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Schmidt T, Gahvari Z, Callander NS. SOHO State of the Art Updates and Next Questions: Diagnosis and Management of Monoclonal Gammopathy of Undetermined Significance and Smoldering Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:653-664. [PMID: 38641486 DOI: 10.1016/j.clml.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/14/2024] [Indexed: 04/21/2024]
Abstract
Monoclonal proteins are common, with a prevalence in the United States around 5% and the incidence increases with age. Although most patients are asymptomatic, the vast majority of cases are caused by a clonal plasma cell disorder. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) are asymptomatic precursor conditions with variable risk of progression to multiple myeloma (MM). In recent years, significant progress has been made to better understand the factors that lead to the development of symptoms and progression to myeloma. In this review, we summarize the current diagnosis treatment guidelines for MGUS and SMM and highlight recent advances that underscore a shifting paradigm in the evaluation and management of plasma cell precursor conditions.
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Affiliation(s)
- Timothy Schmidt
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Zhubin Gahvari
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Natalie S Callander
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison WI.
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2
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Liu S, Pan H, Li S, Li Z, Sun J, Ren T, Zhou J. Radiomic nomogram for predicting high-risk cytogenetic status in multiple myeloma based on fat-suppressed T2-weighted magnetic resonance imaging. J Bone Oncol 2024; 47:100617. [PMID: 39021591 PMCID: PMC11252923 DOI: 10.1016/j.jbo.2024.100617] [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: 01/16/2024] [Revised: 05/30/2024] [Accepted: 06/14/2024] [Indexed: 07/20/2024] Open
Abstract
Rationale and Objectives Radiomics has demonstrated potential in predicting the cytogenetic status of multiple myeloma (MM). However, the role of single-sequence radiomic nomograms in predicting the high-risk cytogenetic (HRC) status of MM remains underexplored. This study aims to develop and validate radiomic nomograms based on fat-suppressed T2-weighted images (T2WI-FS) for predicting MM's HRC status, facilitating pre-treatment decision-making and prognostic assessment. Materials and methods A cohort of 159 MM patients was included, comprising 71 HRC and 88 non-HRC cases. Regions of interest within the most significant tumor lesions on T2WI-FS images were manually delineated, yielding 1688 features. Fourteen radiomic features were selected using 10-fold cross-validation, employing methods such as variance thresholds, Student's t-test, redundancy analysis, and least absolute shrinkage and selection operator (LASSO). Logistic regression was utilized to develop three prediction models: a clinical model (model 1), a T2WI-FS radiomic model (model 2), and a combined clinical-radiomic model (model 3). Receiver operating characteristic (ROC) curves evaluated and compared the diagnostic performance of these models. Kaplan-Meier survival analysis and log-rank tests assessed the prognostic value of the radiomic nomograms. Results Models 2 and 3 demonstrated significantly greater diagnostic efficacy compared to model 1 (p < 0.05). The areas under the ROC curve for models 1, 2, and 3 were as follows: training set-0.650, 0.832, and 0.846; validation set-0.702, 0.730, and 0.757, respectively. Kaplan-Meier survival analysis indicated comparable prognostic values between the radiomic nomogram and MM cytogenetic status, with log-rank test results (p < 0.05) and concordance indices of 0.651 and 0.659, respectively; z-score test results were not statistically significant (p = 0.153). Additionally, Kaplan-Meier analysis revealed that patients in the non-HRC group, low-RS group, and aged ≤ 60 years exhibited the longest overall survival, while those in the HRC group, high-RS group, and aged > 60 years demonstrated the shortest overall survival (p = 0.004, Log-rank test). Conclusions Radiomic nomograms are capable of predicting the HRC status in MM. The cytogenetic status, radiomics model Rad score, and age collectively influence the overall survival of MM patients. These factors potentially contribute to pre-treatment clinical decision-making and prognostic assessment.
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Affiliation(s)
- Suwei Liu
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Haojie Pan
- Second Clinical School, Lanzhou University, Lanzhou, China
| | - Shenglin Li
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Zhengxiao Li
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Jiachen Sun
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Tiezhu Ren
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
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Ferla V, Farina F, Perini T, Marcatti M, Ciceri F. Monoclonal Antibodies in Smoldering Multiple Myeloma and Monoclonal Gammopathy of Undetermined Significance: Current Status and Future Directions. Pharmaceuticals (Basel) 2024; 17:901. [PMID: 39065751 PMCID: PMC11279454 DOI: 10.3390/ph17070901] [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: 05/17/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Monoclonal antibodies (MoAbs) targeting several cellular receptors have significantly improved the prognosis of multiple myeloma (MM). Their high effectiveness and safety raise the question of whether earlier therapeutic intervention in monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) influences the natural course of the disease. MM is preceded by clinically recognized conditions such as MGUS and SMM. Numerous studies are investigating the disease biology and immune profile of SMM and MGUS to unravel the intricate relationship between immunosurveillance and disease progression. The standard approach to MGUS and SMM remains close observation. Early studies indicate benefits in terms of progression or even survival for promptly treating high-risk SMM patients. Ongoing debates are focused on which patients with SMM and MGUS to treat, as well as on determining the optimal therapeutic approach. The first approach aims to cure by attempting to eliminate the pathological clone, while the second approach is preventive, aiming to manage disease progression to active MM and restore the immune system. In this review, we focus on the available and emerging data on early treatment, particularly with MoAbs alone or in combination with other therapies, in SMM and MGUS patients.
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Affiliation(s)
- Valeria Ferla
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.F.); (T.P.); (M.M.); (F.C.)
| | - Francesca Farina
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.F.); (T.P.); (M.M.); (F.C.)
| | - Tommaso Perini
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.F.); (T.P.); (M.M.); (F.C.)
- Age Related Diseases Laboratory, Division of Genetics and Cell Biology, IRCSS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Magda Marcatti
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.F.); (T.P.); (M.M.); (F.C.)
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (F.F.); (T.P.); (M.M.); (F.C.)
- Faculty of Medicine and Surgery, Vita-Salute IRCCS San Raffaele University, 20132 Milan, Italy
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Ho PJ, Moore E, Wellard C, Quach H, Blacklock H, Harrrison SJ, MacDonald EJ, McQuilten ZK, Wood EM, Mollee P, Spencer A. The impact of biomarkers of malignancy (IMWG SLiM criteria) in myeloma in a real-world population: Clinical characteristics, therapy and outcomes from the Australian and New Zealand Myeloma and Related Diseases Registry (ANZ MRDR). Br J Haematol 2024. [PMID: 38965706 DOI: 10.1111/bjh.19624] [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: 03/29/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
A decade after International Myeloma Working Group (IMWG) biomarkers (SLiM criteria) were introduced, this real-world study examined their impact on diagnosis, therapy and outcomes in myeloma. Using the ANZ MRDR, 3489 newly diagnosed patients from 2013 to 2023, comprising 3232 diagnosed by CRAB ('CRAB patients', including 1758 who also satisfied ≥1 SLiM criteria) and 257 by SLiM ('SLiM patients') criteria were analysed. CRAB patients had higher R-ISS and lower performance status, with no difference in cytogenetic risk. SLiM patients had improved progression-free survival (PFS, 37.5 vs. 32.2 months, hazard ratio [HR] 1.31 [1.08-1.59], p = 0.003), overall survival (80.9 vs. 73.2 months, HR 1.64 [1.26-2.13], p < 0.001) and PFS2 (54.6 vs. 40.3 months, HR 1.51 [1.22-1.86], p < 0.001) compared with CRAB patients, partially explained by earlier diagnosis, with no differential impact between the plasma cell and light-chain criteria on PFS. However, 34% of CRAB patients did not manifest SLiM characteristics, raising the possibility that SLiM features are associated with different biological behaviours contributing to a better prognosis, for example, improved PFS2 in SLiM patients suggested less disease resistance at first relapse. These data support earlier initiation of therapy by SLiM. The superior survival outcomes of SLiM versus CRAB patients highlight the importance of defining these subgroups when interpreting therapeutic outcomes at induction and first relapse.
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Affiliation(s)
- P Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Elizabeth Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hang Quach
- St. Vincent's Hospital, Melbourne and University of Melbourne, Melbourne, Australia
| | | | - Simon J Harrrison
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | | | - Zoe K McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Erica M Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter Mollee
- Princess Alexandra Hospital and University of Queensland, Brisbane, Australia
| | - Andrew Spencer
- Department of Haematology, The Alfred Hospital and Monash University, Melbourne, Australia
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Rajkumar SV, Bergsagel PL, Kumar S. Smoldering Multiple Myeloma: Observation Versus Control Versus Cure. Hematol Oncol Clin North Am 2024; 38:293-303. [PMID: 38158241 PMCID: PMC11404782 DOI: 10.1016/j.hoc.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Smoldering multiple myeloma (SMM) is an intermediate clinical stage in the spectrum of monoclonal plasma cell disorders. It represents a heterogeneous clinically defined condition in which some patients (approximately 50%) have monoclonal gammopathy of undetermined significance (premalignancy), and some (approximately 50%) have multiple myeloma (biologic malignancy). Using specific prognostic factors, patients with SMM, in whom malignant transformation has already likely occurred, can be identified. These patients are considered to have high-risk SMM. Patients with newly diagnosed high-risk SMM are candidates for early intervention with lenalidomide or lenalidomide plus dexamethasone for 2 years, or enrollment in clinical trials.
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Affiliation(s)
- S Vincent Rajkumar
- Division of Hematology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
| | - P Leif Bergsagel
- Division of Hematology Oncology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
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Hughes D, Yong K, Ramasamy K, Stern S, Boyle E, Ashcroft J, Basheer F, Rabin N, Pratt G. Diagnosis and management of smouldering myeloma: A British Society for Haematology Good Practice Paper. Br J Haematol 2024; 204:1193-1206. [PMID: 38393718 DOI: 10.1111/bjh.19333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/20/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Multiple myeloma is a bone marrow-based plasma cell tumour that develops from asymptomatic pre-cursor conditions smouldering myeloma and monoclonal gammopathy of uncertain significance and all are characterised by the presence of a monoclonal protein in the blood. Diagnosis and distinction between these conditions is based on blood tests, the bone marrow biopsy and cross sectional imaging. There are various risk stratification models that group patients with smouldering myeloma into risk groups based on risk of progression to symptomatic disease. Management is mainly observational for patients with smouldering myeloma although clinical trials for high-risk disease may be available. Restaging is required if evidence for progression.
