ROLE OF PET/CT IN PROGNOSTICATING POST-TRANSPLANT OUTCOMES BASED ON A NEW SCORING SYSTEM: RESULTS OF PIPET-M TRIAL
(Abstract release date: 05/19/16)
EHA Library. Yanamandra U. 06/09/16; 132858; E1309
Dr. Uday Yanamandra
Contributions
Contributions
Abstract
Abstract: E1309
Type: Eposter Presentation
Background
Multiple myeloma (MM) is a heterogeneous disorder with varied responses to transplantation. 18F-FDG-PET/CT has a role in prognosticating post-transplant outcomes, but the PET positivity has been reported in non-homogenous fashion leading to difficulty in interpretation and inter-trial comparisons. We defined a new staging system for PET/CT reporting in MM and validated it for predicting post-transplant outcomes, first in the world literature.
Aims
Aim: To assess the role of 18 FDG-PET/CT scan in prognostication of MM autologous stem cell transplantation (ASCT) candidates.Objectives: To correlate pre-transplant FDG-PET/CT avidity with (a) Post transplant outcomes (b)Biochemical Markers (c) MRD as assessed by the flow cytometry (FCM)
Methods
It is a prospective systematic protocol based single centre observational study. As part of CTRI registered PIPET-M Trial, all autologous transplant MM patients underwent 18F-FDG-PET/CT during pre-transplant workup. The conditioning and treatment protocols were not modified based on PET/CT findings. PET positivity was defined as per a newly defined PIPET-M staging in lines with modified Deauville's staging based on target lesion SUVmax (Fig 1A). This staging was further classified into two models for defining PET positivity based on background physiological FDG uptake as an internal control (In model 1 - mediastinal SUVmax and in model 2 - Liver SUVmax was taken as physiological SUVmax) (Fig 1B, C). Progression was defined using revised IMWG criteria. Using SPSS ver.16.0, OS/PFS was assessed by Kaplan-Meier/ Cox-regression survival analysis.
Results
A total of 43 patients underwent pre-transplant PET/CT evaluation. The staging was validated in this cohort. Further using model-1, PET negative patients had better PFS (88.2 vs 69.2%, p-0.65) and better OS (94.1 vs 65.4%, p-0.01). The hazard of all-cause mortality was 22.445 times higher for PET positive individuals (p-0.02). Using model-2, only statistically significant result was delayed neutrophil engraftment in PET-positive patients (11.69 vs 10.5d, p-0.02). There was good agreement between two models, but model-1 had significantly higher sensitivity and slightly lower specificity as compared to model-2 for predicting survival. Inter-observer variability was 0.02 for PIPET staging. Also, there was good agreement between the PIPET model -1 and MRD by FCM with Cohen’s Kappa - 0.599,(p < 0.0005). Levels of β2M and LDH were higher in the patients with PET positivity defined based on PIPET model 1, (Abnormal β2M - χ2 (1, 42)-0.842, p-0.017, Abnormal LDH - χ2 (1, 42)-0.762, p-0.037). There was no correlation of PET positivity with pre-transplant SPEP/UPEP/SIFE/SFLCA total of 43 patients underwent pre-transplant PET/CT evaluation. The staging was validated in this cohort. Further using model-1, PET negative patients had better PFS (88.2 vs 69.2%, p-0.65) and better OS (94.1 vs 65.4%, p-0.01). The hazard of all-cause mortality was 22.445 times higher for PET positive individuals (p-0.02). Using model-2, only statistically significant result was delayed neutrophil engraftment in PET-positive patients (11.69 vs 10.5d, p-0.02). There was good agreement between two models, but model-1 had significantly higher sensitivity and slightly lower specificity as compared to model-2 for predicting survival. Inter-observer variability was 0.02 for PIPET staging. Also, there was good agreement between the PIPET model -1 and MRD by FCM with Cohen’s Kappa - 0.599, (p < 0.0005). Levels of β2M and LDH were higher in the patients with PET positivity defined based on PIPET model 1, (p-0.017 and 0.037 respectively). There was no correlation of PET positivity with pre-transplant SPEP/UPEP/SIFE/SFLC.
Conclusion
Utilizing PET stages based on this newly proposed staging model is clinically relevant to predict post-transplant OS.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Multiple myeloma, PET, Prognosis
Type: Eposter Presentation
Background
Multiple myeloma (MM) is a heterogeneous disorder with varied responses to transplantation. 18F-FDG-PET/CT has a role in prognosticating post-transplant outcomes, but the PET positivity has been reported in non-homogenous fashion leading to difficulty in interpretation and inter-trial comparisons. We defined a new staging system for PET/CT reporting in MM and validated it for predicting post-transplant outcomes, first in the world literature.
