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Zirakchian Zadeh M. The role of conventional and novel PET radiotracers in assessment of myeloma bone disease. Bone 2024; 179:116957. [PMID: 37972747 DOI: 10.1016/j.bone.2023.116957] [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: 06/25/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
Over 80 % of patients with multiple myeloma (MM) experience osteolytic bone lesions, primarily due to an imbalanced interaction between osteoclasts and osteoblasts. This imbalance can lead to several adverse outcomes such as pain, fractures, limited mobility, and neurological impairments. Myeloma bone disease (MBD) raises the expense of management in addition to being a major source of disability and morbidity in myeloma patients. Whole-body x-ray radiography was the gold standard imaging modality for detecting lytic lesions. Osteolytic lesions are difficult to identify at an earlier stage on X-ray since the lesions do not manifest themselves on conventional radiographs until at least 30 % to 50 % of the bone mass has been destroyed. Hence, early diagnosis of osteolytic lesions necessitates the utilization of more complex and advanced imaging modalities, such as PET. One of the PET radiotracers that has been frequently investigated in MM is 18F-FDG, which has demonstrated a high level of sensitivity and specificity in detecting myeloma lesions. However, 18F-FDG PET/CT has several restrictions, and therefore the novel PET tracers that can overcome the limitations of 18F-FDG PET/CT should be further examined in assessment of MBD. The objective of this review article is to thoroughly examine the significance of both conventional and novel PET radiotracers in the assessment of MBD. The intention is to present the information in a manner that would be easily understood by healthcare professionals from diverse backgrounds, while minimizing the use of complex nuclear medicine terminology.
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Affiliation(s)
- Mahdi Zirakchian Zadeh
- Molecular Imaging and Therapy and Interventional Radiology Services, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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2
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Xu L, Wu S. New diagnostic strategy for multiple myeloma: A review. Medicine (Baltimore) 2023; 102:e36660. [PMID: 38206744 PMCID: PMC10754592 DOI: 10.1097/md.0000000000036660] [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: 09/09/2023] [Accepted: 11/22/2023] [Indexed: 01/13/2024] Open
Abstract
Multiple myeloma (MM) is the second most prevalent hematological malignancy and is distinguished by the aberrant proliferation of monoclonal plasma cells inside the bone marrow and production of M-protein. This condition frequently results in bone deterioration, acute kidney damage, anemia, and hypercalcemia. However, the clinical manifestations and accompanying symptoms of MM vary and may change as the condition evolves. Therefore, diagnosis of MM is difficult. At present, the confirmation of MM diagnosis necessitates the use of bone marrow biopsy, a procedure that is both invasive and challenging for assessing dynamic alterations in the disease. The integration of laboratory testing technologies with imaging technology has the potential to enhance the diagnostic effectiveness and provide a thorough evaluation of disease progression and prognosis in patients with MM. All the examination methods have advantages and disadvantages. Therefore, diagnosis is determined by the application of clinical characteristics, serological tests, and imaging investigations.
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Affiliation(s)
- Ligong Xu
- Department of Radiology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Shuang Wu
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
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3
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Ishibashi M, Takahashi M, Yamaya T, Imai Y. Current and Future PET Imaging for Multiple Myeloma. Life (Basel) 2023; 13:1701. [PMID: 37629558 PMCID: PMC10455506 DOI: 10.3390/life13081701] [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: 06/07/2023] [Revised: 07/26/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
Positron emission tomography (PET) is an imaging modality used for the noninvasive assessment of tumor staging and response to therapy. PET with 18F labeled fluorodeoxyglucose (18F-FDG PET) is widely used to assess the active and inactive lesions in patients with multiple myeloma (MM). Despite the availability of 18F-FDG PET for the management of MM, PET imaging is less sensitive than next-generation flow cytometry and sequencing. Therefore, the novel PET radiotracers 64Cu-LLP2A, 68Ga-pentixafor, and 89Zr-daratumumab have been developed to target the cell surface antigens of MM cells. Furthermore, recent studies attempted to visualize the tumor-infiltrating lymphocytes using PET imaging in patients with cancer to investigate their prognostic effect; however, these studies have not yet been performed in MM patients. This review summarizes the recent studies on PET with 18F-FDG and novel radiotracers for the detection of MM and the resulting preclinical research using MM mouse models and clinical studies. Novel PET technologies may be useful for developing therapeutic strategies for MM in the future.
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Affiliation(s)
- Mariko Ishibashi
- Department of Microbiology and Immunology, Nippon Medical School, Tokyo 113-8602, Japan;
| | - Miwako Takahashi
- Department of Advanced Nuclear Medicine Sciences, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (M.T.); (T.Y.)
| | - Taiga Yamaya
- Department of Advanced Nuclear Medicine Sciences, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba 263-8555, Japan; (M.T.); (T.Y.)
| | - Yoichi Imai
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi 321-0293, Japan
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4
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Filippi L, Frantellizzi V, Bartoletti P, Vincentis GD, Schillaci O, Evangelista L. Head-to-Head Comparison between FDG and 11C-Methionine in Multiple Myeloma: A Systematic Review. Diagnostics (Basel) 2023; 13:2009. [PMID: 37370904 DOI: 10.3390/diagnostics13122009] [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: 04/15/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this systematic review is to provide a comprehensive overview of the existing literature, comparing 18F-fluorodeoxyglucose (FDG) and 11C-methionine (MET) for the imaging of multiple myeloma (MM) with positron emission computed tomography (PET/CT). Relevant studies published from 2013 up to March 2023 were selected by searching Scopus, PubMed, and Web of Science. Selected imaging studies were analyzed using a modified version of the critical Appraisal Skills Programme (CASP). Ten studies encompassing 335 patients were selected. On a patient-based analysis, MET sensitivity ranged between 75.6% and 100%, resulting higher than that measured for FDG (0-100%). MET outperformed FDG for the detection of focal lesions, diffuse bone marrow involvement and mixed patterns. PET-derived parameters resulted higher for MET than for FDG, with a strong correlation with clinical variables (e.g., monoclonal component and beta-2-microglobulin levels, bone marrow infiltration, etc.), although FDG maintained a prognostic impact on outcome prediction. When compared to other tracers or imaging modalities, MET showed stronger correlation and inter-observer agreement than FDG. Although biased by the small cohorts and requiring confirmation through multicenter studies, preliminary findings suggest that MET-PET should be preferred to FDG for PET imaging of MM, or alternatively used as a complementary imaging modality. Some issues, such as tracer availability and the role of MET with respect to other emerging tracers (i.e., 68Ga-pentixafor, 18F-FACBC and 18F-FET), should be the topic of further investigations.
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Affiliation(s)
- Luca Filippi
- Nuclear Medicine Unit, "Santa Maria Goretti" Hospital, Via Antonio Canova, 04100 Latina, Italy
| | - Viviana Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy
| | - Paola Bartoletti
- Nuclear Medicine Unit, Department of Medicine (DIMED), University of Padua, Via Giustiniani, 35128 Padua, Italy
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
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5
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Prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography at diagnosis in untreated multiple myeloma patients: a systematic review and meta-analysis. Clin Exp Med 2023; 23:31-43. [PMID: 35000022 DOI: 10.1007/s10238-021-00775-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/30/2021] [Indexed: 11/03/2022]
Abstract
Multiple myeloma is a clonal B-lymphocyte tumor of terminally differentiated plasma cells. 18F-FDG PET/CT can provide valuable data for the diagnosis, restaging, and evaluate prognosis of multiple myeloma (MM). This meta-analysis aimed to evaluate the prognostic value of pre-treatment 18F-FDG PET/CT at diagnosis in MM patients. Related researches came from Embase, PubMed, and Cochrane Library databases through a systematic search, and the last one was updated on April 26, 2021. Cochran Q test and I-squared statistics were used to test for heterogeneity among the studies analyzed. The fixed model and random model were used to combine results when appropriate. Stata 12.0 was used to perform statistical analysis, and p < 0.05 was considered statistically significant. A total of 16 articles with 2589 patients were included in this study. Our results indicated PET/CT has an excellent prognostic role in MM, that higher SUVmax, more FL and EMD were associated with poor OS and PFS. SUVmax: OS (HR 1.89, 95% CI 1.47-2.44), PFS (HR 1.34, 95% CI 1.18-1.51); Fl: OS (HR 2.65, 95% CI 1.83-3.79), PFS (HR 1.61, 95% CI 1.40-1.86); EMD: OS (HR 2.11, 95% CI 1.41-3.16), PFS (HR 2.18, 95% CI 1.69-2.81). Furthermore, similar results were observed in most subgroup analyzes. Conclusion Pre-treatment 18F-FDG PET/CT examination has prognostic value for myeloma patients and has guiding significance for clinical treatment.
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6
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Patel P, Dalal I, Griffith B. [ 18F]FDG-PET Evaluation of Spinal Pathology in Patients in Oncology: Pearls and Pitfalls for the Neuroradiologist. AJNR Am J Neuroradiol 2022; 43:332-340. [PMID: 34711547 PMCID: PMC8910786 DOI: 10.3174/ajnr.a7308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022]
Abstract
[18F]FDG-PET is a widely used technique for specific evaluation of disease and treatment response in oncology. However, the principles behind [18F]FDG-PET imaging allow a wide-ranging array of benign and malignant pathologies to be identified on both initial and routine surveillance imaging. This is important for clinicians and radiologists, alike, in that effective and accurate evaluation of malignancy and metastatic disease, specifically involving the spine and central nervous system, is crucial. In this article, we review the normal and posttherapy appearance of the spine on [18F]FDG-PET, the various types and patterns of metastatic disease that involve the spine and spinal cord, and, finally, important spinal pathologies that may mimic malignancy on [18F]FDG-PET.
