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Monoclonal Gammopathies and the Bone Marrow Microenvironment: From Bench to Bedside and Then Back Again. Hematol Rep 2023; 15:23-49. [PMID: 36648882 PMCID: PMC9844382 DOI: 10.3390/hematolrep15010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/11/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
Multiple myeloma (MM) is an incurable hematologic malignancy characterized by a multistep evolutionary pathway, with an initial phase called monoclonal gammopathy of undetermined significance (MGUS), potentially evolving into the symptomatic disease, often preceded by an intermediate phase called "smoldering" MM (sMM). From a biological point of view, genomic alterations (translocations/deletions/mutations) are already present at the MGUS phase, thus rendering their role in disease evolution questionable. On the other hand, we currently know that changes in the bone marrow microenvironment (TME) could play a key role in MM evolution through a progressive shift towards a pro-inflammatory and immunosuppressive shape, which may drive cancer progression as well as clonal plasma cells migration, proliferation, survival, and drug resistance. Along this line, the major advancement in MM patients' survival has been achieved by the introduction of microenvironment-oriented drugs (including immunomodulatory drugs and monoclonal antibodies). In this review, we summarized the role of the different components of the TME in MM evolution from MGUS as well as potential novel therapeutic targets/opportunities.
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Newly Diagnosed Multiple Myeloma Patients with Skeletal-Related Events and Abnormal MRI Pattern Have Poor Survival Outcomes: A Prospective Study on 370 Patients. J Clin Med 2022; 11:jcm11113088. [PMID: 35683473 PMCID: PMC9181401 DOI: 10.3390/jcm11113088] [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: 04/07/2022] [Revised: 05/14/2022] [Accepted: 05/27/2022] [Indexed: 11/21/2022] Open
Abstract
Contemporary information is sparse on the frequency of skeletal-related events (SREs) in multiple myeloma (MM) patients at a population-based level in the era of novel agents. In this context, we conducted this single-center, prospective, observational study to determine the incidence of SREs among newly diagnosed MMs (NDMM) and to explore the possible correlations with disease characteristics, imaging finding, and patient prognosis. A total of 370 patients with available baseline MRIs were included. Among them, 208 (56%) presented with at least one SRE at diagnosis. Fractures were the most common reported SREs (48%). The incidence of SREs at diagnosis was higher in patients with osteolytic lesions, abnormal MRI pattern, hypercalcemia, and at least 60% bone marrow infiltration by plasma cells. Importantly, the patients with normal MRI pattern, who did not present with SREs at diagnosis, had statistically significant improved median OS in comparison with the patients who had abnormal MRI patterns and/or the presence of SREs at diagnosis (9.3 vs. 6.6 years, p = 0.048). Our data, which represent one of a few systematic reports on the incidence and characteristics of SREs in the era of novel agents, was indicative of a high incidence of SREs at the time of MM diagnosis. Early detection of myeloma bone disease and tailored patient management are essential to optimize patient outcomes.
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Zensen S, Bos D, Opitz M, Haubold J, Forsting M, Guberina N, Wetter A. Radiation exposure and establishment of diagnostic reference levels of whole-body low-dose CT for the assessment of multiple myeloma with second- and third-generation dual-source CT. Acta Radiol 2022; 63:527-535. [PMID: 33745295 DOI: 10.1177/02841851211003287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the assessment of diseases causing skeletal lesions such as multiple myeloma (MM), whole-body low-dose computed tomography (WBLDCT) is a sensitive diagnostic imaging modality, which has the potential to replace the conventional radiographic survey. PURPOSE To optimize radiation protection and examine radiation exposure, and effective and organ doses of WBLDCT using different modern dual-source CT (DSCT) devices, and to establish local diagnostic reference levels (DRL). MATERIAL AND METHODS In this retrospective study, 281 WBLDCT scans of 232 patients performed between January 2017 and April 2020 either on a second- (A) or third-generation (B) DSCT device could be included. Radiation exposure indices and organ and effective doses were calculated using a commercially available automated dose-tracking software based on Monte-Carlo simulation techniques. RESULTS The radiation exposure indices and effective doses were distributed as follows (median, interquartile range): (A) second-generation DSCT: volume-weighted CT dose index (CTDIvol) 1.78 mGy (1.47-2.17 mGy); dose length product (DLP) 282.8 mGy·cm (224.6-319.4 mGy·cm), effective dose (ED) 1.87 mSv (1.61-2.17 mSv) and (B) third-generation DSCT: CTDIvol 0.56 mGy (0.47-0.67 mGy), DLP 92.0 mGy·cm (73.7-107.6 mGy·cm), ED 0.61 mSv (0.52-0.69 mSv). Radiation exposure indices and effective and organ doses were significantly lower with third-generation DSCT (P < 0.001). Local DRLs could be set for CTDIvol at 0.75 mGy and DLP at 120 mGy·cm. CONCLUSION Third-generation DSCT requires significantly lower radiation dose for WBLDCT than second-generation DSCT and has an effective dose below reported doses for radiographic skeletal surveys. To ensure radiation protection, DRLs regarding WBLDCT are required, where our locally determined values may help as benchmarks.
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Affiliation(s)
- Sebastian Zensen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Denise Bos
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Nika Guberina
- Department of Radiotherapy, University Hospital Essen, Essen, Germany
| | - Axel Wetter
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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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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Nanni C, Zanoni L, Fanti S. Radiological and Nuclear Medicine Imaging of Multiple Myeloma. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ippolito D, Giandola T, Maino C, Gandola D, Ragusi M, Brambilla P, Bonaffini PA, Sironi S. Diagnostic Value of Whole-Body MRI Short Protocols in Bone Lesion Detection in Multiple Myeloma Patients. Diagnostics (Basel) 2021; 11:diagnostics11061053. [PMID: 34201122 PMCID: PMC8226715 DOI: 10.3390/diagnostics11061053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 02/05/2023] Open
Abstract
The aim of the study is to evaluate the effectiveness of short whole-body magnetic resonance imaging (WBMRI) protocols for the overall assessment of bone marrow involvement in patients with multiple myeloma (MM), in comparison with standard whole-body MRI protocol. Patients with biopsy-proven MM, who underwent a WBMRI with full-body coverage (from vertex to feet) were retrospectively enrolled. WBMRI images were independently evaluated by two expert radiologists, in terms of infiltration patterns (normal, focal, diffuse, and combined), according to location (the whole skeleton was divided into six anatomic districts: skull, spine, sternum and ribs, upper limbs, pelvis and proximal two-thirds of the femur, remaining parts of lower limbs) and lytic lesions number (<5, 5-20, and >20). The majority of patients showed focal and combined infiltration patterns with bone lesions predominantly distributed in the spine and pelvis. As skull and lower limbs are less frequently involved by focal bone lesions, excluding them from the standard MRI protocol allows to obtain a shorter protocol, maintaining a good diagnostic value.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Correspondence:
| | - Teresa Giandola
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Cesare Maino
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Davide Gandola
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Maria Ragusi
- Department of Diagnostic Radiology, “San Gerardo” Hospital, Via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Paolo Brambilla
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy;
| | - Pietro Andrea Bonaffini
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy;
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy;
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Ippolito D, Giandola T, Maino C, Gandola D, Ragusi M, Bonaffini PA, Sironi S. Whole Body Low Dose Computed Tomography (WBLDCT) Can Be Comparable to Whole-Body Magnetic Resonance Imaging (WBMRI) in the Assessment of Multiple Myeloma. Diagnostics (Basel) 2021; 11:diagnostics11050857. [PMID: 34064594 PMCID: PMC8150749 DOI: 10.3390/diagnostics11050857] [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: 04/11/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 02/07/2023] Open
Abstract
Aim of the study is to compare the agreement between whole-body low-dose computed tomography (WBLDCT) and magnetic resonance imaging (WBMRI) in the evaluation of bone marrow involvement in patients with multiple myeloma (MM). Patients with biopsy-proven MM, who underwent both WBLDCT and WBMRI were retrospectively enrolled. After identifying the presence of focal bone involvement (focal infiltration pattern), the whole skeleton was divided into five anatomic districts (skull, spine, sternum and ribs, pelvis, and limbs). Patients were grouped according to the number and location of the lytic lesions (<5, 5-20, and >20) and Durie and Salmon staging system. The agreement between CT and MRI regarding focal pattern, staging, lesion number, and distribution was assessed using the Cohen Kappa statistics. The majority of patients showed focal involvement. According to the distribution of the focal lesions and Durie Salmon staging, the agreement between CT and MRI was substantial or almost perfect (all κ > 0.60). The agreement increased proportionally with the number of lesions in the pelvis and spine (κ = 0.373 to κ = 0.564, and κ = 0.469-0.624), while for the skull the agreement proportionally decreased without reaching a statistically significant difference (p > 0.05). In conclusion, WBLDCT showed an almost perfect agreement in the evaluation of focal involvement, staging, lesion number, and distribution of bone involvement in comparison with WBMRI.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Correspondence:
| | - Teresa Giandola
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Cesare Maino
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Davide Gandola
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Maria Ragusi
- Department of Diagnostic Radiology, “San Gerardo” Hospital, via Pergolesi 33, 20900 Monza, MB, Italy; (T.G.); (C.M.); (D.G.); (M.R.)