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Affiliation(s)
- Daniel Hughes
- UCL Cancer Institute, University College London, London, UK
| | - Kwee Yong
- UCL Cancer Institute, University College London, London, UK
| | - Karthik Ramasamy
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Translational Myeloma Centre, NDORMS, University of Oxford, Oxford, UK
| | - Simon Stern
- Epsom and St Helier University Hospitals NHS Trust, Sutton, UK
| | - Eileen Boyle
- UCL Cancer Institute, University College London, London, UK
| | - John Ashcroft
- The Mid Yorkshire Teaching Hospitals NHS Trust, Wakefield, UK
| | - Faisal Basheer
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Neil Rabin
- University College London Hospitals, London, UK
| | - Guy Pratt
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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7
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Dubaj M, Bigosiński K, Dembowska A, Mlak R, Szudy-Szczyrek A, Małecka-Massalska T, Homa-Mlak I. Role of Non-Coding RNAs in Diagnosis, Prediction and Prognosis of Multiple Myeloma. Cancers (Basel) 2024; 16:1033. [PMID: 38473390 DOI: 10.3390/cancers16051033] [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: 12/27/2023] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Multiple myeloma (MM) is the second most common hematologic malignancy in the world and accounts for 15% of primary hemocytopathies, with an ever-increasing number of new cases. It is asymptomatic in 30% of instances; hence, the determination of highly sensitive and specific markers is necessary to make a proper diagnosis. In the last 20 years, miRNAs, involved in regulating the expression of genes responsible for cell proliferation and differentiation, including tumor cells, have been identified as potential diagnostic and prognostic markers. The main aim of the following review was to outline the role of miRNAs in the diagnosis and prognosis of MM, considering their role in the pathogenesis of the disease and identifying their target genes and pathways. For this purpose, publications dating from 2013-2023 have been reviewed. Based on the available data, it is concluded that non-coding RNAs including miRNAs could be potential markers in MM. Furthermore, they may serve as therapeutic targets for certain drugs.
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Affiliation(s)
- Maciej Dubaj
- Student Scientific Group, Department of Human Physiology, Medical University of Lublin, 20-080 Lublin, Poland
| | - Karol Bigosiński
- Student Scientific Group, Department of Human Physiology, Medical University of Lublin, 20-080 Lublin, Poland
| | - Aleksandra Dembowska
- Student Scientific Group, Department of Human Physiology, Medical University of Lublin, 20-080 Lublin, Poland
| | - Radosław Mlak
- Department of Laboratory Diagnostics, Medical University of Lublin, Doktora Witolda Chodźki 1 Str., 20-093 Lublin, Poland
| | - Aneta Szudy-Szczyrek
- Department of Hematooncology and Bone Marrow Transplantation, Medical University of Lublin, 20-081 Lublin, Poland
| | | | - Iwona Homa-Mlak
- Department of Human Physiology, Medical University of Lublin, 20-080 Lublin, Poland
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Nadal Bosch J, Moya M, Serna S, Drinkard L, Malcolm J. When Two Worlds Collide: A Rare Case of Multiple Myeloma With Extramedullary Plasmacytoma. Cureus 2023; 15:e50058. [PMID: 38186465 PMCID: PMC10769124 DOI: 10.7759/cureus.50058] [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] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
In this case report, we discuss the presentation, diagnosis, and management of a 67-year-old gentleman with stage II multiple myeloma with concurrent biopsy-proven bone plasmacytoma and why it is important to understand the molecular intricacies of these disorders. We emphasize the critical role of radiology in identifying, characterizing, and managing these lesions. Furthermore, we shed light on the critical differentiation between solitary extramedullary plasmacytoma and multiple myeloma and discuss treatment modalities for both conditions.
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Affiliation(s)
- Jorge Nadal Bosch
- Internal Medicine, University of Texas Rio Grande Valley, Edinburg, USA
| | - Mario Moya
- Radiology, Doctors Hospital at Renaissance, Edinburg, USA
| | - Samuel Serna
- Radiology, Doctors Hospital at Renaissance, Edinburg, USA
| | - Lee Drinkard
- Oncology, Doctors Hospital at Renaissance, Edinburg, USA
| | - Javier Malcolm
- Medical Information, Doctors Hospital at Renaissance, Edinburg, 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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11
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Jamet B, Carlier T, Bailly C, Bodet-Milin C, Monnet A, Frampas E, Touzeau C, Moreau P, Kraeber-Bodere F. Hybrid simultaneous whole-body 2-[ 18F]FDG-PET/MRI imaging in newly diagnosed multiple myeloma: first diagnostic performance and clinical added value results. Eur Radiol 2023; 33:6438-6447. [PMID: 37022439 DOI: 10.1007/s00330-023-09593-1] [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: 09/07/2022] [Revised: 01/10/2023] [Accepted: 02/22/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES Mixing diagnostic and prognostic data provided by whole-body MRI (WB-MRI) and 2-18F-fluorodeoxyglucose (2-[18F]FDG) positron emission tomography (2-[18F]FDG-PET) from a single simultaneous imaging technique for newly diagnosed multiple myeloma (NDMM) initial workup seems attractive. However, to date, the published data are scarce and this possibility has not been fully explored. In this prospective study, we aimed to explore the diagnostic performance and added clinical value of WB-2-[18F]FDG-PET/MRI imaging in NDMM. METHODS All patients with confirmed NDMM at the Nantes University Hospital were prospectively enrolled in this study and underwent WB-2-[18F]FDG-PET/MRI imaging on a 3-T Biograph mMR before receiving treatment. Before imaging, they were considered either as symptomatic or as smoldering MM (SMM). Diagnostic performance of global WB-2-[18F]FDG-PET/MRI imaging, as well as PET and MRI separately for FL and diffuse BMI detection, was assessed and compared in each group. PET-based (maximal standardized uptake value, SUVmax) and MRI-based (mean apparent diffusion coefficient value, ADCmean) quantitative features were collected for FL/para-medullary disease (PMD)/bone marrow and were compared. RESULTS A total of 52 patients were included in this study. PET and MRI were equally effective at detecting patients with FL (69% vs. 75%) and with diffuse BMI (62% for both) in the symptomatic MM group. WB-2-[18F]FDG-PET/MRI imaging detected FL in 22% of patients with SMM (with a higher diagnostic performance for MRI), resulting in a significant impact on clinical management in this population. SUVmax and ADCmean quantitative features were weakly or not correlated. CONCLUSIONS WB-2-[18F]FDG-PET/MRI could represent the next-generation imaging modality for MM. KEY POINTS • Whole-body 2-[18F]FDG-PET/MRI imaging detected at least one focal bone lesion in 75% of patients with symptomatic multiple myeloma, and PET and MRI were equally effective at identifying patients with a focal bone lesion. • Whole-body 2-[18F]FDG-PET/MRI imaging detected a focal bone lesion in 22% of patients with smoldering multiple myeloma (with a higher diagnostic performance for MRI). • MRI had a significant impact on clinical management of smoldering multiple myeloma.
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Affiliation(s)
- Bastien Jamet
- Nuclear Medicine Department, University Hospital, 1 Place Ricordeau, 44093, Nantes, France.
| | - Thomas Carlier
- Nuclear Medicine Department, University Hospital, 1 Place Ricordeau, 44093, Nantes, France
- Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France
| | - Clément Bailly
- Nuclear Medicine Department, University Hospital, 1 Place Ricordeau, 44093, Nantes, France
- Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France
| | - Caroline Bodet-Milin
- Nuclear Medicine Department, University Hospital, 1 Place Ricordeau, 44093, Nantes, France
- Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France
| | | | - Eric Frampas
- Radiology Department, University Hospital, Nantes, France
| | - Cyrille Touzeau
- Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France
- Haematology Department, University Hospital, Nantes, France
| | - Philippe Moreau
- Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France
- Haematology Department, University Hospital, Nantes, France
| | - Francoise Kraeber-Bodere
- Nuclear Medicine Department, University Hospital, 1 Place Ricordeau, 44093, Nantes, France
- Nantes Université, Univ Angers, INSERM, CNRS, CRCI2NA, F-44000, Nantes, France
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12
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Solimando AG, Krebs M, Desantis V, Marziliano D, Caradonna IC, Morizio A, Argentiero A, Shahini E, Bittrich M. Breaking through Multiple Myeloma: A Paradigm for a Comprehensive Tumor Ecosystem Targeting. Biomedicines 2023; 11:2087. [PMID: 37509726 PMCID: PMC10377041 DOI: 10.3390/biomedicines11072087] [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: 04/10/2023] [Revised: 06/29/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Multiple myeloma (MM) is a cancerous condition characterized by the proliferation of plasma cells within the hematopoietic marrow, resulting in multiple osteolytic lesions. MM patients typically experience bone pain, kidney damage, fatigue due to anemia, and infections. Historically, MM was an incurable disease with a life expectancy of around three years after diagnosis. However, over the past two decades, the development of novel therapeutics has significantly improved patient outcomes, including response to treatment, remission duration, quality of life, and overall survival. These advancements include thalidomide and its derivatives, lenalidomide and pomalidomide, which exhibit diverse mechanisms of action against the plasma cell clone. Additionally, proteasome inhibitors such as bortezomib, ixazomib, and carfilzomib disrupt protein degradation, proving specifically toxic to cancerous plasma cells. Recent advancements also involve monoclonal antibodies targeting surface antigens, such as elotuzumab (anti-CS1) and daratumumab (anti-CD38), bispecific t-cell engagers such as teclistamab (anti-BCMA/CD3) and Chimeric antigen receptor T (CAR-T)-based strategies, with a growing focus on drugs that exhibit increasingly targeted action against neoplastic plasma cells and relevant effects on the tumor microenvironment.