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Affiliation(s)
- P.Y. Patel
- From the Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - I. Dalal
- From the Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - B. Griffith
- From the Department of Radiology, Henry Ford Health System, Detroit, Michigan
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7
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Vicentini JRT, Bredella MA. Role of FDG PET in the staging of multiple myeloma. Skeletal Radiol 2022; 51:31-41. [PMID: 33813607 DOI: 10.1007/s00256-021-03771-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 02/02/2023]
Abstract
18F-Fluorodeoxyglucose (FDG) PET has been used for staging of hematologic malignancies for years. In multiple myeloma, this imaging modality can be used in many different scenarios, including initial staging, evaluation of treatment response, and investigation of residual disease or early relapse. FDG PET-CT has excellent diagnostic performance, similar to other advanced imaging modalities such as whole-body CT and MRI, and it is particularly helpful for the assessment of extramedullary disease. It also offers important prognostic information on survival and risk of relapse, both at baseline and after therapy. This review will cover the main applications, advantages, and limitations of FDG PET-CT in multiple myeloma and related clonal plasma cell proliferative disorders, such as smoldering multiple myeloma and plasmacytoma.
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Affiliation(s)
- Joao R T Vicentini
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, USA. .,Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street - YAW 6, Boston, MA, 02114, USA.
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8
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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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9
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Furtado FS, Johnson MK, Catalano OA. PET imaging of hematological neoplasia. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00119-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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10
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Fouquet G, Wartski M, Dechmi A, Willems L, Deau-Fischer B, Franchi P, Descroocq J, Deschamps P, Blanc-Autran E, Clerc J, Bouscary D, Barreau S, Chapuis N, Vignon M, Cottereau AS. Prognostic Value of FDG-PET/CT Parameters in Patients with Relapse/Refractory Multiple Myeloma before Anti-CD38 Based Therapy. Cancers (Basel) 2021; 13:4323. [PMID: 34503133 PMCID: PMC8431719 DOI: 10.3390/cancers13174323] [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: 06/30/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
Although anti-CD38 monoclonal antibodies have improved the prognosis of relapsed/refractory multiple myeloma (RRMM), some patients still experience early relapses with poor outcomes. This present study evaluated the predictive value of FDG PET/CT parameters for RRMM prior to initiating anti-CD38 treatment. We included 38 consecutive RRMM patients who underwent a PET/CT scan treated at our institution at relapse. The median PFS was 12.5 months and the median OS was not reached. 42% of the patients had an initial ISS score of 1, 37% of 2, and 21% of 3. The presence of >3 focal lesions (FLs, n = 19) and the ISS score were associated with inferior PFS (p = 0.0036 and p = 0.0026) and OS (p = 0.025 and p = 0.0098). Patients with >3 FLs had a higher initial ISS score (p = 0.028). In multivariable analysis, the ISS score and >3 FLs were independent prognostic factors for PFS (p = 0.010 and p = 0.025 respectively), and combined they individualized a high-risk group with a median PFS and OS of 3.1 months and 8.5 months respectively vs. not reached for the other patients. The presence of >3 FLs on PET was predictive of survival outcomes in patients with RRMM treated using CD38 targeted therapy. Combined with the initial ISS, an ultra-high-risk RRMM population can thus be identified.
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Affiliation(s)
- Guillemette Fouquet
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service d’Hématologie Clinique, Hôpital Cochin, 75014 Paris, France; (G.F.); (L.W.); (B.D.-F.); (P.F.); (J.D.); (P.D.); (D.B.); (M.V.)
| | - Myriam Wartski
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service de Médecine Nucléaire, Hôpital Cochin, 75014 Paris, France; (M.W.); (A.D.); (J.C.)
| | - Amina Dechmi
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service de Médecine Nucléaire, Hôpital Cochin, 75014 Paris, France; (M.W.); (A.D.); (J.C.)
| | - Lise Willems
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service d’Hématologie Clinique, Hôpital Cochin, 75014 Paris, France; (G.F.); (L.W.); (B.D.-F.); (P.F.); (J.D.); (P.D.); (D.B.); (M.V.)
| | - Bénédicte Deau-Fischer
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service d’Hématologie Clinique, Hôpital Cochin, 75014 Paris, France; (G.F.); (L.W.); (B.D.-F.); (P.F.); (J.D.); (P.D.); (D.B.); (M.V.)
| | - Patricia Franchi
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service d’Hématologie Clinique, Hôpital Cochin, 75014 Paris, France; (G.F.); (L.W.); (B.D.-F.); (P.F.); (J.D.); (P.D.); (D.B.); (M.V.)
| | - Justine Descroocq
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service d’Hématologie Clinique, Hôpital Cochin, 75014 Paris, France; (G.F.); (L.W.); (B.D.-F.); (P.F.); (J.D.); (P.D.); (D.B.); (M.V.)
| | - Paul Deschamps
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service d’Hématologie Clinique, Hôpital Cochin, 75014 Paris, France; (G.F.); (L.W.); (B.D.-F.); (P.F.); (J.D.); (P.D.); (D.B.); (M.V.)
| | - Estelle Blanc-Autran
- Hôpital Marie Lannelongue, Service de Médecine Nucléaire, 92350 Le Plessis-Robinson, France;
| | - Jérôme Clerc
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service de Médecine Nucléaire, Hôpital Cochin, 75014 Paris, France; (M.W.); (A.D.); (J.C.)
| | - Didier Bouscary
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service d’Hématologie Clinique, Hôpital Cochin, 75014 Paris, France; (G.F.); (L.W.); (B.D.-F.); (P.F.); (J.D.); (P.D.); (D.B.); (M.V.)
| | - Sylvain Barreau
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service D’hémato-Biologie, Hôpital Cochin, 75014 Paris, France; (S.B.); (N.C.)
| | - Nicolas Chapuis
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service D’hémato-Biologie, Hôpital Cochin, 75014 Paris, France; (S.B.); (N.C.)
| | - Marguerite Vignon
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service d’Hématologie Clinique, Hôpital Cochin, 75014 Paris, France; (G.F.); (L.W.); (B.D.-F.); (P.F.); (J.D.); (P.D.); (D.B.); (M.V.)
| | - Anne-Ségolène Cottereau
- Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Service de Médecine Nucléaire, Hôpital Cochin, 75014 Paris, France; (M.W.); (A.D.); (J.C.)
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11
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Lan L, Liu H, Wang Y, Deng J, Peng D, Feng Y, Wang L, Chen Y, Qiu L. The potential utility of [ 68 Ga]Ga-DOTA-FAPI-04 as a novel broad-spectrum oncological and non-oncological imaging agent-comparison with [ 18F]FDG. Eur J Nucl Med Mol Imaging 2021; 49:963-979. [PMID: 34410435 DOI: 10.1007/s00259-021-05522-w] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/02/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE This study aimed to compare the detection performance of [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT in the patients with various oncological and non-oncological lesions. METHODS A total of 123 patients underwent contemporaneous [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT were included in this prospective study. The maximum standard uptake value (SUVmax) was measured to compare oncological and non-oncological lesion uptake. The sensitivity, specificity, predictive values, and accuracy of [18F]FDG and [68 Ga]Ga-DOTA-FAPI-04 PET/CT for detecting primary, metastatic, and non-oncological lesions were calculated and compared to evaluate the detection efficacy. RESULTS The study subjects consisted of 123 patients (69 men and 54 women; mean age 56.11 ± 11.94 years). Among the 102 patients with either newly diagnosed (82 patients) or previously treated solid tumor (20 patients), a total of 88 solid primary malignant tumors in 84/102 patients were detected. Two patients had two primary tumors each and 1 patient had three primary tumors. Among them, 58/102 and 43/102 patients had nodal (376 lesions) and distant metastases (406 lesions), respectively. Eight patients had hematological neoplasm. No malignant oncological diseases were detected in the remaining 13 patients. A total of 145 non-oncological lesions and benign tumors in 52/123 patients were detected incidentally. [68 Ga]Ga-DOTA-FAPI-04 PET/CT demonstrated a significantly higher uptake and detection rate for the primary (SUVmax 10.98 ± 5.83 vs. 8.36 ± 6.43, p < 0.001; sensitivity 97.67 vs. 84.89%; and accuracy 96.59 vs. 82.95%, X2 = 0.538, p = 0.021), nodal (SUVmax 10.50 ± 5.98 vs. 8.20 ± 6.29, p = 0.011; sensitivity 97.59 vs. 84.72%; and accuracy 97.34 vs. 84.31%, X2 = 2.067, p < 0.001), and distant metastatic lesions (SUVmax 9.64 ± 6.45 vs. 6.74 ± 4.83; p < 0.001; sensitivity 98.01 vs. 65.59%; and accuracy 97.04 vs. 65.51%, X2 = 4.897, p < 0.001) of solid tumor than did [18F]FDG PET/CT. [68 Ga]Ga-DOTA-FAPI-04 PET/CT demonstrated a lower activity (SUVmax: 6.84 ± 4.67 vs. 13.09 ± 7.29, p < 0.001) and detection rate (sensitivity 50.65 vs. 96.75%, and accuracy 51.28 vs. 95.51%, X2 = 5.166, p < 0.001) for multiple myeloma and lymphoma compared to [18F]FDG PET/CT. [68 Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT PET/CT demonstrated a comparative activity (SUVmax 6.40 ± 3.95 vs. 5.74 ± 15.78, p = 0.729) and detection efficacy (sensitivity 86.52 vs. 72.34%, and accuracy 84.83 vs. 72.41%, X2 = 9.460, p = 0.007) for non-oncological lesion and benign tumor detection. CONCLUSIONS Except for myeloma and lymphoma, [68 Ga]Ga-DOTA-FAPI-04 PET/CT showed a superior detection efficacy for detecting various primary and metastatic lesions than [18F]FDG PET/CT. A comparative detection utility for non-oncological lesion was obtained with both tracers. [68 Ga]Ga-DOTA-FAPI-04 could be used as a broad-spectrum tumor and inflammatory imaging agent in the clinical especially for various solid tumors and non-oncological lesions.