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
| | - Pietro Andrea Bonaffini
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, via Cadore 48, 20900 Monza, MB, Italy; (P.A.B.); (S.S.)
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, BG, Italy
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Ippolito D, Giandola T, Maino C, Pecorelli A, Ragusi M, Porta M, Gandola D, Franzesi CT, Sironi S. Whole-body low-dose computed tomography (WBLDCT) in staging and re-staging of multiple myeloma. Ann Hematol 2021; 100:1241-1249. [PMID: 33660034 DOI: 10.1007/s00277-021-04468-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/18/2021] [Indexed: 02/08/2023]
Abstract
The objective of this study is to evaluate the prognostic features of multiple myeloma (MM) using whole-body low-dose computed tomography (WBLDCT). One hundred three patients with biopsy-proven MM who underwent WBLDCT were retrospectively enrolled. The evolution of osteolytic lesions overtime was performed by measuring the maximum axial diameter at the baseline (T0) and the end of follow-up (Te), by using a cut-off value of 10 mm. The location and dimension of up to three lesions were registered. The time-to-fracture (TTF) was recorded. Sixty-three percent of patients presented a focal pattern, 22% a diffuse pattern, and 15% a combined one. Seventy-two percent of patients with lesions ≤ 10 mm presented stability, 27% a dimensional increase, and 1% a decrease. Patients with lesions >10 mm showed a statistically significant difference regarding the mean difference of axial diameter between T0 and Te (p = 0.015). Patients with lesions >10 mm showed an odds ratio (OR) of 29.8 (95%CIs 3.8-230.5) to develop at least one fracture. Mean TTF was significantly lower in patients with lesions >10 mm in comparison with lesions ≤ 10 mm (9 ± 3 vs 23 ± 7 months, respectively, p = 0.011). WBLDCT represents a reliable imaging-based tool for proper management of MM patients, showing that diffuse form or small lytic lesions may deserve a less frequent follow-up.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy.
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.
| | - Anna Pecorelli
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Maria Ragusi
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Marco Porta
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Davide Gandola
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, BG, Italy
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Manyega KM, Lotodo TC, Oduor MA, Namaemba DF, Omondi AA, Oyolo YL, Oguda J, Loehrer PJ, Vik TA, Asirwa FC. Retrospective Analysis of Presentation, Treatment, and Outcomes of Multiple Myeloma at a Large Public Referral Hospital in Eldoret, Kenya. JCO Glob Oncol 2021; 7:391-399. [PMID: 33729826 PMCID: PMC8081506 DOI: 10.1200/go.20.00573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/22/2020] [Accepted: 01/28/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Treatment patterns and survival outcomes of patients with multiple myeloma (MM) in Kenya have not been adequately characterized. The objectives of this study were to describe the clinical, laboratory, and imaging findings at diagnosis, to describe the treatment offered, and to determine the survival outcomes of patients with MM over an 11-year period. PATIENTS AND METHODS A retrospective chart review was carried out for all patients who were diagnosed and treated for MM at Moi Teaching and Referral Hospital from 2009 to 2019. The Kaplan-Meier method was used to estimate survival. Factors affecting survival were identified using univariate and multivariate analyses. RESULTS A total of 221 patient charts were analyzed of which 124 belonged to male patients (56.1%). The median age at diagnosis was 61 years. Bone pain was the most common presenting complaint observed in 69.6% of 194 patients assessed. Out of 102 patients who received imaging studies, 60 (58.8%) had lytic lesions, 30 (29.4%) had fractures, whereas 30 (29.4%) had spinal cord compression. Anemia, renal failure, and hypercalcemia were observed in 87/187 (46.5%), 22/161 (13.7%), and 23/42 (54.8%) patients, respectively. Thalidomide and dexamethasone (65.2%); bortezomib, thalidomide, and dexamethasone (14.6%); and melphalan and prednisolone (11.9%) were the most prescribed initial chemotherapy regimens among 219 patients analyzed. Overall survival at 1 and 5 years was 70% and 21%, respectively; median overall survival was 29.0 months. In multivariate analysis, male sex (hazard ratio [HR] 1.9), baseline anemia (HR 1.8), and baseline renal failure (HR 3.2) were associated with significantly shorter survival. CONCLUSION Survival outcomes were poor despite increased use of multiagent-based chemotherapy regimens. Greater access to available diagnostics and treatments is required to achieve rational treatment and increased survival.
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Affiliation(s)
- Kelvin M. Manyega
- Directorate of Pharmacy and Nutrition, Moi Teaching and Referral Hospital, Eldoret, Kenya
- AMPATH Oncology Institute, Eldoret, Kenya
| | - Teresa C. Lotodo
- AMPATH Oncology Institute, Eldoret, Kenya
- Moi University, Eldoret, Kenya
| | | | | | | | | | - John Oguda
- AMPATH Oncology Institute, Eldoret, Kenya
- Indiana University School of Medicine, Indianapolis, IN
| | | | - Terry A. Vik
- Moi University, Eldoret, Kenya
- Indiana University School of Medicine, Indianapolis, IN
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Valenzuela RF, Madewell JE, Kundra V, Costelloe CM. Advanced Imaging in Musculoskeletal Oncology: Moving Away From RECIST and Embracing Advanced Bone and Soft Tissue Tumor Imaging (ABASTI)-Part II-Novel Functional Imaging Techniques. Semin Ultrasound CT MR 2020; 42:215-227. [PMID: 33814107 DOI: 10.1053/j.sult.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Functional imaging can add valuable information to conventional imaging in the settings of tumor characterization and treatment response assessment. Traditional response criteria rely primarily on physical measurements, while functional imaging can potentially give a more comprehensive evaluation of oncological status. The second part of this review article discusses advanced imaging techniques such as susceptibility-weighted imaging, tumor-associated macrophage imaging, diffusion-weighted imaging, perfusion-weighted imaging, Dixon imaging, whole-body magnetic resonance imaging, whole-body low-dose dual energy computed tomography with virtual noncalcium technique, and ultrasound elastography.