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Affiliation(s)
- Antonio G Solimando
- Unit of Internal Medicine and Clinical Oncology "G. Baccelli", Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Markus Krebs
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, 97080 Würzburg, Germany
- Department of Urology and Pediatric Urology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Vanessa Desantis
- Department of Precision and Regenerative Medicine and Ionian Area, Pharmacology Section, University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Donatello Marziliano
- Unit of Internal Medicine and Clinical Oncology "G. Baccelli", Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Ingrid Catalina Caradonna
- Department of Precision and Regenerative Medicine and Ionian Area, Pharmacology Section, University of Bari Aldo Moro Medical School, 70124 Bari, Italy
| | - Arcangelo Morizio
- Orthopedics and Traumatology Unit ASL BA-Ospedale della Murgia "Fabio Perinei", 70022 Altamura, Italy
| | | | - Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology-IRCCS "Saverio de Bellis", 70013 Castellana Grotte, Italy
| | - Max Bittrich
- Department of Internal Medicine II, University Hospital Würzburg, 97080 Würzburg, Germany
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Ludwig H, Kainz S, Schreder M, Zojer N, Hinke A. SLiM CRAB criteria revisited: temporal trends in prognosis of patients with smoldering multiple myeloma who meet the definition of ‘biomarker-defined early multiple myeloma’—a systematic review with meta-analysis. EClinicalMedicine 2023; 58:101910. [PMID: 36969337 PMCID: PMC10033724 DOI: 10.1016/j.eclinm.2023.101910] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/22/2023] Open
Abstract
Background Biomarker-defined patients with smoldering multiple myeloma (SMM) were included in the diagnostic category of multiple myeloma (MM) by the International Myeloma Working Group (IMWG) in 2014. This includes ≥60% bone marrow plasma cells (BMPCs), free light chain ratio (FLCratio) ≥100, and >1 MRI-defined ≥5 mm focal lesion, also called SLiM CRAB MM. We examined whether the risk of progression of SLiM CRAB MM patients to CRAB positive MM described in recent studies differs from that reported in earlier studies published before the introduction of the new diagnostic criteria. Methods We conducted a systematic review with meta-analysis, and included studies on Embase and PubMed (01/01/2010-01/11/2022), selecting studies with digitizable progression curves. Inconsistent studies were excluded. We created forest plots using random effects models from digitized and published data and Kaplan-Meier curves. Main outcomes were median time to progression (TTP), 2-year progression risk, and odds ratios (ORs) comparing 2-year progression risks. Findings Our meta-analysis including 11 studies with 3482 patients found an approximately 3-fold longer TTP and 50% lower 2-year progression risk of SliM CRAB MM patients in recent (published after 2014) compared with earlier studies. Median TTP in patients with ≥60% BMPCs was 30.31 months [18.71-62.93] in recent compared with 9.20 months [6.02-15.56] in earlier studies; the 2-year progression risk was 45.45% [20.12-62.75] compared with 86.21% [65.74-94.45] in the respective time periods. In patients with a FLCratio ≥ 100, the median TTP was 48.06 months [40.51-64.91] vs. 15.33 months [9.38-19.10], and the 2-year progression risk was 31.61% [25.30-37.39] vs. 73.00% [62.39-80.62] in recent and earlier studies, respectively. Tests for heterogeneity showed that the two time periods differed significantly in their ORs when comparing patients who met the high-and low risk criteria. No appropriate recent studies on focal lesions have been published. Interpretation Recent studies show significantly improved prognosis of biomarker-defined MM with ≥60% BMPCs and FLCratio ≥ 100. This warrants careful evaluation for signs of progression before treatment initiation. Funding Funding was provided by the Austrian Forum against Cancer.
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, c/o First Department of Medicine, Clinic Ottakring, Vienna, Austria
- Corresponding author. Wilhelminen Cancer Research Institute, c/o 1st Department of Medicine, Center for Oncology, Hematology and Palliative Care, Klinik Ottakring, Montleartstraße 37, 1160, Vienna, Austria.
| | - Sarah Kainz
- Wilhelminen Cancer Research Institute, c/o First Department of Medicine, Clinic Ottakring, Vienna, Austria
| | - Martin Schreder
- First Department of Medicine, Center for Oncology, Hematology, and Palliative Care, Clinic Ottakring, Vienna, Austria
| | - Niklas Zojer
- First Department of Medicine, Center for Oncology, Hematology, and Palliative Care, Clinic Ottakring, Vienna, Austria
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The PANGEA model: catching the drift from precursor conditions to myeloma in individual patients. Lancet Haematol 2023; 10:e162-e163. [PMID: 36858673 DOI: 10.1016/s2352-3026(23)00009-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 03/03/2023]
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15
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Kim DK, Park SS, Jung JY. [Clinical Application and Limitations of Myeloma Response Assessment and Diagnosis System (MY-RADS)]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:51-74. [PMID: 36818710 PMCID: PMC9935961 DOI: 10.3348/jksr.2022.0154] [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: 11/13/2022] [Revised: 12/22/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
Multiple myeloma, which is a proliferative disease of plasma cells that originate from a single clone, is the second most common hematologic malignancy following non-Hodgkin lymphoma. In the past, its diagnosis was made based on clinical findings (so-called "CRAB") and a skeletal survey using radiographs. However, since the implementation of the International Myeloma Working Group's revised guideline regarding the radiologic diagnosis of multiple myeloma, whole-body (WB) MRI has emerged to play a central role in the early diagnosis of multiple myeloma. Diffusion-weighted imaging and fat quantification using Dixon methods enable treatment response assessment by MRI. In keeping with the trend, a multi-institutional and multidisciplinary consensus for standardized image acquisition and reporting known as the Myeloma Response Assessment and Diagnostic System (MY-RADS) has recently been proposed. This review aims to describe the clinical application of WB-MRI based on MY-RADS in multiple myeloma, discuss its limitations, and suggest future directions for improvement.
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Affiliation(s)
- Dong Kyun Kim
- Department of Radiology, Seoul St. Mary’s Hospital, and, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Soo Park
- Department of Hematology, Seoul St. Mary’s Hospital, and, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary’s Hospital, and, College of Medicine, The Catholic University of Korea, Seoul, Korea
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16
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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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17
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Hussain M, Khan F, Al Hadidi S. The use of bone-modifying agents in multiple myeloma. Blood Rev 2023; 57:100999. [PMID: 36050125 DOI: 10.1016/j.blre.2022.100999] [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: 06/14/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 01/28/2023]
Abstract
Multiple myeloma is a hematological neoplasm characterized by abnormal proliferation of plasma cells in the bone marrow and is usually associated with increased bone pain and skeletal-related events such as pathological fracture and/or spinal cord compression. Myeloma bone disease results in changes in the bone-marrow microenvironment evidenced by increased osteoclastic activity and/or decreased osteoblastic activity, which negatively affect quality of life. Treatment of myeloma bone disease includes bisphosphonates or denosumab (bone-modifying agents). These agents do not induce the formation of new bone or repair existing bone damage, but they can decrease bone pain and the risk of pathological fracture. While these agents improve quality of life, it is not known whether they improve overall survival. This review focuses on different classes of bone-modifying agents, their mechanisms of action, time of initiation, duration of therapy, and potential survival benefits.
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Affiliation(s)
- Munawwar Hussain
- Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Fatima Khan
- Department of Hematology Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Samer Al Hadidi
- Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
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18
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Termini R, Žihala D, Terpos E, Perez-Montaña A, Jelínek T, Raab M, Weinhold N, Mai EK, Grab AL, Corre J, Vergez F, Sacco A, Chiarini M, Giustini V, Tucci A, Rodriguez S, Moreno C, Perez C, Maia C, Martín-Sánchez E, Guerrero C, Botta C, Garces JJ, Lopez A, Tamariz-Amador LE, Prosper F, Bargay J, Cabezudo ME, Ocio EM, Hájek R, Martinez-Lopez J, Solano F, Iglesias R, Paiva A, Geraldes C, Vitoria H, Gomez C, De Arriba F, Ludwig H, Garcia-Guiñon A, Casanova M, Alegre A, Cabañas V, Sirvent M, Oriol A, de la Rubia J, Hernández-Rivas JÁ, Palomera L, Sarasa M, Rios P, Puig N, Mateos MV, Flores-Montero J, Orfao A, Goldschmidt H, Avet-Loiseau H, Roccaro AM, San-Miguel JF, Paiva B. Circulating Tumor and Immune Cells for Minimally Invasive Risk Stratification of Smoldering Multiple Myeloma. Clin Cancer Res 2022; 28:4771-4781. [PMID: 36074126 DOI: 10.1158/1078-0432.ccr-22-1594] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/01/2022] [Accepted: 09/06/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Early intervention in smoldering multiple myeloma (SMM) requires optimal risk stratification to avoid under- and overtreatment. We hypothesized that replacing bone marrow (BM) plasma cells (PC) for circulating tumor cells (CTC), and adding immune biomarkers in peripheral blood (PB) for the identification of patients at risk of progression due to lost immune surveillance, could improve the International Myeloma Working Group 20/2/20 model. EXPERIMENTAL DESIGN We report the outcomes of 150 patients with SMM enrolled in the iMMunocell study, in which serial assessment of tumor and immune cells in PB was performed every 6 months for a period of 3 years since enrollment. RESULTS Patients with >0.015% versus ≤0.015% CTCs at baseline had a median time-to-progression of 17 months versus not reached (HR, 4.9; P < 0.001). Presence of >20% BM PCs had no prognostic value in a multivariate analysis that included serum free light-chain ratio >20, >2 g/dL M-protein, and >0.015% CTCs. The 20/2/20 and 20/2/0.015 models yielded similar risk stratification (C-index of 0.76 and 0.78). The combination of the 20/2/0.015 model with an immune risk score based on the percentages of SLAN+ and SLAN- nonclassical monocytes, CD69+HLADR+ cytotoxic NK cells, and CD4+CXCR3+ stem central memory T cells, allowed patient' stratification into low, intermediate-low, intermediate-high, and high-risk disease with 0%, 20%, 39%, and 73% rates of progression at 2 years. CONCLUSIONS This study showed that CTCs outperform BM PCs for assessing tumor burden. Additional analysis in larger series are needed to define a consensus cutoff of CTCs for minimally invasive stratification of SMM.