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Affiliation(s)
- Lianjun Lan
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, No 25. Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Hanxiang Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China
| | - Yingwei Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China
| | - Jia Deng
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China
| | - Dengsai Peng
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China
| | - Yue Feng
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China
| | - Li Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China. .,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China. .,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China.
| | - Lin Qiu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China. .,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China. .,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, Sichuan, People's Republic of China.
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12
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Positron Emission Tomography (PET) Imaging of Multiple Myeloma in a Post-Treatment Setting. Diagnostics (Basel) 2021; 11:diagnostics11020230. [PMID: 33546455 PMCID: PMC7913723 DOI: 10.3390/diagnostics11020230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/23/2021] [Accepted: 01/29/2021] [Indexed: 12/01/2022] Open
Abstract
2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (FDG PET/CT) has an established clinical value in the diagnosis and initial staging of multiple myeloma (MM). In the last ten years, a vast body of literature has shown that this tool can also be of high relevance for monitoring therapy responses, making it the recommended imaging approach in this field. Starting from the strengths and weaknesses of radiological imaging in MM, the present review aims to analyze FDG PET/CT’s current clinical value focusing on therapy response assessment and objective interpretation criteria for therapy monitoring. Given the potential occurrence of patients with MM showing non-FDG-avid bone disease, new opportunities can be provided by non-FDG PET tracers. Accordingly, the potential role of non-FDG PET tracers in this setting has also been discussed.
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13
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Maccora D, Caldarella C, Taralli S, Scolozzi V, Lorusso M, Cocciolillo F, Calcagni ML. Diagnostic role of 11C-methionine PET/CT in patients with multiple myeloma and other plasma cell malignancy: a literature review. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-020-00400-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Chen B, Cai L, Zhou F. Management of acute spinal cord compression in multiple myeloma. Crit Rev Oncol Hematol 2020; 160:103205. [PMID: 33387626 DOI: 10.1016/j.critrevonc.2020.103205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 09/04/2020] [Accepted: 12/20/2020] [Indexed: 11/15/2022] Open
Abstract
Spinal cord compression (SCC) is a devastating complication of multiple myeloma and has the potential to cause loss of neurological function. The common symptoms of SCC are back pain, motor weakness, and sensory change. Once diagnosed, the patient should be managed as soon as possible to prevent permanent loss of neurological function. Currently, there have been a number of studies describing the mechanism and management experience of SCC in patients with myeloma. The clinical features, diagnostic strategies, and the roles of different therapeutic options are herein reviewed.
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Affiliation(s)
- Bo Chen
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, China
| | - Lin Cai
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, China.
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15
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Gavriatopoulou M, Βoultadaki A, Koutoulidis V, Ntanasis-Stathopoulos I, Bourgioti C, Malandrakis P, Fotiou D, Migkou M, Kanellias N, Eleutherakis-Papaiakovou E, Kastritis E, Terpos E, Dimopoulos MA, Moulopoulos LA. The Role of Low Dose Whole Body CT in the Detection of Progression of Patients with Smoldering Multiple Myeloma. Blood Cancer J 2020; 10:93. [PMID: 32978365 PMCID: PMC7519647 DOI: 10.1038/s41408-020-00360-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/11/2020] [Accepted: 09/07/2020] [Indexed: 12/27/2022] Open
Abstract
Multiple myeloma (MM) is the second most common hematological malignancy, characterized by plasma cell bone marrow infiltration and end-organ involvement. Smoldering MM (SMM) is an intermediate clinical entity between MGUS and MM, with a risk of progression to symptomatic disease 10% per year. Bone disease is the most frequent symptom of MM, with ~90% of patients developing bone lesions throughout their disease course. Therefore, imaging plays a crucial role in diagnosis and management. Whole-body low-dose CT (WBLDCT) is widely available and has been incorporated in the latest diagnostic criteria of the IMWG. The purpose of this study was to evaluate the role of WBLDCT in the early identification of lesions in patients with SMM who progress solely with bone disease. In total, 100 asymptomatic patients were consecutively assessed with WBLDCT from July 2013 until March 2020 at baseline, 1-year after diagnosis and every 1 year thereafter. Ten percent of patients were identified as progressors with this single imaging modality. This is the first study to evaluate prospectively patients with SMM at different time points to identify early bone lesions related to MM evolution. Serial WBLDCT studies can identify early myeloma evolution and optimize disease monitoring and therapeutic strategies.
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Affiliation(s)
- Maria Gavriatopoulou
- Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, General Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andriani Βoultadaki
- 1st Department of Radiology, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilis Koutoulidis
- 1st Department of Radiology, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, General Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charis Bourgioti
- 1st Department of Radiology, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Malandrakis
- Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, General Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Despina Fotiou
- Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, General Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Magdalini Migkou
- Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, General Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kanellias
- Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, General Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Eleutherakis-Papaiakovou
- Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, General Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Kastritis
- Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, General Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Terpos
- Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, General Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Meletios A Dimopoulos
- Plasma Cell Dyscrasias Unit, Department of Clinical Therapeutics, School of Medicine, General Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Lia-Angela Moulopoulos
- 1st Department of Radiology, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
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16
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Baffour FI, Glazebrook KN, Kumar SK, Broski SM. Role of imaging in multiple myeloma. Am J Hematol 2020; 95:966-977. [PMID: 32350883 DOI: 10.1002/ajh.25846] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 12/17/2022]
Abstract
With rapid advancements in the diagnosis and treatment of multiple myeloma (MM), imaging has become instrumental in detection of intramedullary and extramedullary disease, providing prognostic information, and assessing therapeutic efficacy. Whole-body low dose computed tomography (WBLDCT) has emerged as the study of choice to detect osteolytic bone disease. Positron emission tomography/computed tomography (PET/CT) combines functional and morphologic information to identify MM disease activity and assess treatment response. Magnetic resonance imaging (MRI) has excellent soft-tissue contrast and is the modality of choice for bone marrow evaluation. This review focuses on the imaging modalities available for MM patient management, highlighting advantages, disadvantages, and applications of each.
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Affiliation(s)
| | | | - Shaji K. Kumar
- Department of Internal Medicine, Division of HematologyMayo Clinic Rochester Minnesota USA
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17
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Siska PJ, Singer K, Evert K, Renner K, Kreutz M. The immunological Warburg effect: Can a metabolic-tumor-stroma score (MeTS) guide cancer immunotherapy? Immunol Rev 2020; 295:187-202. [PMID: 32157706 DOI: 10.1111/imr.12846] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 12/14/2022]
Abstract
The "glycolytic switch" also known as the "Warburg effect" is a key feature of tumor cells and leads to the accumulation of lactate and protons in the tumor environment. Intriguingly, non-malignant lymphocytes or stromal cells such as tumor-associated macrophages and cancer-associated fibroblasts contribute to the lactate accumulation in the tumor environment, a phenomenon described as the "Reverse Warburg effect." Localized lactic acidosis has a strong immunosuppressive effect and mediates an immune escape of tumors. However, some tumors do not display the Warburg phenotype and either rely on respiration or appear as a mosaic of cells with different metabolic properties. Based on these findings and on the knowledge that T cell infiltration is predictive for patient outcome, we suggest a metabolic-tumor-stroma score to determine the likelihood of a successful anti-tumor immune response: (a) a respiring tumor with high T cell infiltration ("hot"); (b) a reverse Warburg type with respiring tumor cells but glycolytic stromal cells; (c) a mixed type with glycolytic and respiring compartments; and (d) a glycolytic (Warburg) tumor with low T cell infiltration ("cold"). Here, we provide evidence that these types can be independent of the organ of origin, prognostically relevant and might help select the appropriate immunotherapy approach.