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Affiliation(s)
- Raul Fernando Valenzuela
- The University of Texas MD Anderson Cancer Center, Department of Musculoskeletal Imaging, Houston, TX.
| | - John E Madewell
- The University of Texas MD Anderson Cancer Center, Department of Musculoskeletal Imaging, Houston, TX
| | - Vikas Kundra
- The University of Texas MD Anderson Cancer Center, Department of Musculoskeletal Imaging, Houston, TX
| | - Colleen M Costelloe
- The University of Texas MD Anderson Cancer Center, Department of Musculoskeletal Imaging, Houston, TX
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The Role of Imaging and Systemic Treatments in Myeloma: A Primer for Radiologists. AJR Am J Roentgenol 2020; 214:1321-1334. [DOI: 10.2214/ajr.19.21725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Sieren MM, Brenne F, Hering A, Kienapfel H, Gebauer N, Oechtering TH, Fürschke A, Wegner F, Stahlberg E, Heldmann S, Barkhausen J, Frydrychowicz A. Rapid study assessment in follow-up whole-body computed tomography in patients with multiple myeloma using a dedicated bone subtraction software. Eur Radiol 2020; 30:3198-3209. [DOI: 10.1007/s00330-019-06631-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/20/2019] [Accepted: 12/13/2019] [Indexed: 11/28/2022]
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Medullary Abnormalities in Appendicular Skeletons Detected With 18F-FDG PET/CT Predict an Unfavorable Prognosis in Newly Diagnosed Multiple Myeloma Patients With High-Risk Factors. AJR Am J Roentgenol 2019; 213:918-924. [PMID: 31216203 DOI: 10.2214/ajr.19.21283] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE. The prognostic value of medullary abnormalities in the appendicular skeleton (AS) of patients with multiple myeloma (MM) has recently been suggested. However, functional evaluation of these abnormalities using PET/CT has not been investigated to date. This study aimed to explore the prevalence and prognostic relevance of AS medullary abnormalities depicted by PET/CT in patients with MM. MATERIALS AND METHODS. This retrospective study included 228 consecutive patients with newly diagnosed, symptomatic MM who were treated with novel agents. All patients underwent pretreatment 18F-FDG PET/CT. RESULTS. There were 157 (68.9%) patients with zero AS focal lesions, 33 (14.5%) with one to three AS focal lesions, and 38 (16.7%) with more than three AS focal lesions on pre-treatment PET/CT. Patients with more than three AS focal lesions showed significantly shorter progression-free survival (PFS) and overall survival (OS) than did those with fewer lesions (both, p < 0.001). In multivariate analysis, the presence of more than three AS focal lesions remained prognostic for both PFS and OS (both, p < 0.001). Furthermore, the presence of more than three AS focal lesions discriminated patients with both significantly shorter PFS and significantly shorter OS even among patients with established high-risk parameters, including high-risk cytogenetic abnormalities, advanced disease stage, and established high-risk PET/CT findings. CONCLUSION. The presence of more than three focal lesions in the AS on pretreatment PET/CT was an independent predictor of poor survival in patients with newly diagnosed MM. Remarkably, this finding discriminated patients with shorter survival from among those with established high-risk factors. Evaluation of findings in the AS may complement and improve the prognostic performance of known stratification systems as well as PET/CT.
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Prognostic significance of bone marrow abnormalities in the appendicular skeleton of patients with multiple myeloma. Blood Adv 2019; 2:1032-1039. [PMID: 29739774 DOI: 10.1182/bloodadvances.2017014720] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/10/2018] [Indexed: 12/22/2022] Open
Abstract
We aimed to determine the clinical and prognostic significance of medullary abnormalities detected by low-dose whole-body multidetector computed tomography (MDCT) in the appendicular skeleton (AS) of patients with newly diagnosed symptomatic multiple myeloma (MM). One hundred ninety-six patients underwent low-dose whole-body MDCT as an initial workup. Patients were categorized into 3 groups based on the medullary pattern of the AS: fatty (36.3%), focal (43.4%), and diffuse (20.4%). Medullary abnormalities were associated with Durie-Salmon and revised International Scoring System stage 3, creatinine levels >2.0 mg/dL, and the proportion of bone marrow plasma cells. The median follow-up was 35.4 months. Patients with fatty, focal, and diffuse patterns had a median survival of not reached, 56 months, and 38 months, respectively. Overall survival (OS) was associated with age, Durie-Salmon stage 3, creatinine levels >2.0 mg/dL, ineligibility for autologous stem cell transplantation, and focal and diffuse patterns on univariate analysis. Multivariate analysis showed that age and diffuse pattern (hazard ratio [HR], 1.92; 95% confidence interval [CI], 1.12-3.31; P = .018) were independent predictors of progression-free survival. Age and focal (HR, 2.51; 95% CI, 1.14-5.56; P = .023) and diffuse (HR, 4.12; 95% CI, 1.74-9.77; P = .001) patterns were also independent predictors of OS. The addition of marrow pattern to preexisting risk factors was associated with a net reclassification improvement for predicting OS (to 0.37, P = .015). Medullary abnormalities in the AS (detected by low-dose whole-body MDCT) are associated with a poor prognosis, independent of other clinical variables.
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15
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Barwick T, Bretsztajn L, Wallitt K, Amiras D, Rockall A, Messiou C. Imaging in myeloma with focus on advanced imaging techniques. Br J Radiol 2019; 92:20180768. [PMID: 30604631 DOI: 10.1259/bjr.20180768] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In recent years, there have been major advances in the imaging of myeloma with whole body MRI incorporating diffusion-weighted imaging, emerging as the most sensitive modality. Imaging is now a key component in the work-up of patients with a suspected diagnosis of myeloma. The International Myeloma Working Group now specifies that more than one focal lesion on MRI or lytic lesion on whole body low-dose CT or fludeoxyglucose (FDG) PET/CT fulfil the criteria for bone damage requiring therapy. The recent National Institute for Health and Care Excellence myeloma guidelines recommend imaging in all patients with suspected myeloma. In addition, there is emerging data supporting the use of functional imaging techniques (WB-DW MRI and FDG PET/CT) to predict outcome and evaluate response to therapy. This review summarises the imaging modalities used in myeloma, the latest guidelines relevant to imaging and future directions.
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Affiliation(s)
- Tara Barwick
- 1 Imperial College Healthcare NHS Trust , London , UK.,2 Department of Surgery and Cancer, Imperial College London , London , UK
| | | | | | | | - Andrea Rockall
- 1 Imperial College Healthcare NHS Trust , London , UK.,2 Department of Surgery and Cancer, Imperial College London , London , UK.,3 The Royal Marsden Hospital NHS Foundation Trust , London , UK
| | - Christina Messiou
- 3 The Royal Marsden Hospital NHS Foundation Trust , London , UK.,4 The Institute of Cancer Research , London , UK
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16
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Abstract
Bone disease is the most frequent feature of multiple myeloma (MM) and represents a marker of end-organ damage; it is used to establish the diagnosis and to dictate the immediate need for therapy. For this reason, imaging plays a significant role in the management of MM patients. Although conventional radiography has traditionally been the standard imaging modality, its low sensitivity in detecting osteolytic lesions and inability to evaluate response to therapy has called for the use of 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). In this review, the advantages, indications of use, and applications of the 3 techniques in the management of patients with MM in different settings will be discussed. The European Myeloma Network and the European Society for Medical Oncology 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 detection of bone marrow involvement, whereas PET/CT provides valuable prognostic data and is the preferred technique for assessment of response to therapy. Standardization of most of the techniques is ongoing.
