-Napoca, Romania
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20
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Milara E, Gómez-Grande A, Tomás-Soler S, Seiffert AP, Alonso R, Gómez EJ, Martínez-López J, Sánchez-González P. Bone marrow segmentation and radiomics analysis of [ 18F]FDG PET/CT images for measurable residual disease assessment in multiple myeloma. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107083. [PMID: 36044803 DOI: 10.1016/j.cmpb.2022.107083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/07/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES The last few years have been crucial in defining the most appropriate way to quantitatively assess [18F]FDG PET images in Multiple Myeloma (MM) patients to detect persistent tumor burden. The visual evaluation of images complements the assessment of Measurable Residual Disease (MRD) in bone marrow samples by multiparameter flow cytometry (MFC) or next-generation sequencing (NGS). The aim of this study was to quantify MRD by analyzing quantitative and texture [18F]FDG PET features. METHODS Whole body [18F]FDG PET of 39 patients with newly diagnosed MM were included in the database, and visually evaluated by experts in nuclear medicine. A segmentation methodology of the skeleton from CT images and an additional manual segmentation tool were proposed, implemented in a software solution including a graphical user interface. Both the compact bone and the spinal canal were removed from the segmentation to obtain only the bone marrow mask. SUV metrics, GLCM, GLRLM, and NGTDM parameters were extracted from the PET images and evaluated by Mann-Whitney U-tests and Spearman ρ rank correlation as valuable features differentiating PET+/PET- and MFC+/MFC- groups. Seven machine learning algorithms were applied for evaluating the classification performance of the extracted features. RESULTS Quantitative analysis for PET+/PET- differentiating demonstrated to be significant for most of the variables assessed with Mann-Whitney U-test such as Variance, Energy, and Entropy (p-value = 0.001). Moreover, the quantitative analysis with a balanced database evaluated by Mann-Whitney U-test revealed in even better results with 19 features with p-values < 0.001. On the other hand, radiomics analysis for MFC+/MFC- differentiating demonstrated the necessity of combining MFC evaluation with [18F]FDG PET assessment in the MRD diagnosis. Machine learning algorithms using the image features for the PET+/PET- classification demonstrated high performance metrics but decreasing for the MFC+/MFC- classification. CONCLUSIONS A proof-of-concept for the extraction and evaluation of bone marrow radiomics features of [18F]FDG PET images was proposed and implemented. The validation showed the possible use of these features for the image-based assessment of MRD.
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Affiliation(s)
- Eva Milara
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, Avenida Complutense 30, Madrid 28040, Spain.
| | - Adolfo Gómez-Grande
- Department of Nuclear Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Sebastián Tomás-Soler
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, Avenida Complutense 30, Madrid 28040, Spain
| | - Alexander P Seiffert
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, Avenida Complutense 30, Madrid 28040, Spain
| | - Rafael Alonso
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Department of Hematology and Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain; Clinical Research Hematology Unit, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Enrique J Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, Avenida Complutense 30, Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Joaquín Martínez-López
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Department of Hematology and Instituto de Investigación Sanitaria (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain; Clinical Research Hematology Unit, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain; Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, Avenida Complutense 30, Madrid 28040, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain.
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21
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Fiori T, Lisewski D, Flukes S, Wood C, Gibson D. Lessons learnt from the global iodinated contrast media shortage in head and neck imaging. J Med Imaging Radiat Oncol 2022; 66:1073-1083. [PMID: 36125131 DOI: 10.1111/1754-9485.13472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
Abstract
A recent shortage in the global supply of iodinated contrast media (ICM) has required health service providers to review their contrast administration policies and implement strategies to conserve inventory. This article will review the current best practices in head and neck imaging for a variety of common presentations and provide examples where alternative imaging can be considered due to the recent ICM shortage. Ultrasound and MRI techniques can feature heavily in many diagnostic processes in head and neck pathology, and a variety of common presentations can be appropriately investigated through clinical evaluation or naso-endoscopy. In many instances, for the routine assessment of non-acute adult and paediatric head and neck presentations, the use of contrast-enhanced CT can be safely minimised to conserve ICM if required.
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Affiliation(s)
- Timothy Fiori
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Dean Lisewski
- Department of General Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Stephanie Flukes
- Department of Otolaryngology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Chris Wood
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Daren Gibson
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
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22
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Jiménez-Segura R, Rosiñol L, Cibeira MT, Fernández de Larrea C, Tovar N, Rodríguez-Lobato LG, Bladé E, Moreno DF, Oliver-Caldés A, Bladé J. Paraskeletal and extramedullary plasmacytomas in multiple myeloma at diagnosis and at first relapse: 50-years of experience from an academic institution. Blood Cancer J 2022; 12:135. [PMID: 36114167 PMCID: PMC9481598 DOI: 10.1038/s41408-022-00730-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/14/2022] Open
Abstract
From January 1970 to December 2018, 1304 patients were diagnosed with multiple myeloma (MM) at our institution and 256 (19.6%) had plasmacytomas (Ps) (paraskeletal –PPs- 17.6%, extramedullary –EMPs-1.9%). Patients with Ps had lower serum M-protein and less advanced ISS stage than those without. At first relapse, 192 out of 967 patients (19.8%) developed Ps (PPs 14.6%, EMPs 5.1%). The only factor associated with Ps at relapse was the presence of Ps at diagnosis (46% vs 13%, p < 0.00001) with no impact with exposure to novel drugs or previous autologous stem-cell transplantation (ASCT). The median overall survival (OS) was 45, 44 and 20 months for patients without Ps, PPs and EMPs, respectively (p = 0.013). Patients with PPs who underwent ASCT had similar OS than those without Ps (98 vs. 113 months) and significantly longer than those with EMPs (98 vs 47 months, p = 0.006). In patients non-eligible for ASCT the presence of PPs or EMPs was associated with shorter OS compared with patients without Ps (32 vs. 24 vs. 6 months, p = 0.009). In the relapsed setting, a significant survival benefit was observed beyond the year 2000, but still with significant differences among patients without Ps, PPs and EMPs (37 vs 22 vs 16 months, p = 0.003). Importantly, rescue therapy with combinations of proteasome-inhibitors plus immunomodulatory drugs was associated with prolonged OS from first relapse (over 6 years), even in patients with EMPs.
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Shekhawat AS, Singh B, Malhotra P, Watts A, Basher R, Kaur H, Hooda M, Radotra BD. Imaging CXCR4 receptors expression for staging multiple myeloma by using 68Ga-Pentixafor PET/CT: comparison with 18F-FDG PET/CT. Br J Radiol 2022; 95:20211272. [PMID: 35731811 PMCID: PMC10162067 DOI: 10.1259/bjr.20211272] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 06/16/2022] [Accepted: 06/19/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES 68Ga-Pentixafor positron emission tomography (PET) imaging targets CXCR4 expression which is overexpressed in multiple myeloma (MM). In this study, we evaluated the diagnostic utility of 68Ga-Pentixafor PET/CT for imaging CXCR4 expression in MM and compared results with 18F-fluorodeoxyglucose (18F-FDG) PET/CT. METHODS 34 (21M; 13F; median age = 57.5 years) treatment naive multiple myeloma patients were recruited. All the patients underwent 18F-FDG PET/CT and 68Ga-Pentixafor PET/CT imaging. Freshly prepared 68Ga-Pentixafor (148-185 MBq) was injected intravenously and whole-body PET/CT (low-dose CT) was acquired at 1 h post-injection. The pattern of uptake (diffuse, focal or mixed) and the mean SUVmax value of all the lesions (when lesions were ≤5) or of the five most tracer avid lesions (when lesions was >5) were evaluated. Tumor to background ratio (TBRmax) was calculated for both the tracers. Durie Salmon plus staging (DSPS) was used for disease staging on PET and the results were compared with International staging system (ISS). RESULTS 68Ga-Pentixafor PET/CT showed higher disease extent than seen on 18F-FDG PET/CT in 23/34 patients (68.0%), lesser disease extent in 2/34 (6%) and similar disease extent in 9/34 (26%) patients. Significantly (p < 0.001) higher TBRmax values (5.7; IQR 8.8) were observed on 68Ga-Pentixafor PET/CT as compared to 18F-FDG PET/CT values (2.9; IQR = 4.0). Both the techniques detected extramedullary lesions in six patients. On the other hand, 68Ga-Pentixafor detected medullary lesions in five, whereas, 18F-FDG PET in three patients. Further, only 68Ga-Pentixafor TBRmax correlated significantly (ρ = 0.421; 0.013) with bone marrow plasma cell percentage. 68Ga-Pentixafor PET upstaged more number (9/29) of patients as compared to (4/29) 18F-FDG PET imaging. On the other hand, 18F-FDG PET down-staged 9/29, whereas 68Ga-Pentixafor PET downstaged only 3/29 patients. CONCLUSION 68Ga-Pentixafor PET/CT evaluated the whole-body disease burden of CXCR4 receptors non-invasively which is not possible by tissue sampling methods. This novel PET tracer has also implication for disease staging. Dual 68Ga-Pentixafor/18F-FDG PET/CT imaging may help in determining the tumor heterogeneity in MM. ADVANCES IN KNOWLEDGE This CXCR4 targeting PET tracer has a promising role in the development of CXCR4 targeting theranostics and also for response assessment to these therapies including the conventional treatment.