Aims
Aim: To assess the role of 18 FDG-PET/CT scan in prognostication of MM autologous stem cell transplantation (ASCT) candidates.Objectives: To correlate pre-transplant FDG-PET/CT avidity with (a) Post transplant outcomes (b)Biochemical Markers (c) MRD as assessed by the flow cytometry (FCM)
Methods
It is a prospective systematic protocol based single centre observational study. As part of CTRI registered PIPET-M Trial, all autologous transplant MM patients underwent 18F-FDG-PET/CT during pre-transplant workup. The conditioning and treatment protocols were not modified based on PET/CT findings. PET positivity was defined as per a newly defined PIPET-M staging in lines with modified Deauville's staging based on target lesion SUVmax (Fig 1A). This staging was further classified into two models for defining PET positivity based on background physiological FDG uptake as an internal control (In model 1 - mediastinal SUVmax and in model 2 - Liver SUVmax was taken as physiological SUVmax) (Fig 1B, C). Progression was defined using revised IMWG criteria. Using SPSS ver.16.0, OS/PFS was assessed by Kaplan-Meier/ Cox-regression survival analysis.
Results
A total of 43 patients underwent pre-transplant PET/CT evaluation. The staging was validated in this cohort. Further using model-1, PET negative patients had better PFS (88.2 vs 69.2%, p-0.65) and better OS (94.1 vs 65.4%, p-0.01). The hazard of all-cause mortality was 22.445 times higher for PET positive individuals (p-0.02). Using model-2, only statistically significant result was delayed neutrophil engraftment in PET-positive patients (11.69 vs 10.5d, p-0.02). There was good agreement between two models, but model-1 had significantly higher sensitivity and slightly lower specificity as compared to model-2 for predicting survival. Inter-observer variability was 0.02 for PIPET staging. Also, there was good agreement between the PIPET model -1 and MRD by FCM with Cohen’s Kappa - 0.599,(p < 0.0005). Levels of β2M and LDH were higher in the patients with PET positivity defined based on PIPET model 1, (Abnormal β2M - χ2 (1, 42)-0.842, p-0.017, Abnormal LDH - χ2 (1, 42)-0.762, p-0.037). There was no correlation of PET positivity with pre-transplant SPEP/UPEP/SIFE/SFLCA total of 43 patients underwent pre-transplant PET/CT evaluation. The staging was validated in this cohort. Further using model-1, PET negative patients had better PFS (88.2 vs 69.2%, p-0.65) and better OS (94.1 vs 65.4%, p-0.01). The hazard of all-cause mortality was 22.445 times higher for PET positive individuals (p-0.02). Using model-2, only statistically significant result was delayed neutrophil engraftment in PET-positive patients (11.69 vs 10.5d, p-0.02). There was good agreement between two models, but model-1 had significantly higher sensitivity and slightly lower specificity as compared to model-2 for predicting survival. Inter-observer variability was 0.02 for PIPET staging. Also, there was good agreement between the PIPET model -1 and MRD by FCM with Cohen’s Kappa - 0.599, (p < 0.0005). Levels of β2M and LDH were higher in the patients with PET positivity defined based on PIPET model 1, (p-0.017 and 0.037 respectively). There was no correlation of PET positivity with pre-transplant SPEP/UPEP/SIFE/SFLC.
Conclusion
Utilizing PET stages based on this newly proposed staging model is clinically relevant to predict post-transplant OS.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Multiple myeloma, PET, Prognosis
Abstract: E1309
Type: Eposter Presentation
Background
Multiple myeloma (MM) is a heterogeneous disorder with varied responses to transplantation. 18F-FDG-PET/CT has a role in prognosticating post-transplant outcomes, but the PET positivity has been reported in non-homogenous fashion leading to difficulty in interpretation and inter-trial comparisons. We defined a new staging system for PET/CT reporting in MM and validated it for predicting post-transplant outcomes, first in the world literature.