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Zamagni E, Cavo M, Fakhri B, Vij R, Roodman D. Bones in Multiple Myeloma: Imaging and Therapy. Am Soc Clin Oncol Educ Book 2018; 38:638-646. [PMID: 30231385 DOI: 10.1200/edbk_205583] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
F-fluorodeoxyglucose (FDG)-PET/CT, MRI, and other novel imaging modalities in the management of disease in patients with plasma cell dyscrasias. We also review the state of the art in treatment of MM bone disease (MMBD) and the role of bisphosphonates and denosumab, a monoclonal antibody that binds and blocks the activity of receptor activator of nuclear factor-kappa B ligand (RANKL), which was recently approved by the U.S. Food and Drug Administration for MMBD.
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Affiliation(s)
- Elena Zamagni
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - Michele Cavo
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - Bita Fakhri
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - Ravi Vij
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
| | - David Roodman
- From the "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy; Washington University School of Medicine, St. Louis, MO; Indiana University Simon Cancer Center, Indianapolis, IN
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18
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Myeloma Bone Disease: Update on Pathogenesis and Novel Treatment Strategies. Pharmaceutics 2018; 10:pharmaceutics10040202. [PMID: 30355994 PMCID: PMC6321035 DOI: 10.3390/pharmaceutics10040202] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/15/2018] [Accepted: 10/20/2018] [Indexed: 01/31/2023] Open
Abstract
Bone disease, including osteolytic lesions and/or osteoporosis, is a common feature of multiple myeloma (MM). The consequences of skeletal involvement are severe pain, spinal cord compressions, and bone fractures, which have a dramatic impact on patients’ quality of life and, ultimately, survival. During the past few years, several landmark studies significantly enhanced our insight into MM bone disease (MBD) by identifying molecular mechanisms leading to increased bone resorption due to osteoclast activation, and decreased bone formation by osteoblast inhibition. Bisphosphonates were the mainstay to prevent skeletal-related events in MM for almost two decades. Excitingly, the most recent approval of the receptor activator of NF-kappa B ligand (RANKL) inhibitor, denosumab, expanded treatment options for MBD, for patients with compromised renal function, in particular. In addition, several other bone-targeting agents, including bone anabolic drugs, are currently in preclinical and early clinical assessment. This review summarizes our up-to-date knowledge on the pathogenesis of MBD and discusses novel state-of-the-art treatment strategies that are likely to enter clinical practice in the near future.
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Clinical characteristics and prognosis of multiple myeloma with bone-related extramedullary disease at diagnosis. Biosci Rep 2018; 38:BSR20171697. [PMID: 29685954 PMCID: PMC6435498 DOI: 10.1042/bsr20171697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 02/07/2023] Open
Abstract
Multiple myeloma (MM) is a hematological neoplasm which results in diffuse or focal bone infiltration and extramedullary lesions. It's reported that infiltration of organs by plasma cells indicated worse prognosis, but the prognosis of patients with bone-related extramedullary disease (bEMD) is still unknown. One hundred and fourteen newly diagnosed MM patients were retrospectively reviewed. Results showed that the clinical features, overall survival (OS), and progression-free survival (PFS) of patients with and without bEMD had no statistical significance. Rib (46.1%) and vertebrae (17.9%) are common sites bEMD involved. Patients with diffuse bEMD had worse prognosis compared with patients with focal bEMD. Bisphosphonates played an important role in prolonging the survival of patients with bEMD. Positron emission tomography (PET)/computed tomography (CT) is sensitive in discovering bEMD than whole body low dose CT suggesting PET/CT to be a promising technique for initial staging. High β2-microglobulin and low albumin indicated shorter survival in patients with bEMD.
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20
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Whole-body ultra-low dose CT using spectral shaping for detection of osteolytic lesion in multiple myeloma. Eur Radiol 2018; 28:2273-2280. [PMID: 29322333 DOI: 10.1007/s00330-017-5243-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/16/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the radiation dose and image quality of a whole-body low-dose CT (WBLDCT) using spectral shaping at 100 kV (Sn 100 kV) for the assessment of osteolytic lesions in patients with multiple myeloma. METHODS Thirty consecutive patients were retrospectively selected, who underwent a WBLDCT on a third-generation dual-source CT (DSCT) (Sn 100 kV, ref. mAs: 130). They were matched with patients, who were examined on a second-generation DSCT with a standard low-dose protocol (100 kV, ref. mAs: 111). Objective and subjective image quality, radiation exposure as well as the frequency of osteolytic lesions were evaluated. RESULTS All scans were of diagnostic image quality. Subjective overall image quality was significantly higher in the study group (p = 0.0003). Objective image analysis revealed that signal intensities, signal-to-noise ratio and contrast-to-noise ratio of the bony structures were equal or significantly higher in the control group. There was no significant difference in the frequency of osteolytic lesions (p = 0.259). The median effective dose of the study protocol was significantly lower (1.45 mSv vs. 5.65 mSv; p < 0.0001). CONCLUSION WBLDCT with Sn 100 kV can obtain sufficient image quality for the depiction of osteolytic lesions while reducing the radiation dose by approximately 74%. KEY POINTS • Spectral shaping using tin filtration is beneficial for whole-body low-dose CT • Sn 100 kV yields sufficient image quality for depiction of osteolytic lesions • Whole-body low-dose CT can be performed with a median dose of 1.5 mSv.
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21
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Hansford BG, Silbermann R. Advanced Imaging of Multiple Myeloma Bone Disease. Front Endocrinol (Lausanne) 2018; 9:436. [PMID: 30131767 PMCID: PMC6090033 DOI: 10.3389/fendo.2018.00436] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/16/2018] [Indexed: 12/13/2022] Open
Abstract
Multiple myeloma (MM), a malignancy of mature plasma cells, is the second most common hematologic malignancy and the most frequent cancer to involve the skeleton (1, 2). Bone disease in MM patients is characterized by lytic bone lesions that can result in pathologic fractures and severe pain. While recent advances in MM therapy have significantly increased the median survival of newly diagnosed patients (3), skeletal lesions and their sequelae continue to be a major source of patient morbidity and mortality and bone pain is the most frequent presenting symptom of MM patients (4). Rapid improvements in imaging technology now allow physicians to identify ever smaller skeletal and bone marrow abnormalities, however the clinical value of subtle radiographic findings is not always clear. This review summarizes currently available technologies for assessing MM bone disease and provides guidance for how to choose between imaging modalities.