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Affiliation(s)
- Peter J Siska
- Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Katrin Singer
- Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Kathrin Renner
- Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.,Regensburg Center for Interventional Immunology (RCI), Regensburg, Germany
| | - Marina Kreutz
- Internal Medicine III, University Hospital Regensburg, Regensburg, Germany.,Regensburg Center for Interventional Immunology (RCI), Regensburg, Germany
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18
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Hemke R, Yang K, Husseini J, Bredella MA, Simeone FJ. Organ dose and total effective dose of whole-body CT in multiple myeloma patients. Skeletal Radiol 2020; 49:549-554. [PMID: 31612246 PMCID: PMC7021660 DOI: 10.1007/s00256-019-03292-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/16/2019] [Accepted: 07/29/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate organ dose and total effective dose of whole-body low-dose CT (WBLDCT) performed on different CT-scanner models in patients with multiple myeloma (MM) and to compare it to the effective dose of radiographic skeletal survey and representative diagnostic CTs. MATERIAL AND METHODS We retrospectively analyzed data from 228 patients (47.4% females, mean age 67.9 ± 10.4 years, mean weight 81.8 ± 22.4 kg) who underwent WBLDCT for the work-up or surveillance of MM. Patients were scanned using one of six multi-detector CT-scanners. Organ doses and total effective doses per scan were calculated using a commercially available dose-management platform (Radimetrics, Bayer Healthcare, Leverkusen, Germany). The median effective dose was compared to radiographic skeletal survey and representative diagnostic CTs. RESULTS The mean effective dose of our WBLDCT-protocol was 4.82 mSv. A significantly higher effective dose was observed in females compared to males (4.95 vs. 4.70 mSv, P = 0.002). Mean organ dose ranged from 3.72 mSv (esophagus) to 13.09 mSv (skeleton). Mean effective dose varied amongst different CT-scanners (range 4.34-8.37 mSv). The median effective dose of WBLDCT was more than twice the dose of a skeletal survey (4.82 vs. 2.04 mSv), 23% higher than a diagnostic contrast-enhanced chest CT (3.9 mSv), 46% lower than a diagnostic contrast-enhanced abdomen/pelvis CT (9.0 mSv), and 45% lower than a lumbar spine CT (8.7 mSv). CONCLUSIONS WBLDCT in MM has a higher effective dose than a radiographic skeletal survey, but a lower effective dose than diagnostic CTs of lumbar spine, abdomen and pelvis. This underlines the broad applicability of WBLDCT in the management of MM patients.
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Affiliation(s)
- Robert Hemke
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA ,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Kai Yang
- Division of Diagnostic Imaging Physics, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Jad Husseini
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - Miriam A. Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
| | - F. Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA
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19
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Gupta N, Sharma A, Sharma A. Emerging biomarkers in Multiple Myeloma: A review. Clin Chim Acta 2019; 503:45-53. [PMID: 31901479 DOI: 10.1016/j.cca.2019.12.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/24/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023]
Abstract
Multiple Myeloma (MM) is the second most common hematological malignancy after non-Hodgkin lymphoma and is manifested by uncontrolled proliferation and accumulation of abnormal plasma cells in the bone marrow (BM). The incidence along with deaths associated with MM is on rise due to lack of an effective diagnosis at an early stage. The identification of MM decades ago marks the adoption of certain conventional markers such as plasma cell percentage in BM, serum protein electrophoresis for M-band and urinary Bence-Jones protein. This was then followed by utilization of β2 microglobulin and serum albumin for determining the staging of MM. The need for a better diagnostic or prognostic marker prompts researchers and hence, certain novel markers have been tested which includes extracellular matrix proteins, angiogenic factors, telomeres and telomerase along with the immune markers. Nowadays, proteomic and genomic studies are being performed to identify novel diagnostic and/or prognostic markers for MM. Followed by this, comes the emerging concept of liquid biopsy which allows easy and non-invasive detection of the disease. The liquid biopsy comprises of circulatory tumor cells along with the nucleic acids (microRNAs and cell-free DNA) released from the tumor cells in peripheral circulation which could be a true representation of BM. This review, hence, summarizes the emerging biomarkers involved in the diagnosis and prognosis of MM.
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Affiliation(s)
- Nidhi Gupta
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Aparna Sharma
- Department of Medical Oncology, Dr. B.R Ambedkar IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Alpana Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India.
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20
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Li Q, Ma J, Li H, Xu W, Cao Z, Liu S, Chen L, Gao S, Yan T, Li D, Wang X, Yue Y, Zhao Z, Wang X, Yang H, Zhao H, Yu Y, Zhang Y, Fan F, Wang Y. Correlation Between Uptake of 18F-FDG During PET/CT and Ki-67 Expression in Patients Newly Diagnosed With Multiple Myeloma Having Extramedullary Involvement. Technol Cancer Res Treat 2019; 18:1533033819849067. [PMID: 31092140 PMCID: PMC6535751 DOI: 10.1177/1533033819849067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to evaluate the relationship of prognosis of patients with multiple myeloma having extramedullary involvement (EMM) with the 18F- fluorodeoxyglucose(18F-FDG) maximum standardized uptake value and the expression of Ki-67 in biopsy samples. Sixty-five patients were newly diagnosed with multiple myeloma presenting with EMM at our hospital from January 2005 to January 2015. Of these 65 patients, 20 were enrolled in this study. Over the last decade, both the maximum standardized uptake value and Ki-67 expression in these extramedullary lesions significantly correlated with progression-free survival, respectively (P= .039, P =.009). After combining—the maximum standardized uptake value and the Ki-67 expression as an integral—there was a significant correlation between both the overall survival (P = .027) and progression-free survival (P= .014). Patients have poor outcomes when EMM is detected at presentation. Both the maximum standardized uptake value and Ki-67 expression could aid in accurately evaluating EMM patient prognosis.
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Affiliation(s)
- Qian Li
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,2 Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China.,They are co-first authors and have contributed equally to this article
| | - Jing Ma
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,They are co-first authors and have contributed equally to this article
| | - Han Li
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Wengui Xu
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Zeng Cao
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Su Liu
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Lin Chen
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Shuang Gao
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Tinghui Yan
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Dongying Li
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xue Wang
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Yuanfang Yue
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Zhigang Zhao
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xiaofang Wang
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Hongliang Yang
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Haifeng Zhao
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Yong Yu
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Yizhuo Zhang
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Feiyue Fan
- 3 Institute of Laboratory Animal Sciences, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yafei Wang
- 1 Department of Hematology and Blood and Marrow Transplantation, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer. Tianjin's Clinical Research Center for Cancer. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
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21
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Lecouvet FE, Boyadzhiev D, Collette L, Berckmans M, Michoux N, Triqueneaux P, Pasoglou V, Jamar F, Vekemans MC. MRI versus 18F-FDG-PET/CT for detecting bone marrow involvement in multiple myeloma: diagnostic performance and clinical relevance. Eur Radiol 2019; 30:1927-1937. [PMID: 31844960 DOI: 10.1007/s00330-019-06469-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/24/2019] [Accepted: 09/19/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To compare the diagnostic performance of MRI and 18F-FDG-PET/CT in detecting bone marrow involvement (BMI) in patients with multiple myeloma (MM). MATERIALS AND METHODS This retrospective study was approved by our Institutional Review Board. Two radiologists and two nuclear medicine specialists independently and blindly reviewed 84 pairs of MRI and PET/CT scans obtained in 73 MM patients. Readers assessed the presence and patterns of BMI. The best valuable comparator (BVC) for BMI was established by a panel review of all baseline and follow-up imaging, and biological and pathological information. Intra- and inter-reader agreement and correlation between MRI and PET/CT were assessed using the prevalence-adjusted bias-adjusted kappa (k) coefficient. Diagnostic performance of MRI and PET/CT in detecting BMI was evaluated from ROC characteristics. Association between imaging and biological, pathological, and clinical findings was assessed using Wilcoxon rank-sum and chi-square tests. RESULTS Intra- and inter-reader agreement was very good for MRI (k = 0.90 [0.81; 1.00] and 0.88 [0.78; 0.98]). Intra- and inter-reader agreement was good for PET/CT (k = 0.80 [0.69; 0.91] and 0.71 [0.56; 0.86]). The sensitivity of MRI to detect BMI (97% [90%; 100%]) was significantly superior to that of PET/CT (76% [64%; 85%]) (p < 0.001). The specificity of MRI (86% [57%; 98%]) was lower than that of PET/CT (93% [66%; 100%]), without reaching statistical significance (p = 0.32). There was a strong correlation between decisions regarding patient management and PET/CT findings (p < 0.001). CONCLUSION MRI is significantly more sensitive than PET/CT to detect BMI in MM. Patient management is more strongly correlated with PET/CT findings. KEY POINTS • MRI and PET/CT have very close diagnostic value for the detection of bone marrow involvement in multiple myeloma. • MRI has a significantly higher sensitivity and better reproducibility. • PET/CT findings appear to have a higher impact on clinical decisions.
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Affiliation(s)
- Frédéric E Lecouvet
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10/2942, B-1200, Brussels, Belgium.
| | - Dimitar Boyadzhiev
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10/2942, B-1200, Brussels, Belgium
| | | | - Maude Berckmans
- Department of Nuclear Medicine, IREC, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
| | - Nicolas Michoux
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10/2942, B-1200, Brussels, Belgium
| | - Perrine Triqueneaux
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10/2942, B-1200, Brussels, Belgium
| | - Vassiliki Pasoglou
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10/2942, B-1200, Brussels, Belgium
| | - François Jamar
- Department of Nuclear Medicine, IREC, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
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22
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Imaging Features of Multiple Myeloma Extramedullary Lesions in the Liver with 18F-FDG PET/CT, Contrast-Enhanced CT and MRI. Diagnostics (Basel) 2019; 9:diagnostics9040179. [PMID: 31703386 PMCID: PMC6963877 DOI: 10.3390/diagnostics9040179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 12/11/2022] Open
Abstract
Ηepatic involvement in multiple myeloma is not common; nevertheless, it is associated with poorer outcome. Heterogeneous features have been described in few published reports so far. We present the imaging findings of PET/CT in comparison to those of MRI for two multiple myeloma (MM) patients, one with a liver lesion suspicious for myeloma metastasis on PET and one with multiple liver lesions suspicious for myeloma metastases on MRΙ. The subsequent ultrasound-guided needle biopsies confirmed the extramedullary spread of the disease in both patients. The first case exhibited a match in both functional imaging modalities (PET and MRI) but a mismatch of intense metabolic activity on 18F-fluorodeoxyglucose (18F-FDG) PET/CT and iso-attenuating liver parenchyma on contrast-enhanced CT. The second case showed a mismatch of signal elevation persistence on diffusion-weighted imaging (DWI) and physiologic 18F-FDG distribution in the liver parenchyma. These cases present different imaging features in MM lesions of the liver using PET/CT and MRI, reflecting the high disease heterogeneity in patients with MM and demonstrating that the use of both PET/CT and MRI may offer complementary information.
