Prognostic value of [18F]FDG-PET/CT in multiple myeloma patients before and after allogeneic hematopoietic cell transplantation

Antje Stolzenburg; Katharina Lückerath; Samuel Samnick; Martin Speer; Katharina Kneer; Jan-Stefan Schmid; Götz Ulrich Grigoleit; Susanne Hofmann; Ambros J Beer; Donald Bunjes; Stefan Knop; Andreas K Buck; Hermann Einsele; Constantin Lapa

doi:10.1007/s00259-018-3997-0

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 Sep;45(10):1694-1704. doi: 10.1007/s00259-018-3997-0. Epub 2018 Apr 2.

Authors

Affiliations

¹ Department of Nuclear Medicine, University Hospital Würzburg, Medical Center, Würzburg, Germany.
² Department of Molecular & Medical Pharmacology, Ahmanson Translational Imaging Division, University of California Los Angeles, Los Angeles, USA.
³ Department of Nuclear Medicine, University of Ulm, Medical Center, Ulm, Germany.
⁴ Department of Internal Medicine II, Hematology and Oncology, University Hospital Würzburg, Würzburg, Germany.
⁵ Department of Internal Medicine III, Hematology and Oncology, University of Ulm, Medical Center, Ulm, Germany.
⁶ Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany.
⁷ Department of Nuclear Medicine, University Hospital Würzburg, Medical Center, Würzburg, Germany. lapa_C@ukw.de.

PMID: 29610955
DOI: 10.1007/s00259-018-3997-0

Abstract

Purpose: Despite improved treatment options, multiple myeloma (MM) remains an incurable disease. The aim of this study was to investigate the prognostic value of positron emission tomography/computed tomography (PET/CT) using ¹⁸F-2'-deoxy-2'-fluorodeoxyglucose ([¹⁸F]FDG) in MM patients shortly before and ~100 days after allogeneic hematopoietic cell transplantation (allo-HCT).

Methods: In this retrospective analysis, we evaluated [¹⁸F]FDG-PET/CT-scans of 45 heavily pre-treated MM patients before and 27 patients after scheduled allo-HCT. All scans were qualitatively and semi-quantitatively assessed for the presence of active disease. Serological response was recorded according to International Myeloma Working Group (IMWG) criteria. Progression-free (PFS) and overall survival (OS) were correlated with different PET/CT-derived parameters, such as presence, number and maximum standardized uptake value (SUV_max) of focal myeloma lesions. The impact of extramedullary disease on patient outcome was also assessed.

Results: PET/CT negativity -prior to or following allo-HCT- was a favorable prognostic factor for progression-free and overall survival (both, PFS and OS: pre-HSCT p < 0.001, post-HCT p < 0.005). High FDG-uptake (SUV_max > 6.5) revealed a significantly shortened survival compared to patients with a lower SUV_max (<6.5) (OS, 5.0 ± 1.1 m vs. not reached - longest 122.0 m; p < 0.001). Moreover, our data prove that a higher number (>3) of focal lesions (pre-HCT: both PFS and OS: p < 0.001; post-HCT PFS: p < 0.001, OS: p = 0.139) as well as the presence of extramedullary disease serve as adverse prognostic factors prior to and after allo-HCT. At response assessment after allo-HCT, [¹⁸F]FDG-PET/CT had a complementary value in prognostication in addition to IMWG criteria alone.

Conclusion: [¹⁸F]FDG-PET/CT before and shortly after allogeneic HCT is a powerful predictor for progression-free and overall survival in MM patients.

Keywords: Allogeneic hematopoietic cell transplantation; FDG-PET/CT; Molecular imaging; Multiple myeloma.

MeSH terms

Adult
Aged
Cytogenetic Analysis
Female
Fluorodeoxyglucose F18*
Hematopoietic Stem Cell Transplantation*
Humans
Male
Middle Aged
Multiple Myeloma / diagnostic imaging*
Multiple Myeloma / genetics
Multiple Myeloma / therapy*
Positron Emission Tomography Computed Tomography*
Prognosis
Retrospective Studies
Transplantation, Homologous

Substances

Fluorodeoxyglucose F18

Grants and funding

2013.906.1/Wilhelm Sander-Stiftung/International