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Affiliation(s)
- Barry G. Hansford
- Department of Diagnostic Radiology, Oregon Health and Sciences University, Portland, OR, United States
| | - Rebecca Silbermann
- Division of Hematology and Medical Oncology, Oregon Health and Sciences University, Knight Cancer Institute, Portland, OR, United States
- *Correspondence: Rebecca Silbermann
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22
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Raza S, Leng S, Lentzsch S. The Critical Role of Imaging in the Management of Multiple Myeloma. Curr Hematol Malig Rep 2017; 12:168-175. [PMID: 28317080 DOI: 10.1007/s11899-017-0379-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Multiple myeloma (MM) is characterized by abnormal proliferation of plasma cells in the bone marrow leading to symptoms of anemia, renal failure, hypercalcemia, and bone lesions. Bone imaging is critical for the diagnosis, staging, assessment for the presence and extent of bone lesions, and initial treatment of MM. Skeletal survey is the preferred initial imaging modality due to its availability and low cost. However, it has poor sensitivity and patients with occult myeloma may escape detection, delaying their diagnosis and treatment. New cross-sectional imaging modalities such as low-dose whole body CT, MRI, and PET-CT have high sensitivity and specificity for detecting lytic lesions and extramedullary relapse in MM. The combined use of cross-sectional imaging may provide complimentary information for staging, prognosis, and disease monitoring. In this review, we will discuss commonly used imaging modalities and their advantages and disadvantages in the management of MM.
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Affiliation(s)
- Shahzad Raza
- Division of Hematology/Oncology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, New York, NY, 10032, USA.
| | - Siyang Leng
- Division of Hematology/Oncology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, New York, NY, 10032, USA
| | - Suzanne Lentzsch
- Division of Hematology/Oncology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, New York, NY, 10032, USA
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23
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Abstract
PURPOSE OF REVIEW Bone disease is a defining characteristic of multiple myeloma (MM) and the major cause of morbidity. It manifests as lytic lesions or osteopenia and is often associated with severe pain, pathological fracture, spinal cord compression, vertebral collapse, and hypercalcemia. Here, we have reviewed recent data on understanding its biology and treatment. RECENT FINDINGS The imbalance between bone regeneration and bone resorption underlies the pathogenesis of osteolytic bone disease. Increased osteoclast proliferation and activity accompanied by inhibition of bone-forming osteoblasts leads to progressive bone loss and lytic lesions. Although tremendous progress has been made, MM remains an incurable disease. Novel agents targeting bone disease are under investigation with the goal of not only preventing bone loss and improving bone quality but also harnessing MM tumor growth. Current data illustrate that the interactions between MM cells and the tumor-bone microenvironment contribute to the bone disease and continued MM progression. A better understanding of this microenvironment is critical for novel therapeutic treatments of both MM and associated bone disease.
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Affiliation(s)
- Cristina Panaroni
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Professional Office Building 216, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Andrew J Yee
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Professional Office Building 216, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Noopur S Raje
- Center for Multiple Myeloma, Massachusetts General Hospital Cancer Center, Professional Office Building 216, 55 Fruit Street, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
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24
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GroΔ JP, Nattenmüller J, Hemmer S, Tichy D, Krzykalla J, Goldschmidt H, Bertsch U, Delorme S, Kauczor HU, Hillengass J, Merz M. Body fat composition as predictive factor for treatment response in patients with newly diagnosed multiple myeloma - subgroup analysis of the prospective GMMG MM5 trial. Oncotarget 2017; 8:68460-68471. [PMID: 28978130 PMCID: PMC5620270 DOI: 10.18632/oncotarget.19536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 06/03/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION/BACKGROUND Obesity is a well-known risk factor for malignant tumors and increased body mass index (BMI) is correlated to the risk of developing multiple myeloma (MM). The correlation of body fat composition with disease activity, adverse events and treatment response of MM patients has not been investigated yet. PATIENTS AND METHODS A subgroup of 108 patients from a single institution enrolled in the prospective GMMG-MM5 trial, who received a whole-body low-dose computed tomography (WBLDCT) before induction therapy, were included in this study. Body fat composition was measured in WBLDCT for each patient, divided in the compartments abdomen, pelvis, thigh and further categorized in subcutaneous (SAT) and visceral adipose tissue (VAT). The correlation of these parameters with disease activity (M protein, plasma cell count, LDH, CRAB-criteria), adverse cytogenetics, adverse events and treatment response were evaluated. RESULTS Significant reciprocal correlation was found between adverse cytogenetics and VAT of the abdomen and pelvis, respectively (gain 1q21: p=0.009 and p=0.021; t(4;14): p=0.038 and p=0.042). No correlation of VAT or SAT with adverse events was observed. Significant reciprocal correlation was observed between abdominal (p=0.03) and pelvic (p=0.035) VAT and treatment response. Abdominal VAT remains significant (p=0.034) independently of revised ISS stage and treatment. The BMI did not show a significant correlation with treatment response or investigated cytogenetics. CONCLUSION Based on the clinically relevant difference in treatment outcome depending on VAT and SAT, excessive body fat of abdomen and pelvis might be a predictive factor for poor treatment response. Further influences in this context should be considered as well, e.g. chemotherapy dosing and body fat metabolism. Further studies are necessary to investigate this hypothesis.
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Affiliation(s)
- Jonathan P GroΔ
- University of Heidelberg, Department of Internal Medicine V, Heidelberg, Germany
| | - Johanna Nattenmüller
- University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Stefan Hemmer
- University of Heidelberg, Department of Orthopedics and Trauma Surgery, Heidelberg, Germany
| | - Diana Tichy
- German Cancer Research Centre, Department of Biostatistics, Heidelberg, Germany
| | - Julia Krzykalla
- German Cancer Research Centre, Department of Biostatistics, Heidelberg, Germany
| | - Hartmut Goldschmidt
- University of Heidelberg, Department of Internal Medicine V, Heidelberg, Germany
| | - Uta Bertsch
- University of Heidelberg, Department of Internal Medicine V, Heidelberg, Germany
| | - Stefan Delorme
- German Cancer Research Centre, Department of Radiology, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg, Germany
| | - Jens Hillengass
- University of Heidelberg, Department of Internal Medicine V, Heidelberg, Germany.,German Cancer Research Centre, Department of Radiology, Heidelberg, Germany
| | - Maximilian Merz
- University of Heidelberg, Department of Internal Medicine V, Heidelberg, Germany.,German Cancer Research Centre, Department of Radiology, Heidelberg, Germany
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25
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Chrzan R, Jurczyszyn A, Urbanik A. Whole-Body Low-Dose Computed Tomography (WBLDCT) in Assessment of Patients with Multiple Myeloma - Pilot Study and Standard Imaging Protocol Suggestion. Pol J Radiol 2017; 82:356-363. [PMID: 28740565 PMCID: PMC5505575 DOI: 10.12659/pjr.901742] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/17/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND For decades, the main imaging tool in multiple myeloma (MM) patients was plain radiography. However, computed tomography (CT) has been included in the updated criteria of MM. The main disadvantage of CT is a considerably high radiation dose. Therefore, low-dose CT protocols could be a solution. The aim of the study was to (1) preliminarily analyse the usefulness of Whole-Body Low-Dose CT (WBLDCT) in the evaluation of patients with MM and (2) to make adjustments in the standard CT imaging protocol. MATERIAL/METHODS In 41 patients with MM, WBLDCT was performed. The following parameters were used: detector configuration - 80×0.5 mm, scanning range in a single spiral acquisition from the skull to the proximal femoral bones, tube voltage - 120 kVp, current tube time product - 86 mAs, slice thickness 1 mm. Two sets of axial images were reconstructed for bone and soft tissue assessment, respectively. Secondary coronal and sagittal reconstructions were generated. Typical MM features were analysed and qualitatively compared with radiography results. RESULTS A potentially increased sensitivity of CT, as compared to radiography, in detecting lytic foci obscured by other structures or with a small degree of destruction was seen. A potentially increased specificity of CT was found in detecting cases of small foci suspicious of lytic lesions on skull radiographs, seen as arachnoid granulations fovea in CT. The following radiation parameters were recorded: max. CTDIvol - 7.4 mGy and DLP - 660-810 mGy×cm. WBLDCT was much shorter and more convenient to patients. CONCLUSIONS WBLDCT may become a valuable part of the assessment of MM features at a much lower radiation dose compared to standard CT protocols. It has a potential ability to increase diagnostic accuracy compared to radiography.