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Affiliation(s)
- Amit Singh Shekhawat
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Baljinder Singh
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Clinical Haematology & Medical Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankit Watts
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Basher
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harneet Kaur
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Monika Hooda
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bishan D Radotra
- Histopathology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Neubauer J, Neubauer J. Zentral fettisodense Osteolysen bei Erstdiagnose eines multiplen
Myeloms. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1756605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- J Neubauer
- Universitätsklinikum Freiburg, Radiologie,
Freiburg
| | - J Neubauer
- Institut für Diagnostische und Interventionelle Radiologie,
Universitätsklinikum Freiburg, Freiburg
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25
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Aljohani SA, Saib IH, Syed GS, Alruwaili A, Numani SP, Almuthri SA, Vishwakarm RK, Mendoza MAC, Alsalman MJ, Ozair NM, Alhejazi AY, Alaskar AS, Gmati GE. Radiological outcome of bone disease in multiple myeloma patients pre- and post therapy: A single center experience. Saudi Med J 2022; 43:959-964. [PMID: 35964963 PMCID: PMC9749671 DOI: 10.15537/smj.2022.43.8.20220055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/03/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To find any correlation between the clinical response as per International Working Myeloma Group (IWMG) response criteria and the radiological response at the end of treatment. METHODS A retrospective cohort study was conducted, total of 39 patients whom diagnosed with multiple myeloma (MM) between January 2010 and December 2018 and fulfilled the study criteria were included. RESULTS The high sensitivity and specificity of positron emission tomography/computed tomography (PET/CT) in detecting osteolytic myeloma lesions in the bones was strongly emphasized in our study. Follow up PET/CT, we found that while 17 patients showed complete remission in PET/CT, and 14 of these of patients demonstrated a complete clinical response at end of therapy assessment. CONCLUSION Although we did not find a statistically significant correlation between the response versus metabolic activity and the number of bone/bone marrow lesions, however, our study was limited by the absence of clear criteria for defining disease response in PET/CT in MM patients. Further prospective analysis would be needed to establish a defined criterion.
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Affiliation(s)
- Somaya A. Aljohani
- From the Department of Internal Medicine (Aljohani, Alsalman, Ozair), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Nuclear Medicine (Saib, Syed), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Division of Adult Hematology, Department of Oncology (Alhejazi, Alaskar, Gmati), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Biostatistics (Vishwakarm), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; and from the Clinical Trial Services (Mendoza), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Israa H. Saib
- From the Department of Internal Medicine (Aljohani, Alsalman, Ozair), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Nuclear Medicine (Saib, Syed), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Division of Adult Hematology, Department of Oncology (Alhejazi, Alaskar, Gmati), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Biostatistics (Vishwakarm), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; and from the Clinical Trial Services (Mendoza), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Ghulam Shah Syed
- From the Department of Internal Medicine (Aljohani, Alsalman, Ozair), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Nuclear Medicine (Saib, Syed), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Division of Adult Hematology, Department of Oncology (Alhejazi, Alaskar, Gmati), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Biostatistics (Vishwakarm), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; and from the Clinical Trial Services (Mendoza), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Ahmed Alruwaili
- From the Department of Internal Medicine (Aljohani, Alsalman, Ozair), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Nuclear Medicine (Saib, Syed), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Division of Adult Hematology, Department of Oncology (Alhejazi, Alaskar, Gmati), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Biostatistics (Vishwakarm), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; and from the Clinical Trial Services (Mendoza), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Shah P. Numani
- From the Department of Internal Medicine (Aljohani, Alsalman, Ozair), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Nuclear Medicine (Saib, Syed), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Division of Adult Hematology, Department of Oncology (Alhejazi, Alaskar, Gmati), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Biostatistics (Vishwakarm), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; and from the Clinical Trial Services (Mendoza), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Sulaiman A. Almuthri
- From the Department of Internal Medicine (Aljohani, Alsalman, Ozair), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Nuclear Medicine (Saib, Syed), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Division of Adult Hematology, Department of Oncology (Alhejazi, Alaskar, Gmati), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Biostatistics (Vishwakarm), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; and from the Clinical Trial Services (Mendoza), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Ramesh K. Vishwakarm
- From the Department of Internal Medicine (Aljohani, Alsalman, Ozair), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Nuclear Medicine (Saib, Syed), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Division of Adult Hematology, Department of Oncology (Alhejazi, Alaskar, Gmati), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Biostatistics (Vishwakarm), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; and from the Clinical Trial Services (Mendoza), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - May Anne C. Mendoza
- From the Department of Internal Medicine (Aljohani, Alsalman, Ozair), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Nuclear Medicine (Saib, Syed), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Division of Adult Hematology, Department of Oncology (Alhejazi, Alaskar, Gmati), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Biostatistics (Vishwakarm), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; and from the Clinical Trial Services (Mendoza), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed J. Alsalman
- From the Department of Internal Medicine (Aljohani, Alsalman, Ozair), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Nuclear Medicine (Saib, Syed), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Division of Adult Hematology, Department of Oncology (Alhejazi, Alaskar, Gmati), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Biostatistics (Vishwakarm), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; and from the Clinical Trial Services (Mendoza), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Nabil M. Ozair
- From the Department of Internal Medicine (Aljohani, Alsalman, Ozair), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Nuclear Medicine (Saib, Syed), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Division of Adult Hematology, Department of Oncology (Alhejazi, Alaskar, Gmati), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Biostatistics (Vishwakarm), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; and from the Clinical Trial Services (Mendoza), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Ayman Y. Alhejazi
- From the Department of Internal Medicine (Aljohani, Alsalman, Ozair), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Nuclear Medicine (Saib, Syed), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Division of Adult Hematology, Department of Oncology (Alhejazi, Alaskar, Gmati), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Biostatistics (Vishwakarm), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; and from the Clinical Trial Services (Mendoza), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Ahmed S. Alaskar
- From the Department of Internal Medicine (Aljohani, Alsalman, Ozair), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Nuclear Medicine (Saib, Syed), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Division of Adult Hematology, Department of Oncology (Alhejazi, Alaskar, Gmati), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Biostatistics (Vishwakarm), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; and from the Clinical Trial Services (Mendoza), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Giamal E. Gmati
- From the Department of Internal Medicine (Aljohani, Alsalman, Ozair), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Nuclear Medicine (Saib, Syed), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Division of Adult Hematology, Department of Oncology (Alhejazi, Alaskar, Gmati), King Abdulaziz Medical City Ministry of National Guard - Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; from the Department of Biostatistics (Vishwakarm), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences; and from the Clinical Trial Services (Mendoza), King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
- Address correspondence and reprints request to: Dr. Giamal E. Gmati, Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-9606-0790
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Rajkumar SV. Multiple myeloma: 2022 update on diagnosis, risk stratification, and management. Am J Hematol 2022; 97:1086-1107. [PMID: 35560063 PMCID: PMC9387011 DOI: 10.1002/ajh.26590] [Citation(s) in RCA: 270] [Impact Index Per Article: 135.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 12/22/2022]
Abstract
DISEASE OVERVIEW Multiple myeloma accounts for approximately 10% of hematologic malignancies. DIAGNOSIS The diagnosis requires ≥10% clonal bone marrow plasma cells or a biopsy-proven plasmacytoma plus evidence of one or more multiple myeloma defining events (MDE): CRAB (hypercalcemia, renal failure, anemia, or lytic bone lesions) attributable to the plasma cell disorder, bone marrow clonal plasmacytosis ≥60%, serum involved/uninvolved free light chain (FLC) ratio ≥ 100 (provided involved FLC is ≥100 mg/L), or >1 focal lesion on magnetic resonance imaging. RISK STRATIFICATION The presence of del(17p), t(4;14), t(14;16), t(14;20), gain 1q, or p53 mutation is considered high-risk multiple myeloma. The presence of any two high risk factors is considered double-hit myeloma, and three or more high risk factors is triple-hit myeloma. RISK-ADAPTED INITIAL THERAPY In patients who are candidates for autologous stem cell transplantation, induction therapy consists of bortezomib, lenalidomide, dexamethasone (VRd) given for approximately 3-4 cycles followed by autologous stem cell transplantation (ASCT). In high-risk patients, daratumumab, bortezomib, lenalidomide, dexamethasone (Dara-VRd) is an alternative to VRd. Selected standard-risk patients can collect stem cells, get additional cycles of induction therapy, and delay transplant until first relapse. Patients who are not candidates for transplant are treated with VRd for approximately 8-12 cycles followed by maintenance or alternatively with daratumumab, lenalidomide, dexamethasone (DRd) until progression. MAINTENANCE THERAPY Standard-risk patients need lenalidomide maintenance, while bortezomib plus lenalidomide maintenance is needed for high-risk myeloma. MANAGEMENT OF RELAPSED DISEASE A triplet regimen is usually needed at relapse, with the choice of regimen varying with each successive relapse.