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Muz B, Bandara N, Mpoy C, Sun J, Alhallak K, Azab F, Rogers BE, Azab AK. CXCR4-targeted PET imaging using 64Cu-AMD3100 for detection of Waldenström Macroglobulinemia. Cancer Biol Ther 2019; 21:52-60. [PMID: 31571524 DOI: 10.1080/15384047.2019.1665405] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: Waldenström Macroglobulinemia (WM) is a rare B-cell malignancy characterized by secretion of immunoglobulin M and cancer infiltration in the bone marrow. Chemokine receptor such as CXCR4 and hypoxic condition in the bone marrow play crucial roles in cancer cell trafficking, homing, adhesion, proliferation, survival, and drug resistance. Herein, we aimed to use CXCR4 as a potential biomarker to detect hypoxic-metastatic WM cells in the bone marrow and in the circulation by using CXCR4-detecting radiopharmaceutical.Methods: We radiolabeled a CXCR4-inhibitor (AMD3100) with 64Cu and tested its binding to WM cells with different levels of CXCR4 expression using gamma counter in vitro. The accumulation of this radiopharmaceutical tracer was tested in vivo in subcutaneous and intratibial models using PET/CT scan. In addition, PBMCs spiked with different amounts of WM cells ex vivo were detected using gamma counting.Results: In vitro, 64Cu-AMD3100 binding to WM cell lines demonstrated a direct correlation with the level of CXCR4 expression, which was increased in cells cultured in hypoxia with elevated levels of CXCR4, and decreased in cells with CXCR4 and HIF-1α knockout. Moreover, 64Cu-AMD3100 detected localized and circulating CXCR4high WM cells with high metastatic potential.Conclusions: In conclusion, we developed a molecularly targeted system, 64Cu-AMD3100, which binds to CXCR4 and specifically detects WM cells with hypoxic phenotype and metastatic potential in the subcutaneous and intratibial models. These preliminary findings using CXCR4-detecting PET radiopharmaceutical tracer indicate a potential technology to predict high-risk patients for the progression to WM due to metastatic potential.
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Affiliation(s)
- Barbara Muz
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nilantha Bandara
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Cedric Mpoy
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Jennifer Sun
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Kinan Alhallak
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Feda Azab
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Buck E Rogers
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Abdel Kareem Azab
- Department of Radiation Oncology, Cancer Biology Division, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.,Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
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Paganelli F, Lonetti A, Anselmi L, Martelli AM, Evangelisti C, Chiarini F. New advances in targeting aberrant signaling pathways in T-cell acute lymphoblastic leukemia. Adv Biol Regul 2019; 74:100649. [PMID: 31523031 DOI: 10.1016/j.jbior.2019.100649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/24/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Abstract
T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive disorder characterized by malignant transformation of immature progenitors primed towards T-cell development. Over the past 15 years, advances in the molecular characterization of T-ALL have uncovered oncogenic key drivers and crucial signaling pathways of this disease, opening new chances for the development of novel therapeutic strategies. Currently, T-ALL patients are still treated with aggressive therapies, consisting of high dose multiagent chemotherapy. To minimize and overcome the unfavorable effects of these regimens, it is critical to identify innovative targets and test selective inhibitors of such targets. Major efforts are being made to develop small molecules against deregulated signaling pathways, which sustain T-ALL cell growth, survival, metabolism, and drug-resistance. This review will focus on recent improvements in the understanding of the signaling pathways involved in the pathogenesis of T-ALL and on the challenging opportunities for T-ALL targeted therapies.
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Affiliation(s)
- Francesca Paganelli
- Institute of Molecular Genetics, Luigi Luca Cavalli-Sforza-CNR National Research Council of Italy, Bologna, Italy; IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Annalisa Lonetti
- "Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Laura Anselmi
- Department of Biomedical, Metabolic, and Neural Sciences, Section of Morphology, Signal Transduction Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto M Martelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Camilla Evangelisti
- Institute of Molecular Genetics, Luigi Luca Cavalli-Sforza-CNR National Research Council of Italy, Bologna, Italy; IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Chiarini
- Institute of Molecular Genetics, Luigi Luca Cavalli-Sforza-CNR National Research Council of Italy, Bologna, Italy; IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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Evolving Roles of Fluorodeoxyglucose and Sodium Fluoride in Assessment of Multiple Myeloma Patients. PET Clin 2019; 14:341-352. [DOI: 10.1016/j.cpet.2019.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Madduri D, Barlogie B. PET-Computed Tomography in Myeloma. PET Clin 2019; 14:411-418. [DOI: 10.1016/j.cpet.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18F-fluoro-ethyl-tyrosine ( 18F-FET) PET/CT as a potential new diagnostic tool in multiple myeloma: a preliminary study. Contemp Oncol (Pozn) 2019; 23:23-31. [PMID: 31061633 PMCID: PMC6500394 DOI: 10.5114/wo.2019.83342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/02/2019] [Indexed: 11/29/2022] Open
Abstract
Aim of the study The aim of this study was to analyse the diagnostic accuracy of “18F-fluoro-ethyl-tyrosine (18F-FET) PET/CT tracer in multiple myeloma. Material and methods The analysed group included: patients with newly diagnosed active myeloma (eight patients); in very good partial remission or complete remission (VGPR or CR) after treatment (nine patients); and with active disease after relapse (15 patients). Results In patients with newly diagnosed myeloma, 64 lesions were found using CT and 83 lesions using 18F-FET. In six patients, the number of lesions using CT and 18F-FET was the same, and two had more lesions with the 18F-FET than with the CT. Patients in VGPR or CR had no FET-positive lesions. Fourteen out of 15 patients with active relapsed myeloma had 47 FET-positive lesions, CT assessment of the same group showed 282 lesions. In one patient with relapse soft tissue mass was found with 18F-FET but not with CT. Conclusions 18F-FET can be a promising alternative to 18F-FDG PET/CT for myeloma-related bone disease diagnosis.
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Simeone FJ, Harvey JP, Yee AJ, O'Donnell EK, Raje NS, Torriani M, Bredella MA. Value of low-dose whole-body CT in the management of patients with multiple myeloma and precursor states. Skeletal Radiol 2019; 48:773-779. [PMID: 30218303 PMCID: PMC6447458 DOI: 10.1007/s00256-018-3066-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the value of low-dose whole-body CT (WBCT) in the management of patients with multiple myeloma (MM) and precursor states. MATERIALS AND METHODS The study group comprised 116 patients (mean age: 68 ± 11 years, 48% women) who underwent WBCT for the work-up or surveillance of MM or MM precursor disease. WBCTs were reviewed for the presence of MM-related bone disease and incidental findings requiring therapy. The medical records, results from bone marrow aspirations and biopsies and follow-up imaging studies were reviewed to assess the influence of WBCT on patient management. RESULTS Whole-body CT led to a change in management in 32 patients (28%). Of those, 17 patients with MM precursor disease were found to have MM-related bone disease, 13 patients had progression of MM, requiring a change in treatment, in one patient hepatocellular carcinoma was diagnosed, requiring a change in therapy, and one patient had a rib lesion requiring intervention. In 65 patients (56%), WBCT was performed for surveillance of MM precursor disease or stable treated MM, and did not detect new lesions, thereby providing reassurance to the hematologist on disease status and management. In 15 patients (13%) WBCT was performed as a new baseline before a change or new therapy. In 4 patients (3%), WBCT was performed for a change in symptoms, but did not detect lesions that would lead to a change in management. CONCLUSION Whole-body CT provides important information for disease monitoring and detection of incidental findings, thereby improving the management of patients with MM.
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Affiliation(s)
- F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Joel P Harvey
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Andrew J Yee
- Division of Hematology-Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Elizabeth K O'Donnell
- Division of Hematology-Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Noopur S Raje
- Division of Hematology-Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
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Fludeoxyglucose F 18 PET/Computed Tomography Evaluation of Therapeutic Response in Multiple Myeloma. PET Clin 2019; 14:391-403. [PMID: 31084778 DOI: 10.1016/j.cpet.2019.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Multiple myeloma is a malignancy of terminally differentiated plasma cells representing the second most common hematological malignancy. The recognition that disease outside the marrow can significantly influence the outcome of patients has highlighted the importance of imaging to define presence of tumor. Recent studies have demonstrated an added value of using imaging to assess presence of disease both inside and outside the marrow. To this end, the response criteria have been revised to include PET/computed tomography to be used in conjunction with bone marrow assessment to determine minimal residual disease status.
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Mateos MV, Ludwig H, Bazarbachi A, Beksac M, Bladé J, Boccadoro M, Cavo M, Delforge M, Dimopoulos MA, Facon T, Geraldes C, Goldschmidt H, Hájek R, Hansson M, Jamroziak K, Leiba M, Masszi T, Mendeleeva L, O’Dwyer M, Plesner T, San-Miguel JF, Straka C, van de Donk NW, Yong K, Zver S, Moreau P, Sonneveld P. Insights on Multiple Myeloma Treatment Strategies. Hemasphere 2019; 3:e163. [PMID: 31723802 PMCID: PMC6745941 DOI: 10.1097/hs9.0000000000000163] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/27/2018] [Indexed: 12/14/2022] Open
Abstract
The introduction of new agents and management strategies over the past decade has resulted in a major step change in treatment outcomes with deepening responses and increased survival for patients with multiple myeloma. In daily clinical practice, healthcare professionals are now faced with challenges including, optimal treatment sequencing and changing treatment goals. In light of this, a group of experts met to discuss diagnostic and treatment guidelines, examine current clinical practice, and consider how new clinical trial data may be integrated into the management of multiple myeloma in the future.