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Affiliation(s)
- Rosalinda Termini
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - David Žihala
- Department of Hematooncology, University Hospital Ostrava and University of Ostrava, Ostrava, Czech Republic
| | - Evangelos Terpos
- National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Tomáš Jelínek
- Department of Hematooncology, University Hospital Ostrava and University of Ostrava, Ostrava, Czech Republic
| | - Marc Raab
- Heidelberg University Clinic Hospital, Department of Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Niels Weinhold
- Heidelberg University Clinic Hospital, Department of Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Elias K Mai
- Heidelberg University Clinic Hospital, Department of Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Anna Luise Grab
- Heidelberg University Clinic Hospital, Department of Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Jill Corre
- Centre de Recherche en Cancérologie de Toulouse, Unité 1037, INSERM, Toulouse, France
| | - Francois Vergez
- Centre de Recherche en Cancérologie de Toulouse, Unité 1037, INSERM, Toulouse, France
| | | | | | | | | | - Sara Rodriguez
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Cristina Moreno
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Cristina Perez
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Catarina Maia
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Esperanza Martín-Sánchez
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Camilla Guerrero
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Cirino Botta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Juan-Jose Garces
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Aitziber Lopez
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | | | - Felipe Prosper
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Joan Bargay
- Hospital Sont LLatzer, Palma de Mallorca, Spain
| | | | - Enrique M Ocio
- Hospital Universitario Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
| | - Roman Hájek
- Department of Hematooncology, University Hospital Ostrava and University of Ostrava, Ostrava, Czech Republic
| | | | | | | | - Artur Paiva
- Flow Cytometry Unit (UGOC), Department of Clinical Pathology, Centro Hospitalare Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Catarina Geraldes
- Flow Cytometry Unit (UGOC), Department of Clinical Pathology, Centro Hospitalare Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Helena Vitoria
- Centro Hospitalare Universitário de Coimbra (CHUC), Coimbra, Portugal
| | | | - Felipe De Arriba
- Hospital Morales Meseguer, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Clinic Ottakring, Vienna, Austria
| | | | | | | | - Valentin Cabañas
- Hospital Virgen de la Arrixaca de Murcia, IMIB Arrixaca, Universidad de Murcia, Murcia, Spain
| | | | - Albert Oriol
- Institut Català d'Oncologia Institut Josep Carreras, Badalona, Spain
| | - Javier de la Rubia
- University Hospital de La Fe, School of Medicine and Dentistry, Catholic University of Valencia, CIBERONC CB16/12/00284, Valencia, Spain
| | | | - Luis Palomera
- Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Pablo Rios
- Hospital Nuestra Señora de la Candelara, Santa Cruz de Tenerife, Spain
| | - Noemi Puig
- Hospital Universitario de Salamanca, Instituto de Investigacion Biomedica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Maria-Victoria Mateos
- Hospital Universitario de Salamanca, Instituto de Investigacion Biomedica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Juan Flores-Montero
- Translational and Clinical Research Program, Centro de Investigación del Cancer (IBMCC-USAL, CSIC), Department of Medicine, Cytometry Service, Instituto de Investigación Biosanitaria de Salamanca (IBSAL) and CIBER-ONC (number CB16/12/00400), University of Salamanca, Salamanca, Spain
| | - Alberto Orfao
- Translational and Clinical Research Program, Centro de Investigación del Cancer (IBMCC-USAL, CSIC), Department of Medicine, Cytometry Service, Instituto de Investigación Biosanitaria de Salamanca (IBSAL) and CIBER-ONC (number CB16/12/00400), University of Salamanca, Salamanca, Spain
| | - Hartmut Goldschmidt
- Heidelberg University Clinic Hospital, Department of Internal Medicine V and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Hervé Avet-Loiseau
- Centre de Recherche en Cancérologie de Toulouse, Unité 1037, INSERM, Toulouse, France
| | | | - Jesus F San-Miguel
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
| | - Bruno Paiva
- Clinica Universidad de Navarra, Centro de Investigacion Medica Aplicada (CIMA), Instituto de Investigacion Sanitaria de Navarra (IDISNA), CCUN, CIBER-ONC numbers CB16/12/00369, CB16/12/00489, Pamplona, Spain
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19
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Wennmann M, Klein A, Bauer F, Chmelik J, Grözinger M, Uhlenbrock C, Lochner J, Nonnenmacher T, Rotkopf LT, Sauer S, Hielscher T, Götz M, Floca RO, Neher P, Bonekamp D, Hillengass J, Kleesiek J, Weinhold N, Weber TF, Goldschmidt H, Delorme S, Maier-Hein K, Schlemmer HP. Combining Deep Learning and Radiomics for Automated, Objective, Comprehensive Bone Marrow Characterization From Whole-Body MRI: A Multicentric Feasibility Study. Invest Radiol 2022; 57:752-763. [PMID: 35640004 DOI: 10.1097/rli.0000000000000891] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Disseminated bone marrow (BM) involvement is frequent in multiple myeloma (MM). Whole-body magnetic resonance imaging (wb-MRI) enables to evaluate the whole BM. Reading of such whole-body scans is time-consuming, and yet radiologists can transfer only a small fraction of the information of the imaging data set to the report. This limits the influence that imaging can have on clinical decision-making and in research toward precision oncology. The objective of this feasibility study was to implement a concept for automatic, comprehensive characterization of the BM from wb-MRI, by automatic BM segmentation and subsequent radiomics analysis of 30 different BM spaces (BMS). MATERIALS AND METHODS This retrospective multicentric pilot study used a total of 106 wb-MRI from 102 patients with (smoldering) MM from 8 centers. Fifty wb-MRI from center 1 were used for training of segmentation algorithms (nnU-Nets) and radiomics algorithms. Fifty-six wb-MRI from 8 centers, acquired with a variety of different MRI scanners and protocols, were used for independent testing. Manual segmentations of 2700 BMS from 90 wb-MRI were performed for training and testing of the segmentation algorithms. For each BMS, 296 radiomics features were calculated individually. Dice score was used to assess similarity between automatic segmentations and manual reference segmentations. RESULTS The "multilabel nnU-Net" segmentation algorithm, which performs segmentation of 30 BMS and labels them individually, reached mean dice scores of 0.88 ± 0.06/0.87 ± 0.06/0.83 ± 0.11 in independent test sets from center 1/center 2/center 3-8 (interrater variability between radiologists, 0.88 ± 0.01). The subset from the multicenter, multivendor test set (center 3-8) that was of high imaging quality was segmented with high precision (mean dice score, 0.87), comparable to the internal test data from center 1. The radiomic BM phenotype consisting of 8880 descriptive parameters per patient, which result from calculation of 296 radiomics features for each of the 30 BMS, was calculated for all patients. Exemplary cases demonstrated connections between typical BM patterns in MM and radiomic signatures of the respective BMS. In plausibility tests, predicted size and weight based on radiomics models of the radiomic BM phenotype significantly correlated with patients' actual size and weight ( P = 0.002 and P = 0.003, respectively). CONCLUSIONS This pilot study demonstrates the feasibility of automatic, objective, comprehensive BM characterization from wb-MRI in multicentric data sets. This concept allows the extraction of high-dimensional phenotypes to capture the complexity of disseminated BM disorders from imaging. Further studies need to assess the clinical potential of this method for automatic staging, therapy response assessment, or prediction of biopsy results.
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Affiliation(s)
| | - André Klein
- Medical Image Computing, German Cancer Research Center
| | | | | | | | | | | | - Tobias Nonnenmacher
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg
| | | | - Sandra Sauer
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center, Heidelberg
| | | | | | - Peter Neher
- Medical Image Computing, German Cancer Research Center
| | | | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY
| | | | - Niels Weinhold
- Department of Medicine V, Multiple Myeloma Section, University Hospital Heidelberg
| | - Tim Frederik Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg
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20
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Hou Z, Jiang P, Su S, Zhou H. Hotspots and trends in multiple myeloma bone diseases: A bibliometric visualization analysis. Front Pharmacol 2022; 13:1003228. [PMID: 36313356 PMCID: PMC9614215 DOI: 10.3389/fphar.2022.1003228] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/23/2022] [Indexed: 11/27/2022] Open
Abstract
Objective: This study aims to explore the research hotspots and trends of multiple myeloma bone disease in the past 20 years by bibliometric visualization analysis. Methods: With the Web of Science Core Collection database as the data source, the relevant publications of multiple myeloma bone disease from 2002 to 2021 are retrieved. These data are analyzed using software CiteSpace 5.8.R3 and Scimago Graphica 1.0.24, together with the Online Analysis Platform of Literature Metrology. Results: A total of 6,168 published research papers, including 4668 articles and 1500 review papers, are included in this study. Generally speaking, annual publications and citations are on the rise, especially in recent 2 years. The majority of these papers are published in the United States, with Mayo Clinic being the greatest contributor. The most productive journal and author are Blood and Terpos E, respectively, while the most frequently co-cited reference, author and journal are Rajkumar et al., 2014, Lancet Oncol, Kyle RA and Blood, respectively. The major research subject categories are oncology and hematology. The “disease diagnosis”, “prognosis evaluation”, “pathogenesis”, “imaging technology” and “targeted therapy” are recent research frontiers. The burst keywords “transplantation”, “progression”, “activation”, “lenalidomide”, “flow cytometry”, “drug resistance”, “management” and “mesenchymal stem cell” reflect the latest research hotspots. Conclusion: This study reveals the research hotspots and trends of multiple myeloma bone disease through bibliometric visualization analysis, and provides a valuable reference for further research.
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Affiliation(s)
- Zhaomeng Hou
- Guangxi University of Chinese Medicine, Nanning, China
- Yancheng TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, China
| | - Ping Jiang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shaoting Su
- Guangxi University of Chinese Medicine, Nanning, China
| | - Honghai Zhou
- Guangxi University of Chinese Medicine, Nanning, China
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
- *Correspondence: Honghai Zhou,
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21
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Advanced Imaging in Multiple Myeloma: New Frontiers for MRI. Diagnostics (Basel) 2022; 12:diagnostics12092182. [PMID: 36140583 PMCID: PMC9497462 DOI: 10.3390/diagnostics12092182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/17/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Plasma cell dyscrasias are estimated to newly affect almost 40,000 people in 2022. They fall on a spectrum of diseases ranging from relatively benign to malignant, the malignant end of the spectrum being multiple myeloma (MM). The International Myeloma Working Group (IMWG) has traditionally outlined the diagnostic criteria and therapeutic management of MM. In the last two decades, novel imaging techniques have been employed for MM to provide more information that can guide not only diagnosis and staging, but also treatment efficacy. These imaging techniques, due to their low invasiveness and high reliability, have gained significant clinical attention and have already changed the clinical practice. The development of functional MRI sequences such as diffusion weighted imaging (DWI) or intravoxel incoherent motion (IVIM) has made the functional assessment of lesions feasible. Moreover, the growing availability of positron emission tomography (PET)–magnetic resonance imaging (MRI) scanners is leading to the potential combination of sensitive anatomical and functional information in a single step. This paper provides an organized framework for evaluating the benefits and challenges of novel and more functional imaging techniques used for the management of patients with plasma cell dyscrasias, notably MM.