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Bernstein ZS, Kim EB, Raje N. Bone Disease in Multiple Myeloma: Biologic and Clinical Implications. Cells 2022; 11:cells11152308. [PMID: 35954151 PMCID: PMC9367243 DOI: 10.3390/cells11152308] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023] Open
Abstract
Multiple Myeloma (MM) is a hematologic malignancy characterized by the proliferation of monoclonal plasma cells localized within the bone marrow. Bone disease with associated osteolytic lesions is a hallmark of MM and develops in the majority of MM patients. Approximately half of patients with bone disease will experience skeletal-related events (SREs), such as spinal cord compression and pathologic fractures, which increase the risk of mortality by 20–40%. At the cellular level, bone disease results from a tumor-cell-driven imbalance between osteoclast bone resorption and osteoblast bone formation, thereby creating a favorable cellular environment for bone resorption. The use of osteoclast inhibitory therapies with bisphosphonates, such as zoledronic acid and the RANKL inhibitor denosumab, have been shown to delay and lower the risk of SREs, as well as the need for surgery or radiation therapy to treat severe bone complications. This review outlines our current understanding of the molecular underpinnings of bone disease, available therapeutic options, and highlights recent advances in the management of MM-related bone disease.
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Affiliation(s)
- Zachary S. Bernstein
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA;
| | - E. Bridget Kim
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Noopur Raje
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA;
- Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
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Terao T, Matsue K. Progress of modern imaging modalities in multiple myeloma. Int J Hematol 2022; 115:778-789. [DOI: 10.1007/s12185-022-03360-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 12/26/2022]
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29
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Gundesen MT, Asmussen JT, Haukås E, Schubert M, Abildgaard N, Schjesvold F, Lund T. A prospective study of Skeletal survey versus Low-dose whole-body CT for Osteolytic lesions in Multiple Myeloma. Eur J Haematol 2022; 108:423-429. [PMID: 35113466 DOI: 10.1111/ejh.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/28/2022]
Abstract
Whole-body low-dose CT (WBLDCT) is recommended over classical skeletal surveys (CSS) for investigating bone disease in multiple myeloma (MM) based on retrospective studies. No prospective studies with serial follow-up scans exist. OBJECTIVE To compare WBLDCT to CSS for identifying progressive bone disease in MM in a prospective setting. METHODS Ninety-six patients with MM at Odense University Hospital and Stavanger Hospital were followed for up to four years. Patients were scanned with WBLDCT and CSS every year for the first two years and every six months thereafter or at suspicion of progression. RESULTS Nineteen cases of progressive bone disease were found using WBLDCT vs eight cases using CSS (p < 0.001). All cases of progressive bone disease using CSS were also identified by WBLDCT. Progression not found by CSS was primarily in the spine, sternum, and pelvis. Of the 19 cases, five patients had progressive bone disease only without other criteria for clinical progression. WBLDCT consistently identified more bone lesions per patient, 8.2 CI(6.8;9.6) vs CSS, 3.6 CI(2.7;4.5). CONCLUSION WBLDCT outperformed CSS for finding progressive bone disease and osteolytic lesions. More new lesions were found during follow-up by WBLDCT than CSS. Using CSS for lytic lesions will underestimate progression rates. Our data offer prospective evidence for the current recommendation using WBLDCT for skeletal evaluations in patients with multiple myeloma.
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Affiliation(s)
- Michael T Gundesen
- Department of Hematology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jon T Asmussen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Einar Haukås
- Department of Hematology, Stavanger University Hospital, Norway
| | - Michael Schubert
- Department of Radiology, Stavanger University Hospital, Odense, Norway
| | - Niels Abildgaard
- Department of Hematology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Fredrik Schjesvold
- Oslo Myeloma Center, Oslo University Hospital, Oslo, Norway.,K.G. Jebsen Centre for B-Cell Malignancies, University of Oslo, Oslo, Norway
| | - Thomas Lund
- Department of Hematology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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30
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Park H, Lee SY, Lee J, Pak J, Lee K, Lee SE, Jung JY. Detecting Multiple Myeloma Infiltration of the Bone Marrow on CT Scans in Patients with Osteopenia: Feasibility of Radiomics Analysis. Diagnostics (Basel) 2022; 12:diagnostics12040923. [PMID: 35453971 PMCID: PMC9025143 DOI: 10.3390/diagnostics12040923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 02/04/2023] Open
Abstract
It is difficult to detect multiple myeloma (MM) infiltration of the bone marrow on computed tomography (CT) scans of patients with osteopenia. Our aim is to determine the feasibility of using radiomics analysis to detect MM infiltration of the bone marrow on CT scans of patients with osteopenia. The contrast-enhanced thoracic CT scans of 104 patients with MM and 104 age- and sex-matched controls were retrospectively evaluated. All individuals had decreased bone density on radiography. The study group was divided into development (n = 160) and temporal validation sets (n = 48). The radiomics model was developed using 805 texture features extracted from the bone marrow for a development set, using a Random Forest algorithm. The developed models were applied to evaluate a temporal validation set. For comparison, three radiologists evaluated the CTs for the possibility of MM infiltration in the bone marrow. The diagnostic performances were assessed and compared using an area under the receiver operating characteristic curve (AUC) analysis. The AUC of the radiomics model was not significantly different from those of the radiologists (p = 0.056–0.821). The radiomics analysis results showed potential for detecting MM infiltration in the bone marrow on CT scans of patients with osteopenia.
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Affiliation(s)
- Hyerim Park
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.P.); (J.L.); (K.L.); (S.-E.L.); (J.-Y.J.)
- Department of Radiology, Soonchunhyang University Cheoan Hospital, Cheonan 31151, Korea;
| | - So-Yeon Lee
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.P.); (J.L.); (K.L.); (S.-E.L.); (J.-Y.J.)
- Correspondence: ; Tel.: +82-2-2258-6743
| | - Jooyeon Lee
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.P.); (J.L.); (K.L.); (S.-E.L.); (J.-Y.J.)
