Researchers identified which imaging technique is better for evaluating prognosis of newly-diagnosed multiple myeloma, published in the Journal of Clinical Oncology (published online July 7, 2017; doi:10.1200/JCO.2017.72.2975).
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Magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) are considered reliable imaging techniques to detect bone lesions at diagnosis of multiple myeloma. Recent studies have shown both techniques to be of prognostic value for progression-free survival (PFS) and overall survival (OS) at diagnosis as well as during follow-up. However, few trials have prospectively compared MRI and PET-CT with respect to detecting bone lesions and for prognostic value.
Philippe Moreau, MD, University Hospital, Nantes (France), and colleagues conducted a prospective trial in patients with multiple myeloma designed to compare MRI and PET-CT in regards to detection of bone lesions at diagnosis and the prognostic value of each technique. A total of 134 patients received a combination of lenalidomide, bortezomib, and dexamethasone (RVD) with or without autologous stem cell transplantation (ASCT), followed by lenalidomide maintenance. MRI and PET-CT were performed in all patients at diagnosis, after three cycles of RVD, and before lenalidomide maintenance.
The primary endpoint was detection of bone lesions at diagnosis by MRI versus PET-CT. Secondary endpoints included prognostic impact of MRI versus PET-CT in regards to PFS and OS.
Results of the analysis showed that MRI results were positive in 127 patients (95%) at diagnosis, whereas PET-CT results were positive in 122 patients (91%) at diagnosis.
Normalization of MRI after RVD therapy and before lenalidomide maintenance was deemed not predictive of PFS or OS.
Normalization of PET-CT after three cycles of RVD therapy occurred in 32% of patients with a positive evaluation at baseline. PFS was improved in this group (30-month PFS, 78.7% VS 56.8%, respectively). PET-CT normalization before lenalidomide maintenance was observed in 62% of patients with a positive evaluation at baseline – which was associated with improved PFS and OS.
Additionally, researchers acknowledged that PET-CT normalization before maintenance was an independent prognostic indicator for PFS. Extramedullary disease at baseline was an independent prognostic indicator for PFS and OS.
Researchers concluded that while there was no significant difference in the ability to detect bone lesions at diagnosis between MRI and PET-CT, the latter technique can be used as a tool to evaluate prognosis of newly-diagnosed multiple myeloma.—Zachary Bessette