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22
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Rajkumar SV, Kumar S, Lonial S, Mateos MV. Smoldering multiple myeloma current treatment algorithms. Blood Cancer J 2022; 12:129. [PMID: 36064707 PMCID: PMC9445066 DOI: 10.1038/s41408-022-00719-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Abstract
Smoldering multiple myeloma (SMM) is an asymptomatic condition that occupies a space between monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM) along the spectrum of clonal plasma cell proliferative disorders. It is not a biologic intermediate stage between MGUS and MM, but rather represents a heterogeneous clinically defined condition in which some patients (approximately two-thirds) have MGUS (pre-malignancy), and some (approximately one-third) have MM (biologic malignancy). Unfortunately, no single pathologic or molecular feature can reliably distinguish these two groups of patients. For purposes of practice and clinical trials, specific risk factors are used to identify patients with SMM in whom malignant transformation has already likely occurred (high risk SMM). Patients with newly diagnosed high risk SMM should be offered therapy with lenalidomide or lenalidomide plus dexamethasone (Rd) for 2 years, or enrollment in clinical trials. Patients with low risk SMM should be observed without therapy every 3-4 months.
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Affiliation(s)
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Emory University School of Medicine Atlanta, Atlanta, GA, USA
| | - Maria Victoria Mateos
- Department of Hematology, and Center for Cancer Research, University Hospital of Salamanca, Salamanca, Spain
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23
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Vaxman I, Gertz MA. How I approach smoldering multiple myeloma. Blood 2022; 140:828-838. [PMID: 35576526 PMCID: PMC9412010 DOI: 10.1182/blood.2021011670] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/28/2022] [Indexed: 11/30/2022] Open
Abstract
The current standard of care in smoldering multiple myeloma (SMM) is close surveillance, outside of clinical trials. Efforts are being made to understand the pathobiologic process that leads to the progression of SMM to active MM. This review provides a critical description of available data, including risk factors and risk models of progression, as well as clinical trials investigating interventions for this patient population. We describe 2 cases in which patients were seen before the concept of a myeloma-defining event was established. Today, based on the International Myeloma Working Group criteria, both patients would have been identified as experiencing myeloma-defining events, and therapy would have been initiated. These cases show that occasionally, patients can undergo observation only, even when they exceed criteria for high-risk SMM.
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Affiliation(s)
- Iuliana Vaxman
- Division of Hematology, Mayo Clinic, Rochester, MN
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel; and
- Department of Hematology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Holstein SA, Asimakopoulos F, Azab AK, Bianchi G, Bhutani M, Crews LA, Cupedo T, Giles H, Gooding S, Hillengass J, John L, Kaiser S, Lee L, Maclachlan K, Pasquini MC, Pichiorri F, Shah N, Shokeen M, Shy BR, Smith EL, Verona R, Usmani SZ, McCarthy PL. Proceedings from the Blood and Marrow Transplant Clinical Trials Network Myeloma Intergroup Workshop on Immune and Cellular Therapy in Multiple Myeloma. Transplant Cell Ther 2022; 28:446-454. [PMID: 35605882 PMCID: PMC9357156 DOI: 10.1016/j.jtct.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
Abstract
The Blood and Marrow Transplant Clinical Trials Network (BMT CTN) Myeloma Intergroup conducted a workshop on Immune and Cellular Therapy in Multiple Myeloma on January 7, 2022. This workshop included presentations by basic, translational, and clinical researchers with expertise in plasma cell dyscrasias. Four main topics were discussed: platforms for myeloma disease evaluation, insights into pathophysiology, therapeutic target and resistance mechanisms, and cellular therapy for multiple myeloma. Here we provide a comprehensive summary of these workshop presentations.
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Affiliation(s)
| | - Fotis Asimakopoulos
- Moores Cancer Center, University of California San Diego, La Jolla, California
| | | | - Giada Bianchi
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Leslie A Crews
- Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Tom Cupedo
- ErasmusMC Cancer Institute Rotterdam, Rotterdam, The Netherlands
| | - Hannah Giles
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Sarah Gooding
- MRC Molecular Hematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Lukas John
- University Hospital Heidelberg, Heidelberg, Germany
| | | | - Lydia Lee
- University College London, London, United Kingdom
| | | | | | - Flavia Pichiorri
- Judy and Bernard Briskin Center for Multiple Myeloma Research, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Department of Hematologic Malignancies Translational Science, Beckman Research Institute, City of Hope, Duarte, California
| | - Nina Shah
- University of California San Francisco, San Francisco, California
| | - Monica Shokeen
- Washington University School of Medicine, St. Louis, Missouri
| | - Brian R Shy
- University of California San Francisco, San Francisco, California
| | - Eric L Smith
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Raluca Verona
- Janssen Research & Development, Spring House, Pennsylvania
| | - Saad Z Usmani
- Memorial Sloan Kettering Cancer Center, New York, New York
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25
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Rata M, Blackledge M, Scurr E, Winfield J, Koh DM, Dragan A, Candito A, King A, Rennie W, Gaba S, Suresh P, Malcolm P, Davis A, Nilak A, Shah A, Gandhi S, Albrizio M, Drury A, Roberts S, Jenner M, Brown S, Kaiser M, Messiou C. Implementation of Whole-Body MRI (MY-RADS) within the OPTIMUM/MUKnine multi-centre clinical trial for patients with myeloma. Insights Imaging 2022; 13:123. [PMID: 35900614 PMCID: PMC9334517 DOI: 10.1186/s13244-022-01253-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whole-body (WB) MRI, which includes diffusion-weighted imaging (DWI) and T1-w Dixon, permits sensitive detection of marrow disease in addition to qualitative and quantitative measurements of disease and response to treatment of bone marrow. We report on the first study to embed standardised WB-MRI within a prospective, multi-centre myeloma clinical trial (IMAGIMM trial, sub-study of OPTIMUM/MUKnine) to explore the use of WB-MRI to detect minimal residual disease after treatment. METHODS The standardised MY-RADS WB-MRI protocol was set up on a local 1.5 T scanner. An imaging manual describing the MR protocol, quality assurance/control procedures and data transfer was produced and provided to sites. For non-identical scanners (different vendor or magnet strength), site visits from our physics team were organised to support protocol optimisation. The site qualification process included review of phantom and volunteer data acquired at each site and a teleconference to brief the multidisciplinary team. Image quality of initial patients at each site was assessed. RESULTS WB-MRI was successfully set up at 12 UK sites involving 3 vendor systems and two field strengths. Four main protocols (1.5 T Siemens, 3 T Siemens, 1.5 T Philips and 3 T GE scanners) were generated. Scanner limitations (hardware and software) and scanning time constraint required protocol modifications for 4 sites. Nevertheless, shared methodology and imaging protocols enabled other centres to obtain images suitable for qualitative and quantitative analysis. CONCLUSIONS Standardised WB-MRI protocols can be implemented and supported in prospective multi-centre clinical trials. Trial registration NCT03188172 clinicaltrials.gov; registration date 15th June 2017 https://clinicaltrials.gov/ct2/show/study/NCT03188172.
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Affiliation(s)
- Mihaela Rata
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK.
| | - Matthew Blackledge
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Erica Scurr
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Jessica Winfield
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Dow-Mu Koh
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Alina Dragan
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Antonio Candito
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Alexander King
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Suchi Gaba
- Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Priya Suresh
- University Hospitals Plymouth NHS Foundation Trust, Plymouth, UK
| | - Paul Malcolm
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Amy Davis
- Epsom and St. Helier University Hospitals NHS Trust, Epsom, UK
| | | | - Aarti Shah
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | | | - Mauro Albrizio
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Arnold Drury
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Sadie Roberts
- University of Leeds Clinical Trial Research Unit, Leeds, UK
| | - Matthew Jenner
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Brown
- University of Leeds Clinical Trial Research Unit, Leeds, UK
| | - Martin Kaiser
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
| | - Christina Messiou
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Downs Road, SM2 5PT, Sutton, London, UK
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26
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Abstract
Multiple myeloma (MM) accounts for 0.9% of cancer diagnoses, and incidence and mortality rate have increased in previous years. 18F-fluorodeoxyglucose (FDG) PET-computed tomography (CT) is an established modality for MM evaluation. MR imaging is helpful where 18F-FDG PET-CT is lacking. To standardize PET reporting, methods like Italian Myeloma Criteria for PET Use and Deauville criteria have been studied. Tracers like 11C-acetate and 11C-choline/18F-fluoromethylcholine (FCH) have shown higher sensitivity and detected more focal lesions and diffuse involvement than 18F-FDG PET-CT. 18F-FCH showed higher maximum standardized uptake value than 18FDG. 11C-methionine appears to be the best radiopharmaceutical, apart from 18F-FDG, for evaluating MM.
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Affiliation(s)
- Angel Hemrom
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Avinash Tupalli
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Abass Alavi
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rakesh Kumar
- Diagnostic Nuclear Medicine Division, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.
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27
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Wennmann M, Goldschmidt H, Mosebach J, Hielscher T, Bäuerle T, Komljenovic D, McCarthy PL, Merz M, Schlemmer HP, Raab MS, Sauer S, Delorme S, Hillengass J. Whole-body magnetic resonance imaging plus serological follow-up for early identification of progression in smouldering myeloma patients to prevent development of end-organ damage. Br J Haematol 2022; 199:65-75. [PMID: 35608264 DOI: 10.1111/bjh.18232] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/26/2022]
Abstract
The definition of multiple myeloma (MM) was updated in 2014, with the intent to enable earlier treatment and thereby avoid appearance of end-organ damage at progression from smouldering multiple myeloma (SMM) to MM. The purpose of this study was to investigate to which extent the development of end-organ damage at progression to MM was reduced under the updated guidelines. In this prospective observational cohort study (ClinicalTrials.gov Identifier: NCT01374412), between 2014 and 2020, 96 SMM patients prospectively underwent whole-body magnetic resonance imaging (wb-MRI) and serological follow-up at baseline and every 6 months thereafter. A total of 22 patients progressed into MM during follow-up, of which seven (32%) showed SLiM-criteria only but no end-organ damage. Four (57%) of the seven patients who progressed by SLiM-criteria only progressed with >1 focal lesion (FL) or a growing FL, and three (43%) due to serum free light-chain-ratio ≥100. Fifteen (68%) out of 22 patients who progressed still suffered from end-organ damage at progression. The updated disease definition reduced the proportion of SMM patients suffering from end-organ damage at progression to MM by one third. wb-MRI is an important tool for detection of SMM patients who progress to MM without end-organ damage.