- Department of Applied Statistics, Hanyang University, Seoul 04763, Korea
| | - Juyoung Pak
- Department of Radiology, Soonchunhyang University Cheoan Hospital, Cheonan 31151, Korea;
| | - Koeun Lee
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.P.); (J.L.); (K.L.); (S.-E.L.); (J.-Y.J.)
| | - Seung-Eun Lee
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.P.); (J.L.); (K.L.); (S.-E.L.); (J.-Y.J.)
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (H.P.); (J.L.); (K.L.); (S.-E.L.); (J.-Y.J.)
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Mena E, Turkbey EB, Lindenberg L. Modern radiographic imaging in multiple myeloma, what is the minimum requirement? Semin Oncol 2022; 49:86-93. [PMID: 35190200 PMCID: PMC9149049 DOI: 10.1053/j.seminoncol.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/09/2022] [Indexed: 02/03/2023]
Abstract
Imaging innovations offer useful techniques applicable to many oncology specialties. Treatment advances in the field of multiple myeloma (MM) have increased the need for accurate diagnosis, particularly in the bone marrow, which is an essential component in myeloma-defining criteria. Modern imaging identifies osteolytic lesions, distinguishes solitary plasmacytoma from MM, and evaluates the presence of extramedullary disease. Furthermore, imaging is increasingly valuable in post-treatment response assessment. Detection of minimal residual disease after therapy carries prognostic implications and influences subsequent treatment planning. Whole-body low-dose Computed Tomography is now recommended over the conventional skeletal survey, and more sophisticated functional imaging methods, such as 18F-Fluorodeoxyglucose Positron Emission Tomography , and diffusion-weighted Magnetic Resonance Imaging are proving effective in the assessment and monitoring of MM disease. This review focuses on understanding indications and advantages of these imaging modalities for diagnosing and managing myeloma.
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Affiliation(s)
- Esther Mena
- Molecular Imaging Branch. National Cancer Institute, NIH, Bethesda, MD, USA
| | - Evrim B. Turkbey
- Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Liza Lindenberg
- Molecular Imaging Branch. National Cancer Institute, NIH, Bethesda, MD, USA
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Cowan AJ, Green DJ, Kwok M, Lee S, Coffey DG, Holmberg LA, Tuazon S, Gopal AK, Libby EN. Diagnosis and Management of Multiple Myeloma: A Review. JAMA 2022; 327:464-477. [PMID: 35103762 DOI: 10.1001/jama.2022.0003] [Citation(s) in RCA: 358] [Impact Index Per Article: 179.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Multiple myeloma is a hematologic malignancy characterized by presence of abnormal clonal plasma cells in the bone marrow, with potential for uncontrolled growth causing destructive bone lesions, kidney injury, anemia, and hypercalcemia. Multiple myeloma is diagnosed in an estimated 34 920 people in the US and in approximately 588 161 people worldwide each year. OBSERVATIONS Among patients with multiple myeloma, approximately 73% have anemia, 79% have osteolytic bone disease, and 19% have acute kidney injury at the time of presentation. Evaluation of patients with possible multiple myeloma includes measurement of hemoglobin, serum creatinine, serum calcium, and serum free light chain levels; serum protein electrophoresis with immunofixation; 24-hour urine protein electrophoresis; and full-body skeletal imaging with computed tomography, positron emission tomography, or magnetic resonance imaging. The Revised International Staging System combines data from the serum biomarkers β2 microglobulin, albumin, and lactate dehydrogenase in conjunction with malignant plasma cell genomic features found on fluorescence in situ hybridization-t(4;14), del(17p), and t(14;16)-to assess estimated progression-free survival and overall survival. At diagnosis, 28% of patients are classified as having Revised International Staging stage I multiple myeloma, and these patients have a median 5-year survival of 82%. Among all patients with multiple myeloma, standard first-line (induction) therapy consists of a combination of an injectable proteasome inhibitor (ie, bortezomib), an oral immunomodulatory agent (ie, lenalidomide), and dexamethasone and is associated with median progression-free survival of 41 months, compared with historical reports of 8.5 months without therapy. This induction therapy combined with autologous hematopoietic stem cell transplantation followed by maintenance lenalidomide is standard of care for eligible patients. CONCLUSIONS AND RELEVANCE Approximately 34 920 people in the US and 155 688 people worldwide are diagnosed with multiple myeloma each year. Induction therapy with an injectable proteasome inhibitor, an oral immunomodulatory agent and dexamethasone followed by treatment with autologous hematopoietic stem cell transplantation, and maintenance therapy with lenalidomide are among the treatments considered standard care for eligible patients.
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Affiliation(s)
- Andrew J Cowan
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Seattle Cancer Care Alliance, Seattle, Washington
| | - Damian J Green
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Seattle Cancer Care Alliance, Seattle, Washington
| | - Mary Kwok
- Seattle Cancer Care Alliance, Seattle, Washington
- Division of Hematology, Department of Medicine, University of Washington, Seattle
| | - Sarah Lee
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Seattle Cancer Care Alliance, Seattle, Washington
| | - David G Coffey
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida
| | - Leona A Holmberg
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Seattle Cancer Care Alliance, Seattle, Washington
| | - Sherilyn Tuazon
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Now with Bristol Myers Squibb, Seattle, Washington
| | - Ajay K Gopal
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Seattle Cancer Care Alliance, Seattle, Washington
| | - Edward N Libby
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Seattle Cancer Care Alliance, Seattle, Washington
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Gu R, Amlani A, Haberland U, Hodson D, Streetly M, Antonelli M, Dregely I, Goh V. Correlation between Whole Skeleton Dual Energy CT Calcium-Subtracted Attenuation and Bone Marrow Infiltration in Multiple Myeloma. Eur J Radiol 2022; 149:110223. [PMID: 35240412 PMCID: PMC9026281 DOI: 10.1016/j.ejrad.2022.110223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/19/2022] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
Abstract
Quantification of whole skeleton calcium-subtracted attenuation with dual energy CT is feasible. Whole skeleton calcium-subtracted attenuation correlates with the degree of marrow infiltration by plasma cells on bone marrow biopsy. Whole skeleton calcium-subtracted attenuation provides complementary information to the detection of osteolytic bone lesions.
Objectives Objective evaluation of the extent of skeletal marrow involvement in multiple myeloma remains a clinical gap for CT. We aimed to develop a quantitative segmentation pipeline for dual energy CT and to assess whether quantified whole skeleton calcium-subtracted attenuation values correlate with biopsy-derived bone marrow infiltration in multiple myeloma. Methods Consecutive prospective patients with suspected/established myeloma underwent dual source CT from the skull vertex to proximal tibia. Whole skeleton segmentation was performed for 120 kVp-equivalent images as follows: following Hounsfield unit (HU) thresholding, a Chan-Vese morphological operation was implemented to generate a whole skeleton segmentation mask. This mask was then applied to corresponding whole skeleton material decomposition calcium-subtracted maps, generating whole skeleton HU values. Associations with biopsy-derived bone marrow plasma cell infiltration percentage were assessed with Spearman’s rank correlation; significance was at 5%. Results 21 patients (12 females; median (IQR) 67 (61, 73) years) were included; 16 patients had osteolytic bone lesions; 15 patients underwent bone marrow biopsy. Segmentation and quantification were feasible in all patients. Median (IQR) of the average skeletal calcium-subtracted attenuation was −59.9 HU (-66.3, −51.8HU). There was a positive correlation with bone marrow plasma cell infiltration percentage (Spearman’s rho: + 0.79, p < 0.001). Conclusion Whole skeleton calcium-subtracted attenuation is associated with the degree of bone marrow infiltration by plasma cells, providing an objective measure of marrow involvement with the potential to allow earlier detection of disease.
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Affiliation(s)
- Renyang Gu
- Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7TH, United Kingdom
| | - Ashik Amlani
- Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7TH, United Kingdom; Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7TH, United Kingdom
| | - Ulrike Haberland
- Siemens Healthineers, Siemensstrasse 1, 91301 Forchheim, Germany
| | - Dan Hodson
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7TH, United Kingdom
| | - Matthew Streetly
- Department of Haematology and Oncology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, United Kingdom
| | - Michela Antonelli
- Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7TH London, United Kingdom
| | - Isabel Dregely
- Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7TH London, United Kingdom
| | - Vicky Goh
- Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7TH, United Kingdom; Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London SE1 7TH, United Kingdom.