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Affiliation(s)
- María-Victoria Mateos
- Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (CAUSA/IBSAL), Salamanca, Spain
| | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Meral Beksac
- Ankara University School of Medicine, Ankara, Turkey
| | - Joan Bladé
- Institut d’Investigac’ons Biomedques August Pi Sunyer (IDiBAPS), Barcelona, Spain
| | - Mario Boccadoro
- University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | | | | | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Clinic Heidelberg and National Center of Tumor Diseases, Heidelberg, Germany
| | - Roman Hájek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Markus Hansson
- Department of Hematology, Skåne University Hospital und Lund University, Lund, Sweden
| | | | - Merav Leiba
- Assuta Ashdod University Hospital, Faculty of Health Science, Ben-Gurion University of the Negev, Negev, Israel
| | - Tamás Masszi
- 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Larisa Mendeleeva
- National Research Center for Hematology of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Torben Plesner
- Vejle Hospital and University of Southern Denmark, Vejle, Denmark
| | | | | | | | - Kwee Yong
- Cancer Institute, University College London, London, United Kingdom
| | - Samo Zver
- University Clinical Center Ljubljana and Medical Faculty, Ljubljana, Slovenia
| | | | - Pieter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Aljama MA, Sidiqi MH, Buadi FK, Lacy MQ, Gertz MA, Dispenzieri A, Dingli D, Muchtar E, Fonder AL, Hayman SR, Hobbs MA, Gonsalves WI, Warsame RM, Kourelis T, Hwa YL, Kapoor P, Kyle RA, Leung N, Go RS, Rajkumar SV, Kumar SK. Utility and prognostic value of 18 F-FDG positron emission tomography-computed tomography scans in patients with newly diagnosed multiple myeloma. Am J Hematol 2018; 93:1518-1523. [PMID: 30194770 DOI: 10.1002/ajh.25279] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/03/2018] [Indexed: 12/28/2022]
Abstract
Positron emission tomography-computed tomography (PET-CT) can identify bony lesions, assess disease burden, and detect extramedullary disease (EMD) in patients with multiple myeloma. We retrospectively reviewed records of patients who underwent PET-CT within 60 days of a new diagnosis (before therapy commenced) to identify the nature and prognostic impact of PET-CT abnormalities. Patients (N = 313) were seen from April 2005 through June 2017. Of the 234 patients (75%) with focal lesions (FLs), 182 (58%) had at least 3 FLs, 38 (12%) had EMD, and 204 (65%) had documented myelomatous lytic lesions. The median maximum standardized uptake value (SUVmax ) for the entire cohort was 5.9 (range 1.5-48.3). Presence of at least 3 FLs and EMD predicted inferior overall survival (OS); median OS was 57.8 months for patients with 3 or more FLs and 103.6 months for patients with fewer than 3 FLs (P = .003). The median OS was 45.5 and 71.8 months for patients with and without EMD, respectively (P = .004). No clear SUVmax cutoff was predictive of progression-free survival or OS. PET-CT is a valuable tool for assessing disease burden and could provide prognostic information about a contemporary cohort of patients with newly diagnosed myeloma who received treatment with novel agents.
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Affiliation(s)
| | | | | | - Martha Q. Lacy
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Morie A. Gertz
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - David Dingli
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Eli Muchtar
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Amie L. Fonder
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | | | | | | | | | - Yi Lisa Hwa
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Robert A. Kyle
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | - Nelson Leung
- Division of Nephrology and Hypertension; Mayo Clinic; Rochester Minnesota
| | - Ronald S. Go
- Division of Hematology; Mayo Clinic; Rochester Minnesota
| | | | - Shaji K. Kumar
- Division of Hematology; Mayo Clinic; Rochester Minnesota
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Detappe A, Bustoros M, Mouhieddine TH, Ghoroghchian PP. Advancements in Nanomedicine for Multiple Myeloma. Trends Mol Med 2018; 24:560-574. [DOI: 10.1016/j.molmed.2018.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 12/16/2022]
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Basha MAA, Hamed MAG, Refaat R, AlAzzazy MZ, Bessar MA, Mohamed EM, Ahmed AF, Tantawy HF, Altaher KM, Obaya AA, Afifi AHM. Diagnostic performance of 18F-FDG PET/CT and whole-body MRI before and early after treatment of multiple myeloma: a prospective comparative study. Jpn J Radiol 2018; 36:382-393. [PMID: 29671193 DOI: 10.1007/s11604-018-0738-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/07/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of WB-MRI and 18F-FDG PET/CT in detecting infiltration pattern, disease activity, and response to treatment in patients with multiple myeloma (MM). MATERIALS AND METHODS Fifty-six patients with confirmed MM were included in the present study for pre-treatment evaluation. Among these individuals, 22 patients were available for the post-treatment evaluation of response to therapy. All patients were imaged with both WB-MRI and 18F-FDG PET/CT. All radiographic findings of infiltration pattern, disease activity, and response to therapy were compared. The diagnostic performance of both modalities was estimated using bone marrow aspirate and biopsy as the reference test. RESULTS For detection of active myelomatous tissue at diagnosis, WB-MRI achieved higher sensitivity (94%) than 18F-FDG PET/CT (75%) (p = 0.0039), whereas both modalities achieved the same specificity (80%). For detection of residual myelomatous tissue after treatment, 18F-FDG PET/CT achieved higher specificity (86%) than WB-MRI (43%) (p = 0.0081), whereas both modalities achieved the same sensitivity (75%). CONCLUSION WB-MRI is more sensitive than 18F-FDG PET/CT in the diagnosis of MM before treatment; however, 18F-FDG PET/CT is more specific than WB-MRI in detecting residual involvement in treated patients.
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Affiliation(s)
| | | | - Rania Refaat
- Department of Diagnostic Radiology, Ain Shams University, Cairo, Egypt
| | | | - Manar A Bessar
- Department of Diagnostic Radiology, Zagazig University, Zagazig, Egypt
| | | | - Ayman F Ahmed
- Department of Diagnostic Radiology, Zagazig University, Zagazig, Egypt
| | | | | | - Ahmed Ali Obaya
- Department of Clinical Oncology, Zagazig University, Zagazig, Egypt
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Prognostic value of [18F]FDG-PET/CT in multiple myeloma patients before and after allogeneic hematopoietic cell transplantation. Eur J Nucl Med Mol Imaging 2018; 45:1694-1704. [DOI: 10.1007/s00259-018-3997-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/21/2018] [Indexed: 12/20/2022]
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Radionuclides transform chemotherapeutics into phototherapeutics for precise treatment of disseminated cancer. Nat Commun 2018; 9:275. [PMID: 29348537 PMCID: PMC5773683 DOI: 10.1038/s41467-017-02758-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 12/21/2017] [Indexed: 12/27/2022] Open
Abstract
Most cancer patients succumb to disseminated disease because conventional systemic therapies lack spatiotemporal control of their toxic effects in vivo, particularly in a complicated milieu such as bone marrow where progenitor stem cells reside. Here, we demonstrate the treatment of disseminated cancer by photoactivatable drugs using radiopharmaceuticals. An orthogonal-targeting strategy and a contact-facilitated nanomicelle technology enabled highly selective delivery and co-localization of titanocene and radiolabelled fluorodeoxyglucose in disseminated multiple myeloma cells. Selective ablation of the cancer cells was achieved without significant off-target toxicity to the resident stem cells. Genomic, proteomic and multimodal imaging analyses revealed that the downregulation of CD49d, one of the dimeric protein targets of the nanomicelles, caused therapy resistance in small clusters of cancer cells. Similar treatment of a highly metastatic breast cancer model using human serum albumin-titanocene formulation significantly inhibited cancer growth. This strategy expands the use of phototherapy for treating previously inaccessible metastatic disease.
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Tu H, He Y, Huang T, Choe S, Lan X, Duan X, Sattar H, Li C, Zhou F. Predictive value of 18 F-FDG PET/CT scanning in combination with clinical parameters in patients with newly diagnosed multiple myeloma. Eur J Haematol 2017; 100:189-197. [PMID: 29226428 DOI: 10.1111/ejh.13006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate the association of 18 F-2'-deoxy 2'-fluorodeoxyglucose (18 F-FDG) PET/CT with clinical parameters in predicting patients with newly diagnosed multiple myeloma (MM). METHODS A total of 120 MM patients undergoing 18 F-FDG PET/CT scanning were analyzed in a retrospective cohort study. RESULTS Based on multivariate analysis, β2M, LDH, number of focal lesions (FLs), and SUVmax were significantly correlated with OS. These 4 variables were used to construct a new staging system (NSS) based on the number of risk factors. NSS provided a better discrimination of risk between stages III and II than International staging system (ISS) (P < .001 vs P = .086). For OS, there was no significant difference among risk groups in Durie-Salmon (DS) stage (P > .05). Based on Spearman correlation analysis, the presence of lesions in appendicular skeleton, number of FLs, and SUVmax appeared to indicate advanced stage of MM. ROC curves which showed the combination of β2M with calcium got a specificity of 96.3% for lesions in appendicular skeleton, and LDH alone had 100% specificity in predicting the number of FLs, although the sensitivity was only 50%. CONCLUSIONS 18 F-FDG PET/CT in combination with clinical parameters provided an accurate and simple method for risk stratification of patients with newly diagnosed MM.