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Affiliation(s)
- Markus Wennmann
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hartmut Goldschmidt
- Multiple Myeloma Section, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Jennifer Mosebach
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Bäuerle
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and University Hospital Erlangen, Erlangen, Germany
| | - Dorde Komljenovic
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philip L McCarthy
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Maximilian Merz
- Multiple Myeloma Section, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany.,Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | | | - Marc-Steffen Raab
- Multiple Myeloma Section, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Sandra Sauer
- Multiple Myeloma Section, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Delorme
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jens Hillengass
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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28
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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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29
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Sun M, Cheng J, Ren C, Zhang Y, Li Y, Wang L, Zhang S, Lin L. Evaluation of Diffuse Bone Marrow Infiltration Pattern in Monoclonal Plasma Cell Diseases by Quantitative Whole-body Magnetic Resonance Imaging. Acad Radiol 2022; 29:490-500. [PMID: 34362664 DOI: 10.1016/j.acra.2021.06.015] [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: 04/21/2021] [Revised: 05/18/2021] [Accepted: 06/13/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze diffuse infiltration pattern in monoclonal plasma cell diseases by diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) and quantitative chemical-shift encoded MRI. MATERIALS AND METHODS Ninety-nine patients with monoclonal plasma cell diseases and 15 healthy control subjects were retrospectively analyzed. All patients underwent whole-body MRI (including DWIBS and mDIXON Quant) and were divided into three groups: monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), and multiple myeloma (MM). Apparent diffusion coefficient (ADC), fat fraction (FF), and T2* values for each group were calculated then analyzed by one-way ANOVA and receiver operating characteristic curve. Correlations of ADC, FF, and T2* with clinical indices were analyzed with Spearman correlation test. RESULTS The ADC and T2* values of MM were significantly higher than those of the healthy control, MGUS and SMM (ADC: p = 0.003, p = 0.003, and p = 0.042; T2*: all with p < 0.001). The FF values of MM were significantly lower than those of the healthy control, MGUS and SMM (p < 0.001, p < 0.001 and p = 0.034). The ADC, FF, and T2* thresholds for recognizing MM and MGUS+SMM were 0.51 × 10-3 mm2/s, 31.14%, and 10.53 ms, respectively. The ADC, FF, and T2* values were identified to be significantly associated with bone marrow plasma cells and hemoglobin in patients (all with p < 0.001). CONCLUSION ADC, FF, and T2* were significantly correlated with clinical indices related to monoclonal plasma cell diseases. MM with the diffuse infiltration pattern can be distinguished more objectively from MGUS and SMM by quantitative functional MRI parameters.
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30
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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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31
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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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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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Lussier T, Schoebe N, Mai S. Risk Stratification and Treatment in Smoldering Multiple Myeloma. Cells 2021; 11:130. [PMID: 35011692 PMCID: PMC8750018 DOI: 10.3390/cells11010130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022] Open
Abstract
Smoldering multiple myeloma is a heterogeneous asymptomatic precursor to multiple myeloma. Since its identification in 1980, risk stratification models have been developed using two main stratification methods: clinical measurement-based and genetics-based. Clinical measurement models can be subdivided in three types: baseline measurements (performed at diagnosis), evolving measurements (performed over time during follow-up appointments), and imaging (for example, magnetic resonance imaging). Genetic approaches include gene expression profiling, DNA/RNA sequencing, and cytogenetics. It is important to accurately distinguish patients with indolent disease from those with aggressive disease, as clinical trials have shown that patients designated as "high-risk of progression" have improved outcomes when treated early. The risk stratification models, and clinical trials are discussed in this review.
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Affiliation(s)
- Tyler Lussier
- Department of Physiology and Pathophysiology, University of Manitoba, Cancer Care Manitoba Research Institute, Winnipeg, MB R3E 0V9, Canada; (T.L.); (N.S.)
- Faculté des Sciences, Université de Saint-Boniface, Winnipeg, MB R2H 0H7, Canada
| | - Natalie Schoebe
- Department of Physiology and Pathophysiology, University of Manitoba, Cancer Care Manitoba Research Institute, Winnipeg, MB R3E 0V9, Canada; (T.L.); (N.S.)
- Faculty of Biosciences, University of Heidelberg, 69117 Heidelberg, Germany
| | - Sabine Mai
- Department of Physiology and Pathophysiology, University of Manitoba, Cancer Care Manitoba Research Institute, Winnipeg, MB R3E 0V9, Canada; (T.L.); (N.S.)
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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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Visram A, Cook J, Warsame R. Smoldering multiple myeloma: evolving diagnostic criteria and treatment strategies. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:673-681. [PMID: 34889380 PMCID: PMC8791169 DOI: 10.1182/hematology.2021000304] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The adage for smoldering myeloma (SMM) has been to observe without treatment, until criteria for active multiple myeloma were satisfied. Definitions and risk stratification models have become more sophisticated, with prognostication tailored to include high-risk cytogenetics as per the most recent International Myeloma Working Group 2020 risk model. Moreover, progress in defining genomic evolution and changes in the bone marrow microenvironment through the monoclonal continuum have given insight into the complexities underlying the different patterns of progression observed in SMM. Given recent data showing improved progression-free survival with early intervention in high-risk SMM, the current dilemma is focused on how these patients should be treated. This case-based article maps the significant advancements made in the diagnosis and risk stratification of SMM. Data from landmark clinical trials will also be discussed, and ongoing trials are summarized. Ultimately, we outline our approach to SMM and hope to impart to the reader a sound concept of the current clinical management of SMM.
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Affiliation(s)
- Alissa Visram
- Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - Joselle Cook
- Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Rahma Warsame
- Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada
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Development of a new risk stratification system for patients with newly diagnosed multiple myeloma using R-ISS and 18F-FDG PET/CT. Blood Cancer J 2021; 11:190. [PMID: 34853295 PMCID: PMC8636569 DOI: 10.1038/s41408-021-00577-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 12/02/2022] Open
Abstract
In multiple myeloma (MM), a high number of focal lesions (FL) detected using positron emission tomography/computed tomography (PET/CT) was found to be associated with adverse prognosis. To design a new risk stratification system that combines the Revised International Staging System (R-ISS) with FL, we analyzed the data of 380 patients with newly diagnosed MM (NDMM) who underwent 18F-fluorodeoxyglucose (18F-FDG) PET/CT upon diagnosis. The K-adaptive partitioning algorithm was adopted to define subgroups with homogeneous survival. The combined R-ISS with PET/CT classified NDMM patients into four groups: R-ISS/PET stage I (n = 31; R-ISS I with FL ≤ 3), stage II (n = 156; R-ISS I with FL > 3 and R-ISS II with FL ≤ 3), stage III (n = 162; R-ISS II with FL > 3 and R-ISS III with FL ≤ 3), and stage IV (n = 31; R-ISS III with FL > 3). The 2-year overall survival rates for stages I, II, III, and IV were 96.7%, 89.8%, 74.7%, and 50.3%. The 2-year progression-free survival rates were 84.1%, 64.7%, 40.8%, and 17.1%, respectively. The new R-ISS/PET was successfully validated in an external cohort. This new system had a remarkable prognostic power for estimating the survival outcomes of patients with NDMM. This system helps discriminate patients with a good prognosis from those with a poor prognosis more precisely.
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Burns R, Mulé S, Blanc-Durand P, Tofighi M, Belhadj K, Zerbib P, Le Bras F, Baranes L, Haioun C, Itti E, Luciani A. Optimization of whole-body 2-[ 18F]FDG-PET/MRI imaging protocol for the initial staging of patients with myeloma. Eur Radiol 2021; 32:3085-3096. [PMID: 34842956 DOI: 10.1007/s00330-021-08388-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/08/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the optimal 2-[18F]FDG-PET/MRI imaging protocol for the initial staging of patients with suspected or confirmed multiple myeloma. METHODS Radiologists and nuclear medicine specialists reviewed all PET/MRI exams of 104 patients with a monoclonal gammopathy (MG). The presence of focal and diffuse bone marrow involvement (BMI) was assessed using 4 different image datasets: WB-MRI, PET, WB-PET/MRI, and WB-DCE-PET/MRI. A reference standard was established by a panel review of all baseline and follow-up imaging, and biological and pathological information. The diagnostic performance for each image dataset to detect BMI was evaluated and compared (Fisher's exact test). RESULTS Sensitivity, specificity, and accuracy for focal BMI of WB-MRI was 87%, 97%, and 92%; of PET was 78%, 97%, and 95%; of WB-PET/MRI was 93%, 97%, and 95%; and of WB-DCE-PET/MRI was 93%, 97%, and 95%, respectively. WB-PET/MRI and WB-DCE-PET/MRI were statistically superior to PET (p = 0.036) without decreasing specificity. The sensitivity, specificity, and accuracy of WB-MRI for diffuse BMI detection was 91%, 80%, and 85%; of 3DT1-PET was 53%, 89%, and 74%; of WB-PET/MRI was 98%, 66%, and 79%; and of WB-DCE-PET/MRI was 98%, 59%, and 75%, respectively. PET lacked sensitivity compared to all other dataset studies (p < 0.0001). WB-MRI had the best accuracy without reaching statistical significance when compared to the other datasets. CONCLUSION The WB-PET/MRI dataset including T1 and T2 Dixon, WB-DWI, and PET images provides optimal diagnostic performance to detect both focal lesions and diffuse BMI, with limited added value of WB-DCE for baseline staging of patients with MG. Key Points • The combination of morphological and functional MRI sequences and metabolic (2-[18F]FDG-PET) images increases the diagnostic performance of PET/MRI to detect focal bone lesions. • The adjunction of dynamic contrast-enhanced sequences did not improve diagnostic performance.