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Dual-Energy CT-Based Bone Marrow Imaging in Multiple Myeloma: Assessment of Focal Lesions in Relation to Disease Status and MRI Findings. Acad Radiol 2022; 29:245-254. [PMID: 33707044 DOI: 10.1016/j.acra.2021.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES To assess focal multiple myeloma bone lesions via dual-energy CT-based virtual noncalcium (VNCa) bone marrow imaging in relation to the overall hematological disease status and MRI findings. MATERIALS AND METHODS We retrospectively evaluated 103 focal osteolytic lesions of the axial skeleton in VNCa bone marrow images of 32 patients. Region of interest-based attenuation measurements were correlated with T1w signal intensity and apparent diffusion coefficient (ADC). Results were compared between patients in active and inactive disease. Receiver operating characteristic analysis was performed to determine a cut-off value of VNCa attenuation for differentiation between the two groups. Standard of reference was the overall disease status according to International Myeloma Working Group response criteria. RESULTS Mean attenuation difference between lesions and background bone marrow was significantly lower in inactive disease (16 HU, SD 30) compared to active disease (35 HU, SD 29). VNCa attenuation measurement allowed for differentiation between active and inactive disease with a sensitivity of 92% and a specificity of 58% at a cut-off value of -21 HU. VNCa attenuation was negatively correlated to T1w signal intensity (Spearman's ρ -0.617, p < 0.001) and positively correlated to ADC (Spearman's ρ 0.521, p < 0.001). CONCLUSION Quantitative assessment of attenuation of focal osteolytic lesions in VNCa bone marrow images allows differentiation between overall active and inactive disease with higher attenuation signifying an increasing likelihood of active disease. This is supported by a significant positive correlation between the attenuation and the ADC, as well as a corresponding inverse correlation to T1w signal intensity.
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35
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Floccinaucinihilipilification: is there a continuing role for the radiographic skeletal survey? Skeletal Radiol 2022; 51:5-9. [PMID: 33893515 DOI: 10.1007/s00256-021-03780-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 02/02/2023]
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Lecouvet FE, Vekemans MC, Van Den Berghe T, Verstraete K, Kirchgesner T, Acid S, Malghem J, Wuts J, Hillengass J, Vandecaveye V, Jamar F, Gheysens O, Vande Berg BC. Imaging of treatment response and minimal residual disease in multiple myeloma: state of the art WB-MRI and PET/CT. Skeletal Radiol 2022; 51:59-80. [PMID: 34363522 PMCID: PMC8626399 DOI: 10.1007/s00256-021-03841-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/28/2021] [Accepted: 06/06/2021] [Indexed: 02/02/2023]
Abstract
Bone imaging has been intimately associated with the diagnosis and staging of multiple myeloma (MM) for more than 5 decades, as the presence of bone lesions indicates advanced disease and dictates treatment initiation. The methods used have been evolving, and the historical radiographic skeletal survey has been replaced by whole body CT, whole body MRI (WB-MRI) and [18F]FDG-PET/CT for the detection of bone marrow lesions and less frequent extramedullary plasmacytomas.Beyond diagnosis, imaging methods are expected to provide the clinician with evaluation of the response to treatment. Imaging techniques are consistently challenged as treatments become more and more efficient, inducing profound response, with more subtle residual disease. WB-MRI and FDG-PET/CT are the methods of choice to address these challenges, being able to assess disease progression or response and to detect "minimal" residual disease, providing key prognostic information and guiding necessary change of treatment.This paper provides an up-to-date overview of the WB-MRI and PET/CT techniques, their observations in responsive and progressive disease and their role and limitations in capturing minimal residual disease. It reviews trials assessing these techniques for response evaluation, points out the limited comparisons between both methods and highlights their complementarity with most recent molecular methods (next-generation flow cytometry, next-generation sequencing) to detect minimal residual disease. It underlines the important role of PET/MRI technology as a research tool to compare the effectiveness and complementarity of both methods to address the key clinical questions.
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Affiliation(s)
- Frederic E. Lecouvet
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
| | - Marie-Christiane Vekemans
- Haematology Unit, Cliniques Universitaires Saint-Luc, Institut de Recherche Expérimentale et Clinique (IREC), 1200 Brussels, Belgium
| | - Thomas Van Den Berghe
- Radiology Department, Universiteit Ghent, Sint-Pietersnieuwstraat 33, 9000 Gent, Belgium
| | - Koenraad Verstraete
- Radiology Department, Universiteit Ghent, Sint-Pietersnieuwstraat 33, 9000 Gent, Belgium
| | - Thomas Kirchgesner
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
| | - Souad Acid
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
| | - Jacques Malghem
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
| | - Joris Wuts
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Avenue du Laerbeek 101, 1090 Jette, Belgium
| | - Jens Hillengass
- Departement of Medicine, Myeloma Unit, Park Comprehensive Cancer Center, Buffalo, NY USA
| | - Vincent Vandecaveye
- Radiology Department, Katholieke Univesiteit Leuven, Oude Markt, 13, 3000 Leuven, Belgium
| | - François Jamar
- Nuclear Medicine Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Olivier Gheysens
- Nuclear Medicine Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Bruno C. Vande Berg
- Radiology Department, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, UCLouvain, Hippocrate Avenue 10, 1200 Brussels, Belgium
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Treitl KM, Ricke J, Baur-Melnyk A. Whole-body magnetic resonance imaging (WBMRI) versus whole-body computed tomography (WBCT) for myeloma imaging and staging. Skeletal Radiol 2022; 51:43-58. [PMID: 34031705 PMCID: PMC8626374 DOI: 10.1007/s00256-021-03799-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 02/02/2023]
Abstract
Myeloma-associated bone disease (MBD) develops in about 80-90% of patients and severely affects their quality of life, as it accounts for the majority of mortality and morbidity. Imaging in multiple myeloma (MM) and MBD is of utmost importance in order to detect bone and bone marrow lesions as well as extraosseous soft-tissue masses and complications before the initiation of treatment. It is required for determination of the stage of disease and aids in the assessment of treatment response. Whole-body low-dose computed tomography (WBLDCT) is the key modality to establish the initial diagnosis of MM and is now recommended as reference standard procedure for the detection of lytic destruction in MBD. In contrast, whole-body magnetic resonance imaging (WBMRI) has higher sensitivity for the detection of focal and diffuse plasma cell infiltration patterns of the bone marrow and identifies them prior to osteolytic destruction. It is recommended for the evaluation of spinal and vertebral lesions, while functional, diffusion-weighted MRI (DWI-MRI) is a promising tool for the assessment of treatment response. This review addresses the current improvements and limitations of WBCT and WBMRI for diagnosis and staging in MM, underlining the fact that both modalities offer complementary information. It further summarizes the corresponding radiological findings and novel technological aspects of both modalities.
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Affiliation(s)
- Karla M. Treitl
- grid.5252.00000 0004 1936 973XDepartment of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Jens Ricke
- grid.5252.00000 0004 1936 973XDepartment of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Andrea Baur-Melnyk
- grid.5252.00000 0004 1936 973XDepartment of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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Shapiro YN, O'Donnell EK. Oncologist perspective: role of imaging in myeloma. Skeletal Radiol 2022; 51:123-133. [PMID: 34272993 DOI: 10.1007/s00256-021-03856-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 02/02/2023]
Abstract
With major advancements in treatments for multiple myeloma (MM), it is critical that we evaluate our methods for both diagnosing MM and monitoring its progression over time. Imaging methods, such as conventional skeletal x-ray, low-dose whole-body CT, MRI, and PET-CT, provide valuable information that influences our clinical decision-making. In this review, we will evaluate the role of these imaging techniques throughout the MM disease course, from diagnosis to follow-up after therapy, and also provide appropriate recommendations.