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Affiliation(s)
- Honglei Tu
- Department of Clinical Hematology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Yong He
- Department of Nuclear Medicine, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Tianhe Huang
- Department of Clinical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Songguk Choe
- Department of Nuclear Medicine, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoyi Duan
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Haseeb Sattar
- Department of Clinical Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chongjiao Li
- Department of Nuclear Medicine, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Fuling Zhou
- Department of Clinical Hematology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China.,Hubei Key Laboratory of Tumor Biological Behavior, Wuhan, Hubei, China
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Raza S, Leng S, Lentzsch S. The Critical Role of Imaging in the Management of Multiple Myeloma. Curr Hematol Malig Rep 2017; 12:168-175. [PMID: 28317080 DOI: 10.1007/s11899-017-0379-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Multiple myeloma (MM) is characterized by abnormal proliferation of plasma cells in the bone marrow leading to symptoms of anemia, renal failure, hypercalcemia, and bone lesions. Bone imaging is critical for the diagnosis, staging, assessment for the presence and extent of bone lesions, and initial treatment of MM. Skeletal survey is the preferred initial imaging modality due to its availability and low cost. However, it has poor sensitivity and patients with occult myeloma may escape detection, delaying their diagnosis and treatment. New cross-sectional imaging modalities such as low-dose whole body CT, MRI, and PET-CT have high sensitivity and specificity for detecting lytic lesions and extramedullary relapse in MM. The combined use of cross-sectional imaging may provide complimentary information for staging, prognosis, and disease monitoring. In this review, we will discuss commonly used imaging modalities and their advantages and disadvantages in the management of MM.
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Affiliation(s)
- Shahzad Raza
- Division of Hematology/Oncology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, New York, NY, 10032, USA.
| | - Siyang Leng
- Division of Hematology/Oncology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, New York, NY, 10032, USA
| | - Suzanne Lentzsch
- Division of Hematology/Oncology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, New York, NY, 10032, USA
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38
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Solitary Osteogenic Sternum Plasmacytoma on Bone Scintigraphy and FDG PET/CT. Clin Nucl Med 2017; 42:865-867. [PMID: 28902727 DOI: 10.1097/rlu.0000000000001831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We reported a rare solitary osteogenic sternum plasmacytoma case. A 49-year-old woman experienced progressing pain in the sternum for 2 years. Abnormal Tc-MDP accumulation and increase in F-FDG uptake (SUVmax, 4.4) were co-localized with the osteogenic lesion in the sternum body detected by diagnostic CT. The lesion was histologically confirmed as plasma cell neoplasm suggestive of plasmacytoma. The patient had good response to radiotherapy.
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Abstract
There have been several advances in the diagnosis of multiple myeloma (MM) in recent years. Serum free light chains have improved the ability to diagnose light chain MM; however, there are still difficulties in the serologic diagnosis of MM in some cases, particularly IgA MM. A novel heavy/light chain assay is able to improve the accuracy of diagnosis in these cases. Free light chains may also improve the diagnosis of extramedullary disease in difficult cases such as disease involving the central nervous system, pleura, or ascites. Advances in imaging such as whole body low-dose computed tomography (CT) whole body magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) have improved sensitivity in identifying lytic bone lesions, which would enable earlier treatment, and monitoring of osseous disease particularly in non- or oligosecretory disease. New techniques such as fused PET/MRI may further enhance the diagnosis of both bone lesions and extramedullary disease.
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40
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Wei C, Bajpai R, Sharma H, Heitmeier M, Jain AD, Matulis SM, Nooka AK, Mishra RK, Hruz PW, Schiltz GE, Shanmugam M. Development of GLUT4-selective antagonists for multiple myeloma therapy. Eur J Med Chem 2017; 139:573-586. [PMID: 28837922 DOI: 10.1016/j.ejmech.2017.08.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 12/24/2022]
Abstract
Cancer cells consume more glucose to fuel metabolic programs fundamental to sustaining their survival, growth and proliferation. Among the fourteen SLC2A family members, GLUTs 1 and 4 are high-affinity glucose transporters. GLUT4 (SLC2A4) is highly expressed in muscle and adipose tissue. Basally retained within the cell, GLUT4 traffics to the plasma membrane (PM) in response to insulin and exercise-stimulation. The plasma cell malignancy multiple myeloma (MM) exhibits increased constitutive expression of GLUT4 on the PM, co-opting use of GLUT4 for survival and proliferation. GLUT4 inhibition by knockdown or treatment with the FDA-approved HIV protease inhibitor ritonavir leads to cytostatic and/or cytotoxic and chemosensitizing effects in tumor cells both in vitro and in vivo. We recently reported our generation of GLUT4 homology models and virtual high-throughput screening (vHTS) to identify multiple series of novel GLUT4 antagonists. In this report, we describe our initial hit-to-lead optimization to synthesize new analogs with improved potency and selectivity for GLUT4, and the biological characterization of these compounds in a variety of assays. We show that our lead compound (compound 20) decreases glucose uptake and cell proliferation as well as inhibits the expression of pro-survival MCL-1 in MM similar to the effect observed via knockdown of GLUT4 expression. Compound 20 is also effective at chemosensitizing multiple myeloma cell lines and patient samples to venetoclax, dexamethasone and melphalan. In sum, we report development of selective GLUT4 inhibitors lacking inhibitory activity against GLUT1 and GLUT8. We show that selective pharmacological inhibition of GLUT4 is feasible and this may represent a novel strategy for the treatment and chemosensitization of multiple myeloma to standard therapeutics.
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Affiliation(s)
- Changyong Wei
- Department of Hematology and Medical Oncology, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Richa Bajpai
- Department of Hematology and Medical Oncology, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Horrick Sharma
- Center for Molecular Innovation and Drug Discovery, Northwestern University, Evanston, IL 60208, USA
| | - Monique Heitmeier
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Atul D Jain
- Center for Molecular Innovation and Drug Discovery, Northwestern University, Evanston, IL 60208, USA
| | - Shannon M Matulis
- Department of Hematology and Medical Oncology, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Ajay K Nooka
- Department of Hematology and Medical Oncology, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Rama K Mishra
- Center for Molecular Innovation and Drug Discovery, Northwestern University, Evanston, IL 60208, USA
| | - Paul W Hruz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Gary E Schiltz
- Center for Molecular Innovation and Drug Discovery, Northwestern University, Evanston, IL 60208, USA; Department of Pharmacology, Northwestern University, Chicago, IL 60611, USA; Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
| | - Mala Shanmugam
- Department of Hematology and Medical Oncology, School of Medicine, Emory University, Atlanta, GA 30322, USA.
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41
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Cavo M, Terpos E, Nanni C, Moreau P, Lentzsch S, Zweegman S, Hillengass J, Engelhardt M, Usmani SZ, Vesole DH, San-Miguel J, Kumar SK, Richardson PG, Mikhael JR, da Costa FL, Dimopoulos MA, Zingaretti C, Abildgaard N, Goldschmidt H, Orlowski RZ, Chng WJ, Einsele H, Lonial S, Barlogie B, Anderson KC, Rajkumar SV, Durie BGM, Zamagni E. Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol 2017; 18:e206-e217. [PMID: 28368259 DOI: 10.1016/s1470-2045(17)30189-4] [Citation(s) in RCA: 339] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/21/2016] [Accepted: 11/29/2016] [Indexed: 12/26/2022]
Abstract
The International Myeloma Working Group consensus aimed to provide recommendations for the optimal use of 18fluorodeoxyglucose (18F-FDG) PET/CT in patients with multiple myeloma and other plasma cell disorders, including smouldering multiple myeloma and solitary plasmacytoma. 18F-FDG PET/CT can be considered a valuable tool for the work-up of patients with both newly diagnosed and relapsed or refractory multiple myeloma because it assesses bone damage with relatively high sensitivity and specificity, and detects extramedullary sites of proliferating clonal plasma cells while providing important prognostic information. The use of 18F-FDG PET/CT is mandatory to confirm a suspected diagnosis of solitary plasmacytoma, provided that whole-body MRI is unable to be performed, and to distinguish between smouldering and active multiple myeloma, if whole-body X-ray (WBXR) is negative and whole-body MRI is unavailable. Based on the ability of 18F-FDG PET/CT to distinguish between metabolically active and inactive disease, this technique is now the preferred functional imaging modality to evaluate and to monitor the effect of therapy on myeloma-cell metabolism. Changes in FDG avidity can provide an earlier evaluation of response to therapy compared to MRI scans, and can predict outcomes, particularly for patients who are eligible to receive autologous stem-cell transplantation. 18F-FDG PET/CT can be coupled with sensitive bone marrow-based techniques to detect minimal residual disease (MRD) inside and outside the bone marrow, helping to identify those patients who are defined as having imaging MRD negativity.