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Affiliation(s)
- Robert Burns
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France. .,Department of Medical Imaging, 51 Av. du Maréchal de Lattre de Tassigny, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.
| | - Sébastien Mulé
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Department of Medical Imaging, 51 Av. du Maréchal de Lattre de Tassigny, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Université Paris-Est Créteil, 94010, Créteil, France
| | - Paul Blanc-Durand
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Université Paris-Est Créteil, 94010, Créteil, France.,Department of Nuclear Medicine, Henri Mondor Hospital, AP-HP, 94010, Créteil, France
| | - Mojdeh Tofighi
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Department of Nuclear Medicine, Henri Mondor Hospital, AP-HP, 94010, Créteil, France
| | - Karim Belhadj
- Hematology Department, University Hospital, Creteil, France
| | - Pierre Zerbib
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Department of Medical Imaging, 51 Av. du Maréchal de Lattre de Tassigny, Henri Mondor Hospital, AP-HP, 94010, Créteil, France
| | - Fabien Le Bras
- Hematology Department, University Hospital, Creteil, France
| | - Laurence Baranes
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Department of Medical Imaging, 51 Av. du Maréchal de Lattre de Tassigny, Henri Mondor Hospital, AP-HP, 94010, Créteil, France
| | - Corinne Haioun
- Université Paris-Est Créteil, 94010, Créteil, France.,Hematology Department, University Hospital, Creteil, France
| | - Emmanuel Itti
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Université Paris-Est Créteil, 94010, Créteil, France.,Department of Nuclear Medicine, Henri Mondor Hospital, AP-HP, 94010, Créteil, France
| | - Alain Luciani
- SyMPTOm PET/MRI Platform, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Department of Medical Imaging, 51 Av. du Maréchal de Lattre de Tassigny, Henri Mondor Hospital, AP-HP, 94010, Créteil, France.,Université Paris-Est Créteil, 94010, Créteil, France
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Nsiala L, Bobin A, Levy A, Gruchet C, Sabirou F, Gardeney H, Cailly L, Manier S, Moya N, Tomowiak C, Guidez S, Leleu X, Decaux O. Smoldering multiple myeloma: biology, clinical manifestations and management. Leuk Lymphoma 2021; 63:518-529. [PMID: 34672244 DOI: 10.1080/10428194.2021.1992615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Smoldering multiple myeloma (SMM) is a heterogeneous group of asymptomatic plasma cell disorder characterized by the presence of monoclonal protein ≥ 30 g/L and/or 10-60% of bone marrow plasma cells and no evidence of SLiM-CRAB criteria according to the 2014 International Myeloma Working Group (IMWG) recommendations. Once the effort to reclassify SMM with active disease as MM requiring treatment was completed, the need to redefine new high-risk SMM arose. The 20/2/20 and the IMWG risk model with the add-on high-risk cytogenetic abnormalities allow to identify high-risk SMM with 50% risk of progression to MM within 2 years, and therefore might help to propose a better therapeutic approach, either with the goal to « cure » by profoundly debulk the MM with aggressive therapies, or alternatively to restore the immune surveillance like a « delay » strategy with immune-based therapies. The debate is still ongoing but clearly challenges the watch-and-wait standard of care.
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Affiliation(s)
- Laly Nsiala
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Arthur Bobin
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Anthony Levy
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Cécile Gruchet
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Florence Sabirou
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Hélène Gardeney
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Laura Cailly
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Salomon Manier
- Service d'Hematologie Clinique, CHRU Lille, Lille 2 64 University, INSERM UMR-S1172, Lille, France
| | - Niels Moya
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Cécile Tomowiak
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Stephanie Guidez
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Xavier Leleu
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Olivier Decaux
- Service d'Hématologie Clinique, CHU Rennes, INSERM U1236, Rennes 1 University, Rennes, France
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Mesguich C, Hindie E, de Senneville BD, Tlili G, Pinaquy JB, Marit G, Saut O. Improved 18-FDG PET/CT diagnosis of multiple myeloma diffuse disease by radiomics analysis. Nucl Med Commun 2021; 42:1135-1143. [PMID: 34001823 DOI: 10.1097/mnm.0000000000001437] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES In multiple myeloma, the diagnosis of diffuse bone marrow infiltration on 18-FDG PET/CT can be challenging. We aimed to develop a PET/CT radiomics-based model that could improve the diagnosis of multiple myeloma diffuse disease on 18-FDG PET/CT. METHODS We prospectively performed PET/CT and whole-body diffusion-weighted MRI in 30 newly diagnosed multiple myeloma. MRI was the reference standard for diffuse disease assessment. Twenty patients were randomly assigned to a training set and 10 to an independent test set. Visual analysis of PET/CT was performed by two nuclear medicine physicians. Spine volumes were automatically segmented, and a total of 174 Imaging Biomarker Standardisation Initiative-compliant radiomics features were extracted from PET and CT. Selection of best features was performed with random forest features importance and correlation analysis. Machine-learning algorithms were trained on the selected features with cross-validation and evaluated on the independent test set. RESULTS Out of the 30 patients, 18 had established diffuse disease on MRI. The sensitivity, specificity and accuracy of visual analysis were 67, 75 and 70%, respectively, with a moderate kappa coefficient of agreement of 0.6. Five radiomics features were selected. On the training set, random forest classifier reached a sensitivity, specificity and accuracy of 93, 86 and 91%, respectively, with an area under the curve of 0.90 (95% confidence interval, 0.89-0.91). On the independent test set, the model achieved an accuracy of 80%. CONCLUSIONS Radiomics analysis of 18-FDG PET/CT images with machine-learning overcame the limitations of visual analysis, providing a highly accurate and more reliable diagnosis of diffuse bone marrow infiltration in multiple myeloma patients.
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Affiliation(s)
- Charles Mesguich
- Nuclear Medicine Department, CHU Bordeaux
- INSERM U1035, University of Bordeaux, Bordeaux
- University of Bordeaux, IMB, UMR CNRS 5251, INRIA Project team Monc, Talence, France
| | | | | | | | | | | | - Olivier Saut
- University of Bordeaux, IMB, UMR CNRS 5251, INRIA Project team Monc, Talence, France
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Ghai A, Fettig N, Fontana F, DiPersio J, Rettig M, Neal JO, Achilefu S, Shoghi KI, Shokeen M. In vivo quantitative assessment of therapeutic response to bortezomib therapy in disseminated animal models of multiple myeloma with [ 18F]FDG and [ 64Cu]Cu-LLP2A PET. EJNMMI Res 2021; 11:97. [PMID: 34586539 PMCID: PMC8481408 DOI: 10.1186/s13550-021-00840-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/13/2021] [Indexed: 02/06/2023] Open
Abstract
Background Multiple myeloma (MM) is a disease of cancerous plasma cells in the bone marrow. Imaging-based timely determination of therapeutic response is critical for improving outcomes in MM patients. Very late antigen-4 (VLA4, CD49d/CD29) is overexpressed in MM cells. Here, we evaluated [18F]FDG and VLA4 targeted [64Cu]Cu-LLP2A for quantitative PET imaging in disseminated MM models of variable VLA4 expression, following bortezomib therapy. Methods In vitro and ex vivo VLA4 expression was evaluated by flow cytometry. Human MM cells, MM.1S-CG and U266-CG (C: luciferase and G: green fluorescent protein), were injected intravenously in NOD-SCID gamma mice. Tumor progression was monitored by bioluminescence imaging (BLI). Treatment group received bortezomib (1 mg/kg, twice/week) intraperitoneally. All cohorts (treated, untreated and no tumor) were longitudinally imaged with [18F]FDG (7.4–8.0 MBq) and [64Cu]Cu-LLP2A (2–3 MBq; Molar Activity: 44.14 ± 1.40 MBq/nmol) PET, respectively. Results Flow cytometry confirmed high expression of CD49d in U266 cells (> 99%) and moderate expression in MM.1S cells (~ 52%). BLI showed decrease in total body flux in treated mice. In MM.1S-CG untreated versus treated mice, [64Cu]Cu-LLP2A localized with a significantly higher SUVmean in spine (0.58 versus 0.31, p < 0.01) and femur (0.72 versus 0.39, p < 0.05) at week 4 post-tumor inoculation. There was a four-fold higher uptake of [64Cu]Cu-LLP2A (SUVmean) in untreated U266-CG mice compared to treated mice at 3 weeks post-treatment. Compared to [64Cu]Cu-LLP2A, [18F]FDG PET detected treatment-related changes at later time points. Conclusion [64Cu]Cu-LLP2A is a promising tracer for timely in vivo assessment of therapeutic response in disseminated models of MM. Supplementary Information The online version contains supplementary material available at 10.1186/s13550-021-00840-4.
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Affiliation(s)
- Anchal Ghai
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4515 McKinley Avenue, 2nd floor, St. Louis, MO, 63110, USA
| | - Nikki Fettig
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4515 McKinley Avenue, 2nd floor, St. Louis, MO, 63110, USA
| | - Francesca Fontana
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - John DiPersio
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Mike Rettig
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie O Neal
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Samuel Achilefu
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4515 McKinley Avenue, 2nd floor, St. Louis, MO, 63110, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.,Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kooresh I Shoghi
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4515 McKinley Avenue, 2nd floor, St. Louis, MO, 63110, USA
| | - Monica Shokeen
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4515 McKinley Avenue, 2nd floor, St. Louis, MO, 63110, USA. .,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.
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Kunacheewa C, Manasanch EE. The benefits of early intervention using lenalidomide for high-risk smoldering multiple myeloma: emerging data and its promising clinical impact. Expert Rev Hematol 2021; 14:1059-1069. [PMID: 34550841 DOI: 10.1080/17474086.2021.1984225] [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: 10/20/2022]
Abstract
INTRODUCTION Multiple myeloma is preceded by the early stages: monoclonal gammopathy of unknown significance (M.G.U.S.) and smoldering myeloma (S.M.M.), which are less genomically complex and where patients are overall healthier with preserved quality of life. AREAS COVERED This review focuses on the current evidence in risk stratification and initial therapy for these patients with the goal to delay progression to and/or cure multiple myeloma. EXPERT OPINION Advances in the understanding of the factors that contribute to myeloma evolution coupled with new therapeutics that have high efficacy and limited toxicity have revolutionized our approach to early myeloma. Although our current recommendation continues to be to observe S.M.M. outside of clinical trials, the clinical benefit of lenalidomide sets the stage for combinations with immunotherapy, which, in our opinion, will likely lead to regulatory approvals and more widespread treatment of early myeloma.