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[Radiological diagnosis of multiple myeloma : Role of imaging and the current S3 guideline]. Radiologe 2021; 62:35-43. [PMID: 34919153 DOI: 10.1007/s00117-021-00943-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
CLINICAL ISSUE Multiple myeloma is a clonal B‑lymphocyte neoplasm of terminally differentiated plasma cells and accounts for approximately 10% of all hematologic malignancies. Reduction of bone mass, seen on computed tomography (CT) as focal osteolysis, or general osteopenia is mainly caused by tumor-induced resorption of bone. STANDARD RADIOLOGICAL METHODS Imaging methods are used in multiple myeloma to record the extent of various dimensions of the disease manifestations (damage to bone substance, bone marrow infiltration, extramedullary involvement) and the disease course. The aim of this review article is to summarize and outline the recommendations of the S3 guideline "Diagnostics, therapy and follow-up care for patients with monoclonal gammopathy of unclear significance (MGUS) or multiple myeloma" in terms of radiographic imaging. APPRAISAL AND PRACTICAL RECOMMENDATIONS The use of the conventional X‑ray skeletal status (Paris scheme) is obsolete. When a patient with symptomatic multiple myeloma is initially diagnosed, a whole-body CT should be performed to determine the extent of skeletal damage. The S3 guideline also regards CT as the first imaging modality in relapse and progression.
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Abstract
BACKGROUND Plasma cell dyscrasias are a spectrum of diseases characterized by clonal plasma cell proliferation. Important entities within this group are monoclonal gammopathy of unknown significance, smoldering multiple myeloma, and symptomatic multiple myeloma. PURPOSE The goal of this review is to illustrate plasma cell dyscrasia imaging findings of bone and bone marrow as seen on whole-body computed tomography (CT) and magnetic resonance imaging (MRI) and to discuss the relevance of imaging for management of patients with plasma cell dyscrasias. MATERIALS AND METHODS Selective literature search with analysis of dedicated original research articles and reviews and discussion of clinical guidelines. RESULTS Diagnostic classification of plasma cell dyscrasias is based on the SLiM-CRAB criteria. CT primarily represents imaging of mineralized bone to show osseous end organ damage by detecting osteodestruction. MRI is primarily used for bone marrow imaging to detect diffuse or focal bone marrow infiltration, even in the absence of bone destruction. Different patterns of bone marrow infiltration can be distinguished. Treatment response is associated with characteristic imaging signs of lesion regression. CONCLUSION Imaging plays a prominent role in treatment stratification of patients with plasma cell dyscrasia at first diagnosis and during follow-up.
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Doyle E, Dimmock M, Lee K, Ng J, Bassed R. A systematised literature review: Can low-dose whole-body computed tomography replace a radiographic skeletal survey when investigating paediatric non-accidental injury? FORENSIC IMAGING 2021. [DOI: 10.1016/j.fri.2021.200481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pierro A, Posa A, Astore C, Sciandra M, Tanzilli A, Petrosino A, del Balso MS, Fraticelli V, Cilla S, Iezzi R. Whole-Body Low-Dose Multidetector-Row CT in Multiple Myeloma: Guidance in Performing, Observing, and Interpreting the Imaging Findings. Life (Basel) 2021; 11:life11121320. [PMID: 34947851 PMCID: PMC8707516 DOI: 10.3390/life11121320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 01/21/2023] Open
Abstract
Multiple myeloma is a hematological malignancy of plasma cells usually detected due to various bone abnormalities on imaging and rare extraosseous abnormalities. The traditional approach for disease detection was based on plain radiographs, showing typical lytic lesions. Still, this technique has many limitations in terms of diagnosis and assessment of response to treatment. The new approach to assess osteolytic lesions in patients newly diagnosed with multiple myeloma is based on total-body low-dose CT. The purpose of this paper is to suggest a guide for radiologists in performing and evaluating a total-body low-dose CT in patients with multiple myeloma, both newly-diagnosed and in follow-up (pre and post treatment).
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Affiliation(s)
- Antonio Pierro
- Department of Radiology, “A. Cardarelli” Regional Hospital, ASReM, Contrada Tappino, 86100 Campobasso, Italy; (A.P.); (M.S.); (M.S.d.B.)
| | - Alessandro Posa
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy; (A.T.); (A.P.); (R.I.)
- Correspondence:
| | - Costanzo Astore
- Radiology Unit, Gemelli Molise Hospital, L.go A. Gemelli 1, 86100 Campobasso, Italy;
| | - Mariacarmela Sciandra
- Department of Radiology, “A. Cardarelli” Regional Hospital, ASReM, Contrada Tappino, 86100 Campobasso, Italy; (A.P.); (M.S.); (M.S.d.B.)
| | - Alessandro Tanzilli
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy; (A.T.); (A.P.); (R.I.)
| | - Antonella Petrosino
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy; (A.T.); (A.P.); (R.I.)
| | - Maria Saveria del Balso
- Department of Radiology, “A. Cardarelli” Regional Hospital, ASReM, Contrada Tappino, 86100 Campobasso, Italy; (A.P.); (M.S.); (M.S.d.B.)
| | - Vincenzo Fraticelli
- Hematology Unit, Gemelli Molise Hospital, L.go A. Gemelli 1, 86100 Campobasso, Italy;
| | - Savino Cilla
- Medical Phisics Unit, Gemelli Molise Hospital, L.go A. Gemelli 1, 86100 Campobasso, Italy;
| | - Roberto Iezzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy; (A.T.); (A.P.); (R.I.)
- Radiology Unit, Gemelli Molise Hospital, L.go A. Gemelli 1, 86100 Campobasso, Italy;
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Musto P, Engelhardt M, Caers J, Bolli N, Kaiser M, Van de Donk N, Terpos E, Broijl A, De Larrea CF, Gay F, Goldschmidt H, Hajek R, Vangsted AJ, Zamagni E, Zweegman S, Cavo M, Dimopoulos M, Einsele H, Ludwig H, Barosi G, Boccadoro M, Mateos MV, Sonneveld P, Miguel JS. 2021 European Myeloma Network review and consensus statement on smoldering multiple myeloma: how to distinguish (and manage) Dr. Jekyll and Mr. Hyde. Haematologica 2021; 106:2799-2812. [PMID: 34261295 PMCID: PMC8561280 DOI: 10.3324/haematol.2021.278519] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/15/2021] [Indexed: 11/09/2022] Open
Abstract
According to the updated International Myeloma Working Group criteria, smoldering multiple myeloma (SMM) is an asymptomatic plasma cell disorder characterized by an M-component >3 g/dL, bone marrow plasma cell infiltration >10% and <60%, and absence of any myeloma-defining event. Active multiple myeloma is preceded by SMM, with a median time to progression of approximately 5 years. Cases of SMM range from the extremes of "monoclonal gammopathy of undetermined significance-like", in which patients never progress during their lifetimes, to "early multiple myeloma", in which transformation into symptomatic disease, based on genomic evolution, may be rapid and devastating. Such a "split personality" makes the prognosis and management of individual patients challenging, particularly with regard to the identification and possible early treatment of high-risk SMM. Outside of clinical trials, the conventional approach to SMM generally remains close observation until progression to active multiple myeloma. However, two prospective, randomized trials have recently demonstrated a significant clinical benefit in terms of time to progression, and of overall survival in one of the two studies, for some patients with higher-risk SMM treated with lenalidomide ± dexamethasone, raising the question of whether such an approach should be considered a new standard of care. In this paper, experts from the European Myeloma Network describe current biological and clinical knowledge on SMM, focusing on novel insights into its molecular pathogenesis, new prognostic scoring systems proposed to identify SMM patients at higher risk of early transformation, and updated results of completed or ongoing clinical trials. Finally, some practical recommendations for the real-life management of these patients, based on Delphi consensus methodology, are provided.