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Affiliation(s)
- Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Cristina Nanni
- Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Philippe Moreau
- Haematology Department, University Hospital of Nantes, Nantes, France
| | | | - Sonja Zweegman
- Department of Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - Jens Hillengass
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Monika Engelhardt
- Department of Medicine, Hematology, Oncology & Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Saad Z Usmani
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - David H Vesole
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ, USA
| | | | - Shaji K Kumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paul G Richardson
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joseph R Mikhael
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Fernando Leal da Costa
- Myeloma Clinic, Hematology Department, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal
| | | | | | - Niels Abildgaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Hartmut Goldschmidt
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Wee Joo Chng
- National University Cancer Institute, National University Health System, Singapore
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Sagar Lonial
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Bart Barlogie
- Tisch Cancer Institute/Multiple Myeloma Program, Mt. Sinai Cancer Institute, New York, NY, USA
| | - Kenneth C Anderson
- Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - S Vincent Rajkumar
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian G M Durie
- Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Elena Zamagni
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
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42
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An Approach to the Evaluation of Incidentally Identified Bone Lesions Encountered on Imaging Studies. AJR Am J Roentgenol 2017; 208:960-970. [DOI: 10.2214/ajr.16.17434] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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43
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Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol 2017. [DOI: 10.1016/s1470-2045%2817%2930189-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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44
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Abstract
PET-magnetic resonance (MR) is a hybrid imaging modality that combines PET and MR. Evidence for this new modality is in the process of being developed, but both component modalities are well tested in the diagnosis and management of multiple myeloma. It allows advanced bimodality imaging of the whole body with an adaptable field of view and it can be used for monitoring plasma cell dyscrasias for progression to multiple myeloma, for assessing disease burden in patients with known multiple myeloma, for assessing response to therapy and relapse after remission, and for radiation therapy treatment planning.
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Affiliation(s)
- Shetal N Shah
- Abdominal Imaging Section and Nuclear Medicine Department, Imaging Institute and Taussig Cancer Institute, Cleveland Clinic Main Campus, Mail Code JB3, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Jorge D Oldan
- Nuclear Medicine, Department of Radiology, 2006 Old Clinic, CB# 7510, Chapel Hill, NC 27599, USA
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45
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Hanbali A, Hassanein M, Rasheed W, Aljurf M, Alsharif F. The Evolution of Prognostic Factors in Multiple Myeloma. Adv Hematol 2017; 2017:4812637. [PMID: 28321258 PMCID: PMC5339490 DOI: 10.1155/2017/4812637] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/22/2017] [Accepted: 02/05/2017] [Indexed: 12/23/2022] Open
Abstract
Multiple myeloma (MM) is a heterogeneous hematologic malignancy involving the proliferation of plasma cells derived by different genetic events contributing to the development, progression, and prognosis of this disease. Despite improvement in treatment strategies of MM over the last decade, the disease remains incurable. All efforts are currently focused on understanding the prognostic markers of the disease hoping to incorporate the new therapeutic modalities to convert the disease into curable one. We present this comprehensive review to summarize the current standard prognostic markers used in MM along with novel techniques that are still in development and highlight their implications in current clinical practice.
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Affiliation(s)
- Amr Hanbali
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mona Hassanein
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Walid Rasheed
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fahad Alsharif
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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46
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Terpos E, Dimopoulos MA, Moulopoulos LA. The Role of Imaging in the Treatment of Patients With Multiple Myeloma in 2016. Am Soc Clin Oncol Educ Book 2017; 35:e407-17. [PMID: 27249748 DOI: 10.1200/edbk_159074] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The novel criteria for the diagnosis of symptomatic multiple myeloma have revealed the value of modern imaging for the management of patients with myeloma. Whole-body low-dose CT (LDCT) has increased sensitivity over conventional radiography for the detection of osteolytic lesions, and several myeloma organizations and institutions have suggested that whole-body LDCT should replace conventional radiography for the work-up of patients with myeloma. MRI is the best imaging method for the depiction of marrow infiltration by myeloma cells. Whole-body MRI (or at least MRI of the spine and pelvis if whole-body MRI is not available) should be performed for all patients with smoldering multiple myeloma with no lytic lesions to look for occult disease, which may justify treatment. In addition, MRI accurately illustrates the presence of plasmacytomas, spinal cord, and/or nerve compression for surgical intervention or radiation therapy; it is also recommended for the work-up of solitary bone plasmacytoma, and it may distinguish malignant from benign fractures (which is very important in cases of patients in biochemical remission with no other signs of progression). Diffusion weighted imaging (DWI) seems to improve MRI diagnosis in patients with myeloma. PET/CT is a functional imaging technique, more sensitive than conventional radiography for the detection of lytic lesions, which probably allows better definition of complete response and minimal residual disease compared with all other imaging methods. PET/CT has shown the best results in the follow-up of patients with myeloma and has an independent prognostic value both at diagnosis and following treatment. PET/CT can also be used for the work-up of solitary bone plasmacytoma and nonsecretory myeloma.
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Affiliation(s)
- Evangelos Terpos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Meletios A Dimopoulos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Lia A Moulopoulos
- From the School of Medicine, National and Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
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47
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Ayaz S, Ayaz ÜY. Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (FDG PET/CT) Findings in an Unusual Case of Multiple Myeloma Presenting with a Large Extra-Axial Intracranial Mass. Pol J Radiol 2017; 81:602-605. [PMID: 28058074 PMCID: PMC5175789 DOI: 10.12659/pjr.899444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 05/15/2016] [Indexed: 01/26/2023] Open
Abstract
Background We aimed to present unusual cranial FDG PET/CT findings of a 56-year-old female with multiple myeloma (MM). Case Report Plain CT images revealed a lytic lesion in the right parietal bone, filled with an oval-shaped, large, extra-axial, extradural, intracranial mass which measured 75×75×40 mm and had smooth borders. The right parietal lobe was compressed by the mass. The maximum standardized uptake value (SUVmax) of the mass lesion was 8.94 on FDG PET/CT images. Multiple lytic lesions with an increased uptake were also detected in other calvarial bones, in several vertebras and in the proximal left femur. After seven months, a control FDG PET/CT following radiotherapy and chemotherapy revealed almost complete regression of the right parietal extra-axial mass lesion. The number, size and metabolism of lytic lesions in other bones also decreased. Conclusions FDG PET/CT was useful for an initial evaluation of MM lesions and was effective in monitoring the response of these lesions to therapy.
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Affiliation(s)
- Sevin Ayaz
- Department of Nuclear Medicine, Mersin State Hospital, Mersin, Turkey
| | - Ümit Yaşar Ayaz
- Department of Radiology, Mersin Women's and Children's Hospital, Mersin, Turkey
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48
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The role of 68Ga-DOTA-TATE PET/CT scanning in the evaluation of patients with multiple myeloma. Nucl Med Commun 2017; 38:76-83. [DOI: 10.1097/mnm.0000000000000610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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49
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de Waal EGM, Glaudemans AWJM, Schröder CP, Vellenga E, Slart RHJA. Nuclear medicine imaging of multiple myeloma, particularly in the relapsed setting. Eur J Nucl Med Mol Imaging 2016; 44:332-341. [PMID: 27900520 PMCID: PMC5215256 DOI: 10.1007/s00259-016-3576-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/18/2016] [Indexed: 02/04/2023]
Abstract
Multiple myeloma (MM) is characterized by a monoclonal plasma cell population in the bone marrow. Lytic lesions occur in up to 90 % of patients. For many years, whole-body X-ray (WBX) was the method of choice for detecting skeleton abnormalities. However, the value of WBX in relapsing disease is limited because lesions persist post-treatment, which restricts the capacity to distinguish between old, inactive skeletal lesions and new, active ones. Therefore, alternative techniques are necessary to visualize disease activity. Modern imaging techniques such as magnetic resonance imaging, positron emission tomography and computed tomography offer superior detection of myeloma bone disease and extramedullary manifestations. In particular, the properties of nuclear imaging enable the identification of disease activity by directly targeting the specific cellular properties of malignant plasma cells. In this review, an overview is provided of the effectiveness of radiopharmaceuticals that target metabolism, surface receptors and angiogenesis. The available literature data for commonly used nuclear imaging tracers, the promising first results of new tracers, and our pilot work indicate that a number of these radiopharmaceutical applications can be used effectively for staging and response monitoring of relapsing MM patients. Moreover, some tracers can potentially be used for radio immunotherapy.
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Affiliation(s)
- Esther G M de Waal
- Department of Hematology, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands.
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carolien P Schröder
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edo Vellenga
- Department of Hematology, University of Groningen, University Medical Center Groningen, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
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50
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Fakhri AA, Rodrigue PD, Fakhri AF. Extramedullary Plasmacytoma of the Gallbladder Detected on Fluorine 18-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. J Clin Imaging Sci 2016; 6:40. [PMID: 27761300 PMCID: PMC5070038 DOI: 10.4103/2156-7514.191127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/22/2016] [Indexed: 01/12/2023] Open
Abstract
Extramedullary plasmacytoma is rare in patients with diagnosed multiple myeloma. Soft tissue plasmacytoma of the gallbladder is particularly uncommon and has been described in only a handful of cases. Diagnosis of gallbladder plasmacytoma with fluorine 18-fluorodeoxyglucose (F18-FDG) positron emission tomography/computed tomography (PET/CT) has not previously been reported. We present a 65-year-old female with a history of multiple myeloma who underwent a restaging F18-FDG-PET/CT which showed a focal area of hypermetabolic activity, corresponding to a nodular lesion within the posterior gallbladder wall. The patient underwent successful cholecystectomy, with surgical pathology revealing gallbladder plasmacytoma. A follow-up scan was negative for active malignancy. This is a novel case of gallbladder plasmacytoma diagnosed on whole-body F18-FDG PET/CT – thus demonstrating the clinical value of this imaging modality in staging, restaging, and surveillance for patients with multiple myeloma.
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Affiliation(s)
- Asif Ali Fakhri
- Department of Nuclear Medicine and Molecular Imaging, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Paul David Rodrigue
- Department of Nuclear Medicine and Molecular Imaging, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Amena Fatima Fakhri
- Department of Nuclear Medicine and Molecular Imaging, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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