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Affiliation(s)
- Chutima Kunacheewa
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Elisabet E Manasanch
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ravi G, Gonsalves WI. Current diagnosis, risk stratification and treatment paradigms in newly diagnosed multiple myeloma. Cancer Treat Res Commun 2021; 29:100444. [PMID: 34555665 DOI: 10.1016/j.ctarc.2021.100444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/03/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Gayathri Ravi
- Division of Hematology, Mayo Clinic, Rochester MN, USA
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Sun M, Cheng J, Ren C, Zhang Y, Li Y, Wang L, Liu Y. Differentiation of Diffuse Infiltration Pattern in Multiple Myeloma From Hyperplastic Hematopoietic Bone Marrow: Qualitative and Quantitative Analysis Using Whole-Body MRI. J Magn Reson Imaging 2021; 55:1213-1225. [PMID: 34558141 DOI: 10.1002/jmri.27934] [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: 07/19/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The visual assessment used for diffuse infiltration of multiple myeloma (MM) is inadequate. It can be difficult to differentiate MM from hyperplastic hematopoietic bone marrow (HHBM) because the MRI signal characteristics overlap. PURPOSE To analyze the bone marrow diffuse signal changes on whole-body MRI caused by MM and HHBM. STUDY TYPE Retrospective. SUBJECTS Thirty Four patients with MM (21 men and 13 women), 22 patients with HHBM (9 men and 13 women), and 15 healthy controls (9 men and 6 women). FIELD STRENGTH/SEQUENCE A 3.0 T MRI; diffusion-weighted whole-body imaging with background body signal suppression (DWIBS), modified Dixon T1 fast field echo, and T2 STIR. ASSESSMENT Three radiologists analyzed the whole-body MRI alone and in combination with apparent diffusion coefficient (ADC) and fat fraction (FF) with qualitative and quantitative analysis. Normalized T1 and T2 signal intensities (nT1 and nT2) and signal-to-noise ratio (SNR) were obtained. STATISTICAL TESTS Kruskal-Wallis and chi-square tests. RESULTS The MM group had significantly higher ADC and significantly lower FF than HHBM and control groups. There was no significant difference in nT1, nT2 or SNR between MM and HHBM (P = 0.932, P = 0.097, and P = 0.110, respectively). Receiver operating characteristic (ROC) analysis using ADC and FF cut-off values of 0.47 × 10-3 mm2 /sec and 20.63%, respectively. The AUC was 0.866 for ADC and 0.886 for FF. The quantitative analysis yielded better specificity (observer 1: 81.8% vs. 27.3%; observer 2: 68.2% vs. 22.7%; and observer 3: 72.7% vs. 18.2%) and a higher diagnostic accuracy (observer 1: 82.1% vs. 51.8%; observer 2: 80.4% vs. 50.0%; observer 3: 76.8% vs. 44.6%) than the qualitative analysis. DATA CONCLUSION Whole-body MRI combined with DWIBS and mDIXON could be used to differentiate between MM and HHBM. Combining the quantitative ADC and FF with the whole-body MRI improved the specificity and accuracy in differentiating these conditions. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Mengtian Sun
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
| | - Cuiping Ren
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
| | - Yinhua Li
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
| | - Linlin Wang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
| | - Yu Liu
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, 1st, Jianshe Dong Road, Zhengzhou, Henan Province, 450052, China
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Smoldering Myeloma Treatment: Who, What, and When. ACTA ACUST UNITED AC 2021; 27:185-189. [PMID: 34549905 DOI: 10.1097/ppo.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Smoldering multiple myeloma (MM) is a clonal plasma cell disorder characterized by excess marrow involvement and immunoglobulin production. It is the precursor of MM, differing by the lack of end-organ damage. Smoldering MM encompasses a heterogeneous group of patients, with a median risk of progression to active disease of 50% in the first 5 years. Until recently, the standard of care would dictate observation off therapy until the development of end-organ damage. The recognition of high-risk and ultrahigh-risk subgroups of smoldering MM, with more likely evolution to MM, has led to earlier initiation of therapy in the disease course. Ongoing studies to define the ideal timing and patient population are underway, as well as identification of which agents would be of greatest benefit, as the armamentarium for MM continues to grow.
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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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47
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Messiou C, Porta N, Sharma B, Levine D, Koh DM, Boyd K, Pawlyn C, Riddell A, Downey K, Croft J, Morgan V, Stern S, Cheung B, Kyriakou C, Kaczmarek P, Winfield J, Blackledge M, Oyen WJG, Kaiser MF. Prospective Evaluation of Whole-Body MRI versus FDG PET/CT for Lesion Detection in Participants with Myeloma. Radiol Imaging Cancer 2021; 3:e210048. [PMID: 34559006 PMCID: PMC8489453 DOI: 10.1148/rycan.2021210048] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 05/22/2023]
Abstract
Purpose To compare disease detection of myeloma using contemporary whole-body (WB) MRI and fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT protocols and to correlate imaging with laboratory estimates of disease burden, including molecular characteristics. Materials and Methods In this observational, prospective study, participants were recruited from November 2015 to March 2018 who had a diagnosis of myeloma, who were planned to undergo chemotherapy and autologous stem cell transplantation, and who underwent baseline WB-MRI and FDG PET/CT (ClinicalTrials.gov identifier NCT02403102). Baseline clinical data, including genetics, were collected. Paired methods were used to compare burden and patterns of disease. Results Sixty participants (mean age, 60 years ± 9 [standard deviation]; 35 men) underwent baseline WB-MRI and FDG PET/CT. WB-MRI showed significantly higher detection for focal lesions at all anatomic sites (except ribs, scapulae, and clavicles) and for diffuse disease at all sites. Two participants presented with two or more focal lesions smaller than 5 mm only at WB-MRI but not FDG PET/CT. Participants with diffuse disease at MRI had higher plasma cell infiltration (percentage of nucleated cells: median, 60% [interquartile range {IQR}, 50%-61%] vs 15% [IQR, 4%-50%]; P = .03) and paraprotein levels (median, 32.0 g/L [IQR, 24.0-48.0 g/L] vs 20.0 g/L [IQR, 12.0-22.6 g/L]; P = .02) compared with those without diffuse disease. All genetically high-risk tumors showed diffuse infiltration at WB-MRI. Conclusion WB-MRI helped detect a higher number of myeloma lesions than FDG PET/CT, and diffuse disease detected at WB-MRI correlated with laboratory measures of disease burden and molecular markers of risk. Keywords: MR-Imaging, Skeletal-Appendicular, Skeletal-Axial, Bone Marrow, Hematologic Diseases, Oncology Clinical trial registration no. NCT02403102. Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Christina Messiou
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Nuria Porta
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Bhupinder Sharma
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Daniel Levine
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Dow-Mu Koh
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Kevin Boyd
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Charlotte Pawlyn
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Angela Riddell
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Katherine Downey
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - James Croft
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Veronica Morgan
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Simon Stern
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Betty Cheung
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Charalampia Kyriakou
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Pawel Kaczmarek
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Jessica Winfield
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Matthew Blackledge
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Wim J. G. Oyen
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
| | - Martin F. Kaiser
- From the Royal Marsden Hospital Foundation NHS Trust, Fulham Rd,
London SW3 6JJ, England (C.M., B.S., D.L., D.M.K., K.B., C.P., A.R.,
K.D., J.C., V.M., S.S., J.W., W.J.G.O., M.F.K.); The Institute of Cancer
Research, London, England (C.M., N.P., D.M.K., C.P., J.W., M.B., W.J.G.O.,
M.F.K.); Epsom and St Helier University Hospitals NHS Trust, Epsom, England
(S.S.); Croydon University Hospital, Croydon, England (B.C.); University College
London Hospital NHS Foundation Trust, London, England (C.K.); and Surrey and
Sussex Healthcare NHS Trust, Redhill, England (P.K.)
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48
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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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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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Li J, Tan H, Xu T, Shi H, Liu P. Bone marrow tracer uptake pattern of PET-CT in multiple myeloma: image interpretation and prognostic value. Ann Hematol 2021; 100:2979-2988. [PMID: 34415386 DOI: 10.1007/s00277-021-04629-2] [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: 03/09/2021] [Accepted: 07/31/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the prognostic value of bone marrow (BM) imaging pattern and other imaging findings assessed by 18F-FDG PET-CT in multiple myeloma(MM) and to find out the image interpretation cut-off to define different BM tracer uptake pattern. MATERIALS AND METHODS We retrospectively studied PET-CT examinations and clinical data of 100 healthy individuals and 172 newly diagnosed MM patients. A BM uptake > liver SUVmean was selected as the positivity cut-off of pathological uptake in BM after comparing BM uptake in normal control and MM patients. With this interpretation cut-off, we defined the BM FDG uptake pattern as four types: normal, focal, diffuse, and mixed. The clinical correlation and prognostic value of BM uptake pattern were evaluated. The findings were validated in an independent prospective cohort with 72 MM patients. RESULTS In MM cohort, 34.9% patients had focal BM uptake pattern, 3.5% had diffuse pattern, 38.4% had mixed pattern, and 23.3% had normal BM uptake. Diffuse/mixed pattern was correlated with clinical and imaging parameters indicating high tumor burden, and inferior progression free survival (PFS; 3-year-PFS 26.8%) and overall survival (OS; 3-year-OS 50.6%). BM uptake pattern was an independent prognostic factor and diffuse/mixed pattern was associated with inferior OS (P = 0.037, HR 7.16) and PFS (P = 0.015, HR 7.77). The prognostic value of BM uptake pattern was also confirmed in validation set. CONCLUSION We propose an FDG uptake higher than liver as the positivity cut-off to discriminate between physiological and pathological uptake in BM and defined four BM FDG uptake pattern. BM FDG uptake pattern is a reliable prognostic predictor of MM.
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Affiliation(s)
- Jing Li
- Department of Hematology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Hui Tan
- Department of Nuclear Medicine, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.,Institute of Nuclear Medicine, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, People's Republic of China
| | - Tianhong Xu
- Department of Hematology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China. .,Institute of Nuclear Medicine, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, People's Republic of China.
| | - Peng Liu
- Department of Hematology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
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