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Affiliation(s)
- Robert Chrzan
- Department of Radiology, Jagiellonian University Medical College, Cracow, Poland
| | - Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Cracow, Poland
| | - Andrzej Urbanik
- Department of Radiology, Jagiellonian University Medical College, Cracow, Poland
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26
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Heusschen R, Muller J, Duray E, Withofs N, Bolomsky A, Baron F, Beguin Y, Menu E, Ludwig H, Caers J. Molecular mechanisms, current management and next generation therapy in myeloma bone disease. Leuk Lymphoma 2017; 59:14-28. [PMID: 28573897 DOI: 10.1080/10428194.2017.1323272] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Multiple myeloma (MM) bone disease is a major cause of morbidity and mortality in MM patients and persists even in patients in remission. This bone disease is caused by an uncoupling of bone remodeling, with increased osteoclast and decreased osteoblast activity and formation, culminating in lytic bone destruction. Bisphosphonates are the current standard of care but new therapies are needed. As the molecular mechanisms controlling MM bone disease are increasingly well understood, new therapeutic targets are extensively explored in the preclinical setting and initial clinical trials with novel compounds now show promising results. In this review, we will provide a comprehensive overview of the biology of MM bone disease, summarize its current clinical management and discuss preclinical and clinical data on next generation therapies.
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Affiliation(s)
- Roy Heusschen
- a Laboratory of Hematology , University of Liège, GIGA-I3 , Liège , Belgium
| | - Joséphine Muller
- a Laboratory of Hematology , University of Liège, GIGA-I3 , Liège , Belgium
| | - Elodie Duray
- a Laboratory of Hematology , University of Liège, GIGA-I3 , Liège , Belgium
| | - Nadia Withofs
- b Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics , University and CHU of Liège , Liège , Belgium
| | - Arnold Bolomsky
- c Wilhelminen Cancer Research Institute, Department of Medicine I , Center for Oncology and Hematology, Wilhelminenspital , Vienna , Austria
| | - Frédéric Baron
- a Laboratory of Hematology , University of Liège, GIGA-I3 , Liège , Belgium.,d Division of Hematology, Department of Medicine , University and CHU of Liège , Liège , Belgium
| | - Yves Beguin
- a Laboratory of Hematology , University of Liège, GIGA-I3 , Liège , Belgium.,d Division of Hematology, Department of Medicine , University and CHU of Liège , Liège , Belgium
| | - Eline Menu
- e Department of Hematology and Immunology , Myeloma Center Brussels, Vrije Universiteit Brussel , Brussels , Belgium
| | - Heinz Ludwig
- c Wilhelminen Cancer Research Institute, Department of Medicine I , Center for Oncology and Hematology, Wilhelminenspital , Vienna , Austria
| | - Jo Caers
- a Laboratory of Hematology , University of Liège, GIGA-I3 , Liège , Belgium.,d Division of Hematology, Department of Medicine , University and CHU of Liège , Liège , Belgium
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27
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Ippolito D, Talei Franzesi C, Spiga S, Besostri V, Pezzati S, Rossini F, Sironi S. Diagnostic value of whole-body ultra-low dose computed tomography in comparison with spinal magnetic resonance imaging in the assessment of disease in multiple myeloma. Br J Haematol 2017; 177:395-403. [PMID: 28233900 DOI: 10.1111/bjh.14545] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/23/2016] [Indexed: 02/05/2023]
Abstract
This study compared the diagnostic value of Whole-Body Ultra Low-Dose computed tomography (WBULDCT) with that of Spinal Magnetic Resonance Imaging (SMRI) in identification of spinal bone marrow involvement in patients with Multiple Myeloma (MM). Thirty-five patients with histologically proven MM underwent WBULDCT and dedicated SMRI. Unenhanced WBULDCT was performed on a 256-slice scanner, with 120 kV and 40 mAs. SMRI was performed on a 1·5T magnet, with T1-turbo spin echo and T2-short tau inversion recovery sequences on sagittal plane. WBULDCT was compared with SMRI in terms of lesion detection, pattern and bone marrow involvement. The overall concordance between WBULDCT and SMRI in lesion detection was 76·7%, detecting (25/35) or excluding (8/35) involvement of the axial skeleton, while in 2/35 patients WBULDCT and SMRI were discordant in terms of axial skeleton involvement. The concordance in spinal distribution of lesions was 61·6% on cervical, 71·5% on dorsal, 86·4% on lumbar and 94·4% on sacral, while for the pattern of disease, it was 56·1% for the focal and 88·7% for the combined pattern. Cohen's kappa index was 0·85 (P < 0·001) assessing an excellent agreement. WBULDCT represents a useful diagnostic tool in the detection of spinal involvement of MM patients, offering detailed information about extra-axial involvement, which could be potentially missed with dedicated SMRI.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Sara Spiga
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Valeria Besostri
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
| | - Sara Pezzati
- Department of Haematology, San Gerardo Hospital, Monza, MB, Italy
| | - Fausto Rossini
- Department of Haematology, San Gerardo Hospital, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Monza, MB, Italy
- Department of Diagnostic Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Abstract
Myeloma bone disease (MBD), the skeletal lesions caused by multiple myeloma, is also known as skeletal related events and includes bone pain, osteoporosis, pathological fractures, osteolytic bone lesions, spinal instability, spinal cord and nerve root compression and extramedullary plasmacytoma. It is now generally accepted that patients with these complications usually require surgical management and that such treatment is safe and effective. The aims of surgical interventions are to alleviate pain, improve quality of life, treat potential or existing pathological fractures, decompress the spinal cord and nerve roots, and reestablish bone continuity. Thus far, there have not been uniform standards for surgical treatment of MBD. The Surgeon's Committee of the Chinese Myeloma Working Group has therefore achieved a consensus with the aim of providing guidance for clinicians and benefitting patients with MBD. This consensus focuses on the treatment of MBD, including its clinical definition and characteristics, diagnosis and surgical management. This expert consensus document was compiled after discussion and revision by experts from several relevant institutions in China. However, it is only an interim guide that cannot be enforced legally. It will be updated with development of new techniques of treatment.
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Diekhoff T, Hermann KGA, Greese J, Schwenke C, Poddubnyy D, Hamm B, Sieper J. Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study. Ann Rheum Dis 2017; 76:1502-1508. [PMID: 28283515 DOI: 10.1136/annrheumdis-2016-210640] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/23/2017] [Accepted: 02/06/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Radiographs of sacroiliac (SI) joints are used for the detection of structural damage in patients with axial spondyloarthritis (axSpA), but are often difficult to interpret. Here, we address the question how the T1-weighted MRI (T1w MRI) sequence compares with radiography for SI joints' structural lesions using low-dose CT as the standard of reference. METHODS Radiographs, T1w MRI and low-dose CT of the SI joints from 110 patients (mean age 36.1 (19-57) years, 52% males and 48% females; 53% with axSpA, 21 non-radiographic axSpA and 32% radiographic axSpA, 47% with non-SpA) referred to the rheumatologist because of unclear chronic back pain, but possible axSpA, were scored for structural lesions (erosions, sclerosis, joint space changes and an overall impression of positivity). RESULTS Using low-dose CT as the standard of reference, T1w MRI showed markedly better sensitivity with significantly more correct imaging findings compared with radiography for erosions (79% vs 42%; p=0.002), joint space changes (75% vs 41%; p=0.002) and overall positivity (85% vs 48%; p=0.001), respectively, while there were no differences between X-rays and MRI-T1 sequence regarding specificity (>80% for all scores). Only for sclerosis, MRI-T1 was inferior to radiography (sensitivity 30% vs 70%, respectively), however, not statistically significant (p=0.663). CONCLUSIONS T1w MRI was superior to radiography in the detection of structural lesion of the SI joints in patients with axSpA. Future studies should focus on finding an agreement on the definition of MRI-T1 positivity.