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Affiliation(s)
- Pellegrino Musto
- "Aldo Moro" University School of Medicine, Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico, Bari.
| | - Monika Engelhardt
- Department of Medicine I, Medical Center - University of Freiburg, Freiburg, Faculty of Medicine, University of Freiburg
| | - Jo Caers
- Department of Clinical Hematology, CHU of Liège, Liège, Belgium; Laboratory of Hematology, GIGA-I3, University of Liège, Liège
| | - Niccolo' Bolli
- Division of Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Department of Oncology and Onco-Hematology, University of Milan, Milano
| | - Martin Kaiser
- The Institute of Cancer Research, Division of Molecular Pathology, London, UK; The Royal Marsden Hospital, Department of Haematology, London
| | - Niels Van de Donk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam
| | - Evangelos Terpos
- Stem Cell Transplantation Unit, Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens
| | - Annemiek Broijl
- Erasmus MC Cancer Institute and Erasmus University of Rotterdam, Rotterdam
| | - Carlos Fernández De Larrea
- Amyloidosis and Myeloma Unit, Department of Hematology, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino
| | - Hartmut Goldschmidt
- University Hospital Heidelberg Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg
| | - Roman Hajek
- Department of Hemato-oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | | | - Elena Zamagni
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna
| | - Sonja Zweegman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Cancer Center Amsterdam, Amsterdam
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna
| | - Meletios Dimopoulos
- National and Kapodistrian University of Athens, School of Medicine, Department of Clinical Therapeutics, Athens
| | - Hermann Einsele
- University Hospital Würzburg, Internal Medicine II, Würzburg
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, 1st Department of Medicine, Center for Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna
| | | | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino
| | | | - Pieter Sonneveld
- Erasmus MC Cancer Institute and Erasmus University of Rotterdam, Rotterdam
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Schenone D, Dominietto A, Campi C, Frassoni F, Cea M, Aquino S, Angelucci E, Rossi F, Torri L, Bignotti B, Tagliafico AS, Piana M. Radiomics and Artificial Intelligence for Outcome Prediction in Multiple Myeloma Patients Undergoing Autologous Transplantation: A Feasibility Study with CT Data. Diagnostics (Basel) 2021; 11:diagnostics11101759. [PMID: 34679456 PMCID: PMC8535117 DOI: 10.3390/diagnostics11101759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/08/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
Multiple myeloma is a plasma cell dyscrasia characterized by focal and non-focal bone lesions. Radiomic techniques extract morphological information from computerized tomography images and exploit them for stratification and risk prediction purposes. However, few papers so far have applied radiomics to multiple myeloma. A retrospective study approved by the institutional review board: n = 51 transplanted patients and n = 33 (64%) with focal lesion analyzed via an open-source toolbox that extracted 109 radiomics features. We also applied a dedicated tool for computing 24 features describing the whole skeleton asset. The redundancy reduction was realized via correlation and principal component analysis. Fuzzy clustering (FC) and Hough transform filtering (HTF) allowed for patient stratification, with effectiveness assessed by four skill scores. The highest sensitivity and critical success index (CSI) were obtained representing each patient, with 17 focal features selected via correlation with the 24 features describing the overall skeletal asset. These scores were higher than the ones associated with a standard cytogenetic classification. The Mann–Whitney U-test showed that three among the 17 imaging descriptors passed the null hypothesis. This AI-based interpretation of radiomics features stratified relapsed and non-relapsed MM patients, showing some potentiality for the determination of the prognostic image-based biomarkers in disease follow-up.
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Affiliation(s)
- Daniela Schenone
- LISCOMP, Dipartimento di Matematica, Università di Genova, Via Dodecaneso 35, 16146 Genova, Italy; (D.S.); (C.C.); (F.F.)
| | - Alida Dominietto
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
| | - Cristina Campi
- LISCOMP, Dipartimento di Matematica, Università di Genova, Via Dodecaneso 35, 16146 Genova, Italy; (D.S.); (C.C.); (F.F.)
| | - Francesco Frassoni
- LISCOMP, Dipartimento di Matematica, Università di Genova, Via Dodecaneso 35, 16146 Genova, Italy; (D.S.); (C.C.); (F.F.)
| | - Michele Cea
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
- Dipartimento di Medicina Interna, Università di Genova, Viale Benedetto XV, 16132 Genova, Italy
| | - Sara Aquino
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
| | - Emanuele Angelucci
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
| | - Federica Rossi
- Dipartimento di Medicina Sperimentale, Università di Genova, Via L. B. Alberti 1, 16132 Genova, Italy;
| | - Lorenzo Torri
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
| | - Bianca Bignotti
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
- Dipartimento di Medicina Sperimentale, Università di Genova, Via L. B. Alberti 1, 16132 Genova, Italy;
| | - Alberto Stefano Tagliafico
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
- Dipartimento di Scienze della Salute, Università di Genova, Via Pastore 1, 16132 Genova, Italy
- Correspondence: (A.S.T.); (M.P.)
| | - Michele Piana
- Ospedale Policlinico San Martino-IRCCS, Largo Rossana Benzi 10, 16132 Genova, Italy; (A.D.); (M.C.); (S.A.); (E.A.); (L.T.); (B.B.)
- CNR-SPIN Genova, Via Dodecaneso 33, 16146 Genova, Italy
- Correspondence: (A.S.T.); (M.P.)
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45
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Wallington-Beddoe CT, Mynott RL. Prognostic and predictive biomarker developments in multiple myeloma. J Hematol Oncol 2021; 14:151. [PMID: 34556161 PMCID: PMC8461914 DOI: 10.1186/s13045-021-01162-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022] Open
Abstract
New approaches to stratify multiple myeloma patients based on prognosis and therapeutic decision-making, or prediction, are needed since patients are currently managed in a similar manner regardless of individual risk factors or disease characteristics. However, despite new and improved biomarkers for determining the prognosis of patients, there is currently insufficient information to utilise biomarkers to intensify, reduce or altogether change treatment, nor to target patient-specific biology in a so-called predictive manner. The ever-increasing number and complexity of drug classes to treat multiple myeloma have improved response rates and so clinically useful biomarkers will need to be relevant in the era of such novel therapies. Therefore, the field of multiple myeloma biomarker development is rapidly progressing, spurred on by new technologies and therapeutic approaches, and underpinned by a deeper understanding of tumour biology with individualised patient management the goal. In this review, we describe the main biomarker categories in multiple myeloma and relate these to diagnostic, prognostic and predictive applications. ![]()
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Affiliation(s)
- Craig T Wallington-Beddoe
- College of Medicine and Public Health, Level 4, Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, 5042, Australia. .,Flinders Medical Centre, Bedford Park, SA, 5042, Australia. .,Centre for Cancer Biology, SA Pathology and The University of South Australia, Adelaide, SA, 5000, Australia. .,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Rachel L Mynott
- College of Medicine and Public Health, Level 4, Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, 5042, Australia
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46
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Dalen V, Vegsgaard Olsen AS, Jerome CP, Geitung JT, Dahm AEA. Low diagnostic accuracy and inter-observer agreement on CT and MRI in diagnosis of spinal fractures in multiple myeloma. Hematol Rep 2021; 13:9037. [PMID: 34733448 PMCID: PMC8506199 DOI: 10.4081/hr.2021.9037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 09/10/2021] [Indexed: 11/23/2022] Open
Abstract
Skeletal disease is common in multiple myeloma. We investigated the inter-observer agreement and diagnostic accuracy of spinal fractures diagnosed by computer tomography (CT) and magnetic resonance imaging (MRI) from 12 myeloma patients. Two radiologists independently assessed the images. CT, MRI, and other images were combined to a gold standard. The inter-observer agreement was assessed with Cohen’s kappa. Radiologist 1 diagnosed 20 malignant spinal fractures on CT and 26 on MRI, while radiologist 2 diagnosed 12 malignant spinal fractures on CT and 22 on MRI. In comparison the gold standard diagnosed 10 malignant spinal fractures. The sensitivity for malignant fractures varied from 0.5 to 1 for CT and MRI, and the specificity varied from 0.17 to 0.67. On MRI, the specificity for malignant spinal fractures was 0.17 for both radiologists. The inter-observer agreement for malignant spinal fractures on CT was -0.42 (Cohen’s kappa) and -0.13 for MRI, while for osteoporotic fractures it was -0.24 for CT and 0.53 for MRI. We conclude that malignant spinal fractures were over-diagnosed on CT and MRI. The inter-observer agreement was extremely poor.
