Prognostic significance of 68Ga-Pentixafor PET/CT in multiple myeloma recurrence: a comparison to 18F-FDG PET/CT and laboratory results

Serkan Kuyumcu; Emine Goknur Isik; Tarik Onur Tiryaki; Duygu Has-Simsek; Yasemin Sanli; Fikret Buyukkaya; Zeynep Gözde Özkan; Sevgi Kalayoglu-Besisik; Seher Nilgun Unal

doi:10.1007/s12149-021-01652-1

Prognostic significance of ⁶⁸Ga-Pentixafor PET/CT in multiple myeloma recurrence: a comparison to ¹⁸F-FDG PET/CT and laboratory results

Ann Nucl Med. 2021 Oct;35(10):1147-1156. doi: 10.1007/s12149-021-01652-1. Epub 2021 Jun 29.

Authors

Serkan Kuyumcu¹, Emine Goknur Isik², Tarik Onur Tiryaki³, Duygu Has-Simsek², Yasemin Sanli², Fikret Buyukkaya², Zeynep Gözde Özkan², Sevgi Kalayoglu-Besisik³, Seher Nilgun Unal²

Affiliations

¹ Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul, Turkey. serkan.kuyumcu@istanbul.edu.tr.
² Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul, Turkey.
³ Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey.

PMID: 34185263
DOI: 10.1007/s12149-021-01652-1

Abstract

Purpose: This study investigates the prognostic value of ⁶⁸Ga-Pentixafor PET/CT using PET-derived quantitative in multiple myeloma (MM) patients with suspected recurrence in comparison to ¹⁸F-FDG PET/CT and clinical data.

Methods: Twenty-four MM patients with suspicion for relapse who underwent ⁶⁸Ga-Pentixafor and ¹⁸F-FDG PET/CT were retrospectively evaluated. Total bone marrow glycolysis for ¹⁸F-FDG (TBM_FDG) and total bone marrow uptake for ⁶⁸Ga-Pentixafor PET/CT (TBM_CXCR4) were calculated using whole-body metabolic tumor burden obtained by dedicated software (MIM 7.0.6). The patients were followed for 19-24 months, and the association of PET-derived quantitative data with overall survival (OS) was analyzed.

Results: ⁶⁸Ga-Pentixafor PET/CT was positive in 17 patients, of which 13 were also positive on ¹⁸F-FDG PET/CT, whereas 7 patients were negative on both scans. The positive rate of ⁶⁸Ga-Pentixafor and ¹⁸F-FDG PET/CT on a patient-based approach was 70.8% and 54.1%, respectively. ⁶⁸Ga-Pentixafor positivity was significantly associated with OS (p = 0.009), and ¹⁸F-FDG positivity was at the margin of statistical significance (p = 0.056). TBM_CXCR4 and TBM_FDG were negatively correlated with OS (r = -0.457, p = 0.025 and r = -0.617, p = 0.001, respectively). The OS was negatively correlated with beta-2-microglobulin levels (r = -0.511, p = 0.01) and CRAB score (r = -0.592, p = 0.002) as an indicator of the end-organ disease, which confirmed these results. Serum beta-2-microglobulin levels and CRAB score were also correlated with TBM_CXCR4 (r = 0.442, p = 0.039 and r = 0.573, p = 0.003, respectively) and TBM_FDG (r = 0.543, p = 0.009 and r = -0.424, p = 0.003, respectively).

Conclusion: ⁶⁸Ga-Pentixafor PET/CT positivity is a negative prognostic factor in the survival outcome of MM patients. Complementary ⁶⁸Ga-Pentixafor PET/CT has the potential to overcome ¹⁸F-FDG PET/CT limitations and helps a more precise risk stratification.

Keywords: CXCR4; FDG; Multiple myeloma; PET; Pentixafor.

MeSH terms

Adult
Fluorodeoxyglucose F18
Humans
Middle Aged
Multiple Myeloma*
Positron Emission Tomography Computed Tomography*

Substances

Fluorodeoxyglucose F18