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Affiliation(s)
- Torsten Diekhoff
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Kay-Geert A Hermann
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Juliane Greese
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | | | - Denis Poddubnyy
- Clinic of Rheumatology, Medical Department I, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Humbolt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Joachim Sieper
- Clinic of Rheumatology, Medical Department I, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Humbolt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
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30
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Hanbali A, Hassanein M, Rasheed W, Aljurf M, Alsharif F. The Evolution of Prognostic Factors in Multiple Myeloma. Adv Hematol 2017; 2017:4812637. [PMID: 28321258 PMCID: PMC5339490 DOI: 10.1155/2017/4812637] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/22/2017] [Accepted: 02/05/2017] [Indexed: 12/23/2022] Open
Abstract
Multiple myeloma (MM) is a heterogeneous hematologic malignancy involving the proliferation of plasma cells derived by different genetic events contributing to the development, progression, and prognosis of this disease. Despite improvement in treatment strategies of MM over the last decade, the disease remains incurable. All efforts are currently focused on understanding the prognostic markers of the disease hoping to incorporate the new therapeutic modalities to convert the disease into curable one. We present this comprehensive review to summarize the current standard prognostic markers used in MM along with novel techniques that are still in development and highlight their implications in current clinical practice.
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Affiliation(s)
- Amr Hanbali
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mona Hassanein
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Walid Rasheed
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fahad Alsharif
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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31
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de Mel S, Chen Y, Gopalakrishnan SK, Ooi M, Teo C, Tan D, Teo MLC, Tso ACY, Lee LK, Nagarajan C, Goh YT, Chng WJ. The Singapore Myeloma Study Group Consensus Guidelines for the management of patients with multiple myeloma. Singapore Med J 2017; 58:55-71. [PMID: 27609508 PMCID: PMC5311886 DOI: 10.11622/smedj.2016150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Multiple myeloma (MM) is an incurable plasma cell neoplasm with an incidence of 100 patients per year in Singapore. Major advances have been made in the diagnosis, risk stratification and treatment of MM in the recent past. The reclassification of a subset of patients with smouldering MM, based on high-risk biomarkers, and the development of the revised international staging system are among the key new developments in diagnosis and staging. The use of novel agent-based treatment has resulted in significant improvements in the survival and quality of life of many patients with MM. Determining the optimal use of proteasome inhibitors, immunomodulators and, more recently, monoclonal antibodies is an area of ongoing investigation. In this guideline, we aim to provide an overview of the management of MM, incorporating the latest developments in diagnosis and treatment.
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Affiliation(s)
- Sanjay de Mel
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Yunxin Chen
- Department of Haematology, Singapore General Hospital, Singapore
| | | | - Melissa Ooi
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore
| | - Constance Teo
- Division of Oncology Pharmacy, National University Cancer Institute, National University Health System, Singapore
| | - Daryl Tan
- Raffles Cancer Centre, Raffles Hospital, Singapore
| | | | - Allison CY Tso
- Department of Haematology, Tan Tock Seng Hospital, Singapore
| | - Lian King Lee
- Department of Haematology, Tan Tock Seng Hospital, Singapore
| | | | - Yeow Tee Goh
- Department of Haematology, Singapore General Hospital, Singapore
| | - Wee Joo Chng
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore
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32
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Terpos E, Dimopoulos MA, Moulopoulos LA. The Role of Imaging in the Treatment of Patients With Multiple Myeloma in 2016. Am Soc Clin Oncol Educ Book 2017; 35:e407-17. [PMID: 27249748 DOI: 10.1200/edbk_159074] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The novel criteria for the diagnosis of symptomatic multiple myeloma have revealed the value of modern imaging for the management of patients with myeloma. Whole-body low-dose CT (LDCT) has increased sensitivity over conventional radiography for the detection of osteolytic lesions, and several myeloma organizations and institutions have suggested that whole-body LDCT should replace conventional radiography for the work-up of patients with myeloma. MRI is the best imaging method for the depiction of marrow infiltration by myeloma cells. Whole-body MRI (or at least MRI of the spine and pelvis if whole-body MRI is not available) should be performed for all patients with smoldering multiple myeloma with no lytic lesions to look for occult disease, which may justify treatment. In addition, MRI accurately illustrates the presence of plasmacytomas, spinal cord, and/or nerve compression for surgical intervention or radiation therapy; it is also recommended for the work-up of solitary bone plasmacytoma, and it may distinguish malignant from benign fractures (which is very important in cases of patients in biochemical remission with no other signs of progression). Diffusion weighted imaging (DWI) seems to improve MRI diagnosis in patients with myeloma. PET/CT is a functional imaging technique, more sensitive than conventional radiography for the detection of lytic lesions, which probably allows better definition of complete response and minimal residual disease compared with all other imaging methods. PET/CT has shown the best results in the follow-up of patients with myeloma and has an independent prognostic value both at diagnosis and following treatment. PET/CT can also be used for the work-up of solitary bone plasmacytoma and nonsecretory myeloma.
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Affiliation(s)
- Evangelos Terpos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Meletios A Dimopoulos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Lia A Moulopoulos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
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33
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de Waal EGM, Glaudemans AWJM, Schröder CP, Vellenga E, Slart RHJA. Nuclear medicine imaging of multiple myeloma, particularly in the relapsed setting. Eur J Nucl Med Mol Imaging 2016; 44:332-341. [PMID: 27900520 PMCID: PMC5215256 DOI: 10.1007/s00259-016-3576-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/18/2016] [Indexed: 02/04/2023]
Abstract
Multiple myeloma (MM) is characterized by a monoclonal plasma cell population in the bone marrow. Lytic lesions occur in up to 90 % of patients. For many years, whole-body X-ray (WBX) was the method of choice for detecting skeleton abnormalities. However, the value of WBX in relapsing disease is limited because lesions persist post-treatment, which restricts the capacity to distinguish between old, inactive skeletal lesions and new, active ones. Therefore, alternative techniques are necessary to visualize disease activity. Modern imaging techniques such as magnetic resonance imaging, positron emission tomography and computed tomography offer superior detection of myeloma bone disease and extramedullary manifestations. In particular, the properties of nuclear imaging enable the identification of disease activity by directly targeting the specific cellular properties of malignant plasma cells. In this review, an overview is provided of the effectiveness of radiopharmaceuticals that target metabolism, surface receptors and angiogenesis. The available literature data for commonly used nuclear imaging tracers, the promising first results of new tracers, and our pilot work indicate that a number of these radiopharmaceutical applications can be used effectively for staging and response monitoring of relapsing MM patients. Moreover, some tracers can potentially be used for radio immunotherapy.