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Affiliation(s)
| | | | | | - Jonn-Terje Geitung
- Department of Radiology, Akershus University Hospital, Lørenskog.,Institute of Clinical Medicine, University of Oslo
| | - Anders E A Dahm
- Institute of Clinical Medicine, University of Oslo.,Department of Haematology, Akershus University Hospital, Lørenskog, Norway
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47
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Lee K, Kim KW, Ko Y, Park HY, Chae EJ, Lee JH, Ryu JS, Chung HW. Comprehensive Updates in the Role of Imaging for Multiple Myeloma Management Based on Recent International Guidelines. Korean J Radiol 2021; 22:1497-1513. [PMID: 34448381 PMCID: PMC8390819 DOI: 10.3348/kjr.2020.0886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 01/18/2021] [Accepted: 01/31/2021] [Indexed: 02/02/2023] Open
Abstract
The diagnostic and treatment methods of multiple myeloma (MM) have been rapidly evolving owing to advances in imaging techniques and new therapeutic agents. Imaging has begun to play an important role in the management of MM, and international guidelines are frequently updated. Since the publication of 2015 International Myeloma Working Group (IMWG) criteria for the diagnosis of MM, whole-body magnetic resonance imaging (MRI) or low-dose whole-body computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/CT have entered the mainstream as diagnostic and treatment response assessment tools. The 2019 IMWG guidelines also provide imaging recommendations for various clinical settings. Accordingly, radiologists have become a key component of MM management. In this review, we provide an overview of updates in the MM field with an emphasis on imaging modalities.
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Affiliation(s)
- Koeun Lee
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea.,Department of Nuclear Medicine, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Yousun Ko
- Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Ho Young Park
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jin Chae
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Won Chung
- Department of Radiology, Asan Image Metrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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48
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Bravo-Pérez C, Sola M, Teruel-Montoya R, García-Malo MD, Ortuño FJ, Vicente V, de Arriba F, Jerez A. Minimal Residual Disease in Multiple Myeloma: Something Old, Something New. Cancers (Basel) 2021; 13:4332. [PMID: 34503142 PMCID: PMC8430644 DOI: 10.3390/cancers13174332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022] Open
Abstract
The game-changing outcome effect, due to the generalized use of novel agents in MM, has cre-ated a paradigm shift. Achieving frequent deep responses has placed MM among those neoplasms where the rationale for assessing MRD is fulfilled. However, its implementation in MM has raised specific questions: how might we weight standard measures against deep MRD in the emerging CAR-T setting? Which high sensitivity method to choose? Are current response criteria still useful? In this work, we address lessons learned from the use of MRD in other neoplasms, the steps followed for the harmonization of current methods for comprehensively measuring MRD, and the challenges that new therapies and concepts pose in the MM clinical field.
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Affiliation(s)
- Carlos Bravo-Pérez
- Hematology and Medical Oncology Department, University Hospital Morales Meseguer, IMIB, 30003 Murcia, Spain; (C.B.-P.); (M.S.); (M.D.G.-M.); (F.J.O.); (V.V.); (F.d.A.); (A.J.)
| | - María Sola
- Hematology and Medical Oncology Department, University Hospital Morales Meseguer, IMIB, 30003 Murcia, Spain; (C.B.-P.); (M.S.); (M.D.G.-M.); (F.J.O.); (V.V.); (F.d.A.); (A.J.)
| | - Raúl Teruel-Montoya
- Hematology and Medical Oncology Department, University Hospital Morales Meseguer, IMIB, 30003 Murcia, Spain; (C.B.-P.); (M.S.); (M.D.G.-M.); (F.J.O.); (V.V.); (F.d.A.); (A.J.)
- CB15/00055-CIBERER, 30003 Murcia, Spain
| | - María Dolores García-Malo
- Hematology and Medical Oncology Department, University Hospital Morales Meseguer, IMIB, 30003 Murcia, Spain; (C.B.-P.); (M.S.); (M.D.G.-M.); (F.J.O.); (V.V.); (F.d.A.); (A.J.)
| | - Francisco José Ortuño
- Hematology and Medical Oncology Department, University Hospital Morales Meseguer, IMIB, 30003 Murcia, Spain; (C.B.-P.); (M.S.); (M.D.G.-M.); (F.J.O.); (V.V.); (F.d.A.); (A.J.)
| | - Vicente Vicente
- Hematology and Medical Oncology Department, University Hospital Morales Meseguer, IMIB, 30003 Murcia, Spain; (C.B.-P.); (M.S.); (M.D.G.-M.); (F.J.O.); (V.V.); (F.d.A.); (A.J.)
- CB15/00055-CIBERER, 30003 Murcia, Spain
| | - Felipe de Arriba
- Hematology and Medical Oncology Department, University Hospital Morales Meseguer, IMIB, 30003 Murcia, Spain; (C.B.-P.); (M.S.); (M.D.G.-M.); (F.J.O.); (V.V.); (F.d.A.); (A.J.)
| | - Andrés Jerez
- Hematology and Medical Oncology Department, University Hospital Morales Meseguer, IMIB, 30003 Murcia, Spain; (C.B.-P.); (M.S.); (M.D.G.-M.); (F.J.O.); (V.V.); (F.d.A.); (A.J.)
- CB15/00055-CIBERER, 30003 Murcia, Spain
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49
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Spinnato P, Filonzi G, Conficoni A, Facchini G, Ponti F, Sambri A, De Paolis M, Cavo M, Salizzoni E, Nanni C. Skeletal Survey in Multiple Myeloma: Role of Imaging. Curr Med Imaging 2021; 17:956-965. [PMID: 33573573 DOI: 10.2174/1573405617666210126155129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/23/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022]
Abstract
Bone disease is the hallmark of multiple myeloma. Skeletal lesions are evaluated to establish the diagnosis, to choose the therapies and also to assess the response to treatments. Due to this, imaging procedures play a key role in the management of multiple myeloma. For decades, conventional radiography has been the standard imaging modality. Subsequently, advances in the treatment of multiple myeloma have increased the need for an accurate evaluation of skeletal disease. The introduction of new high performant imaging tools, such as whole-body lowdose computed tomography, different types of magnetic resonance imaging studies, and 18F-fluorodeoxyglucose positron emission tomography, replaced the conventional radiography. In this review, we analyze the diagnostic potentials, indications of use, and applications of the imaging tools nowadays available. Whole-body low-dose CT should be considered as the imaging modality of choice for the initial assessment of multiple myeloma lytic bone lesions. MRI is the gold-standard for the detection of bone marrow involvement, while PET/CT is the preferred technique in the assessment of response to therapy. Both MRI and PET/CT are able to provide prognostic information.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alberto Conficoni
- Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Sambri
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Michele Cavo
- "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Eugenio Salizzoni
- Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, MNM AOU S.Orsola-Malpighi, Bologna, Italy
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50
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Hemminki K, Försti A, Houlston R, Sud A. Epidemiology, genetics and treatment of multiple myeloma and precursor diseases. Int J Cancer 2021; 149:1980-1996. [PMID: 34398972 DOI: 10.1002/ijc.33762] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/17/2022]
Abstract
Multiple myeloma (MM) is a hematological malignancy caused by the clonal expansion of plasma cells. The incidence of MM worldwide is increasing with greater than 140 000 people being diagnosed with MM per year. Whereas 5-year survival after a diagnosis of MM has improved from 28% in 1975 to 56% in 2012, the disease remains essentially incurable. In this review, we summarize our current understanding of MM including its epidemiology, genetics and biology. We will also provide an overview of MM management that has led to improvements in survival, including recent changes to diagnosis and therapies. Areas of unmet need include the management of patients with high-risk MM, those with reduced performance status and those refractory to standard therapies. Ongoing research into the biology and early detection of MM as well as the development of novel therapies, such as immunotherapies, has the potential to influence MM practice in the future.
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Affiliation(s)
- Kari Hemminki
- Biomedical Center, Faculty of Medicine, Charles University in Pilsen, Pilsen, Czech Republic.,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Richard Houlston
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Amit Sud
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.,The Department of Haemato-Oncology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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