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Affiliation(s)
- Esther G M de Waal
- Department of Hematology, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edo Vellenga
- Department of Hematology, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
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Affiliation(s)
- Elisabet E Manasanch
- a Department of Lymphoma and Myeloma , University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Ola Landgren
- b Department of Medicine , Memorial Sloan-Kettering Cancer Center , New York , NY , USA
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35
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Terpos E, Kleber M, Engelhardt M, Zweegman S, Gay F, Kastritis E, van de Donk NWCJ, Bruno B, Sezer O, Broijl A, Bringhen S, Beksac M, Larocca A, Hajek R, Musto P, Johnsen HE, Morabito F, Ludwig H, Cavo M, Einsele H, Sonneveld P, Dimopoulos MA, Palumbo A. European Myeloma Network guidelines for the management of multiple myeloma-related complications. Haematologica 2016; 100:1254-66. [PMID: 26432383 DOI: 10.3324/haematol.2014.117176] [Citation(s) in RCA: 239] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The European Myeloma Network provides recommendations for the management of the most common complications of multiple myeloma. Whole body low-dose computed tomography is more sensitive than conventional radiography in depicting osteolytic disease and thus we recommend it as the novel standard for the detection of lytic lesions in myeloma (grade 1A). Myeloma patients with adequate renal function and bone disease at diagnosis should be treated with zoledronic acid or pamidronate (grade 1A). Symptomatic patients without lytic lesions on conventional radiography can be treated with zoledronic acid (grade 1B), but its advantage is not clear for patients with no bone involvement on computed tomography or magnetic resonance imaging. In asymptomatic myeloma, bisphosphonates are not recommended (grade 1A). Zoledronic acid should be given continuously, but it is not clear if patients who achieve at least a very good partial response benefit from its continuous use (grade 1B). Treatment with erythropoietic-stimulating agents may be initiated in patients with persistent symptomatic anemia (hemoglobin <10g/dL) in whom other causes of anemia have been excluded (grade 1B). Erythropoietic agents should be stopped after 6-8 weeks if no adequate hemoglobin response is achieved. For renal impairment, bortezomib-based regimens are the current standard of care (grade 1A). For the management of treatment-induced peripheral neuropathy, drug modification is needed (grade 1C). Vaccination against influenza is recommended; vaccination against streptococcus pneumonia and hemophilus influenza is appropriate, but efficacy is not guaranteed due to suboptimal immune response (grade 1C). Prophylactic aciclovir (or valacyclovir) is recommended for patients receiving proteasome inhibitors, autologous or allogeneic transplantation (grade 1A).
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Affiliation(s)
- Evangelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Martina Kleber
- Department of Hematology and Oncology, University of Freiburg Medical Center, Germany Clinic for Internal Medicine, University Hospital Basel, Switzerland
| | - Monika Engelhardt
- Department of Hematology and Oncology, University of Freiburg Medical Center, Germany
| | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, the Netherlands
| | - Francesca Gay
- Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | | | - Benedetto Bruno
- Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy
| | - Orhan Sezer
- Department of Hematology, Memorial Sisli Hospital, Istanbul, Turkey
| | - Annemiek Broijl
- Department of Hematology, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Sara Bringhen
- Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy
| | - Meral Beksac
- Department of Hematology, Ankara University, Turkey
| | - Alessandra Larocca
- Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy
| | - Roman Hajek
- Department of Hemato-Oncology, University Hospital Ostrava and Faculty of Medicine OU, Ostrava, Czech Republic
| | - Pellegrino Musto
- Centro di Riferimento Oncologico della Basilicata, Istituto di Ricovero e Cura a Carattere Scientifico, Rionero in Vulture, Italy
| | | | - Fortunato Morabito
- Department of Hematology, Azienda Ospedaliera dell'Annunziata, Cosenza, Italy
| | - Heinz Ludwig
- Department of Medicine I, Center of Oncology, Hematology and Palliative Care, Wilhelminenspital, Vienna, Austria
| | - Michele Cavo
- "Seràgnoli" Institute of Hematology and Medical Oncology, University of Bologna, Italy
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würburg, Würzburg, Germany
| | - Pieter Sonneveld
- Department of Hematology, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Antonio Palumbo
- Division of Hematology, S. Giovanni Battista Hospital, University of Turin, Italy
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Mangiacavalli S, Pezzatti S, Rossini F, Doni E, Cocito F, Bolis S, Corso A. Implemented myeloma management with whole-body low-dose CT scan: a real life experience. Leuk Lymphoma 2016; 57:1539-45. [DOI: 10.3109/10428194.2015.1129535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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37
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Vij R, Fowler KJ, Shokeen M. New Approaches to Molecular Imaging of Multiple Myeloma. J Nucl Med 2015; 57:1-4. [PMID: 26541780 DOI: 10.2967/jnumed.115.163808] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/02/2015] [Indexed: 01/26/2023] Open
Abstract
Molecular imaging plays an important role in detection and staging of hematologic malignancies. Multiple myeloma (MM) is an age-related hematologic malignancy of clonal bone marrow plasma cells characterized by destructive bone lesions and is fatal in most patients. Traditional skeletal survey and bone scans have sensitivity limitations for osteolytic lesions manifested in MM. Progressive biomedical imaging technologies such as low-dose CT, molecularly targeted PET, MRI, and the functional-anatomic hybrid versions (PET/CT and PET/MRI) provide incremental advancements in imaging MM. Imaging with PET and MRI using molecularly targeted probes is a promising precision medicine platform that might successfully address the clinical ambiguities of myeloma spectrum diseases. The intent of this focus article is to provide a concise review of the present status and promising developments on the horizon, such as the new molecular imaging biomarkers under investigation that can either complement or potentially supersede existing standards.
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Affiliation(s)
- Ravi Vij
- Division of Hematology and Oncology, Washington University School of Medicine, Saint Louis, Missouri; and
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri
| | - Monica Shokeen
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri
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Mechanism of Action of Bortezomib and the New Proteasome Inhibitors on Myeloma Cells and the Bone Microenvironment: Impact on Myeloma-Induced Alterations of Bone Remodeling. BIOMED RESEARCH INTERNATIONAL 2015; 2015:172458. [PMID: 26579531 PMCID: PMC4633537 DOI: 10.1155/2015/172458] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/22/2015] [Accepted: 09/27/2015] [Indexed: 12/17/2022]
Abstract
Multiple myeloma (MM) is characterized by a high capacity to induce alterations in the bone remodeling process. The increase in osteoclastogenesis and the suppression of osteoblast formation are both involved in the pathophysiology of the bone lesions in MM. The proteasome inhibitor (PI) bortezomib is the first drug designed and approved for the treatment of MM patients by targeting the proteasome. However, recently novel PIs have been developed to overcome bortezomib resistance. Interestingly, several preclinical data indicate that the proteasome complex is involved in both osteoclast and osteoblast formation. It is also evident that bortezomib either inhibits osteoclast differentiation induced by the receptor activator of nuclear factor kappa B (NF-κB) ligand (RANKL) or stimulates the osteoblast differentiation. Similarly, the new PIs including carfilzomib and ixazomib can inhibit bone resorption and stimulate the osteoblast differentiation. In a clinical setting, PIs restore the abnormal bone remodeling by normalizing the levels of bone turnover markers. In addition, a bone anabolic effect was described in responding MM patients treated with PIs, as demonstrated by the increase in the osteoblast number. This review summarizes the preclinical and clinical evidence on the effects of bortezomib and other new PIs on myeloma bone disease.
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