Aims
Aim: To assess the role of 18 FDG-PET/CT scan in prognostication of MM autologous stem cell transplantation (ASCT) candidates.Objectives: To correlate pre-transplant FDG-PET/CT avidity with (a) Post transplant outcomes (b)Biochemical Markers (c) MRD as assessed by the flow cytometry (FCM)
Methods
It is a prospective systematic protocol based single centre observational study. As part of CTRI registered PIPET-M Trial, all autologous transplant MM patients underwent 18F-FDG-PET/CT during pre-transplant workup. The conditioning and treatment protocols were not modified based on PET/CT findings. PET positivity was defined as per a newly defined PIPET-M staging in lines with modified Deauville's staging based on target lesion SUVmax (Fig 1A). This staging was further classified into two models for defining PET positivity based on background physiological FDG uptake as an internal control (In model 1 - mediastinal SUVmax and in model 2 - Liver SUVmax was taken as physiological SUVmax) (Fig 1B, C). Progression was defined using revised IMWG criteria. Using SPSS ver.16.0, OS/PFS was assessed by Kaplan-Meier/ Cox-regression survival analysis.
Results
A total of 43 patients underwent pre-transplant PET/CT evaluation. The staging was validated in this cohort. Further using model-1, PET negative patients had better PFS (88.2 vs 69.2%, p-0.65) and better OS (94.1 vs 65.4%, p-0.01). The hazard of all-cause mortality was 22.445 times higher for PET positive individuals (p-0.02). Using model-2, only statistically significant result was delayed neutrophil engraftment in PET-positive patients (11.69 vs 10.5d, p-0.02). There was good agreement between two models, but model-1 had significantly higher sensitivity and slightly lower specificity as compared to model-2 for predicting survival. Inter-observer variability was 0.02 for PIPET staging. Also, there was good agreement between the PIPET model -1 and MRD by FCM with Cohen’s Kappa - 0.599,(p < 0.0005). Levels of β2M and LDH were higher in the patients with PET positivity defined based on PIPET model 1, (Abnormal β2M - χ2 (1, 42)-0.842, p-0.017, Abnormal LDH - χ2 (1, 42)-0.762, p-0.037). There was no correlation of PET positivity with pre-transplant SPEP/UPEP/SIFE/SFLCA total of 43 patients underwent pre-transplant PET/CT evaluation. The staging was validated in this cohort. Further using model-1, PET negative patients had better PFS (88.2 vs 69.2%, p-0.65) and better OS (94.1 vs 65.4%, p-0.01). The hazard of all-cause mortality was 22.445 times higher for PET positive individuals (p-0.02). Using model-2, only statistically significant result was delayed neutrophil engraftment in PET-positive patients (11.69 vs 10.5d, p-0.02). There was good agreement between two models, but model-1 had significantly higher sensitivity and slightly lower specificity as compared to model-2 for predicting survival. Inter-observer variability was 0.02 for PIPET staging. Also, there was good agreement between the PIPET model -1 and MRD by FCM with Cohen’s Kappa - 0.599, (p < 0.0005). Levels of β2M and LDH were higher in the patients with PET positivity defined based on PIPET model 1, (p-0.017 and 0.037 respectively). There was no correlation of PET positivity with pre-transplant SPEP/UPEP/SIFE/SFLC.
Conclusion
Utilizing PET stages based on this newly proposed staging model is clinically relevant to predict post-transplant OS.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Multiple myeloma, PET, Prognosis
Type: Eposter Presentation
Background
Multiple myeloma (MM) is a heterogeneous disorder with varied responses to transplantation. 18F-FDG-PET/CT has a role in prognosticating post-transplant outcomes, but the PET positivity has been reported in non-homogenous fashion leading to difficulty in interpretation and inter-trial comparisons. We defined a new staging system for PET/CT reporting in MM and validated it for predicting post-transplant outcomes, first in the world literature.
Aims
Aim: To assess the role of 18 FDG-PET/CT scan in prognostication of MM autologous stem cell transplantation (ASCT) candidates.Objectives: To correlate pre-transplant FDG-PET/CT avidity with (a) Post transplant outcomes (b)Biochemical Markers (c) MRD as assessed by the flow cytometry (FCM)
Methods
It is a prospective systematic protocol based single centre observational study. As part of CTRI registered PIPET-M Trial, all autologous transplant MM patients underwent 18F-FDG-PET/CT during pre-transplant workup. The conditioning and treatment protocols were not modified based on PET/CT findings. PET positivity was defined as per a newly defined PIPET-M staging in lines with modified Deauville's staging based on target lesion SUVmax (Fig 1A). This staging was further classified into two models for defining PET positivity based on background physiological FDG uptake as an internal control (In model 1 - mediastinal SUVmax and in model 2 - Liver SUVmax was taken as physiological SUVmax) (Fig 1B, C). Progression was defined using revised IMWG criteria. Using SPSS ver.16.0, OS/PFS was assessed by Kaplan-Meier/ Cox-regression survival analysis.
Results
A total of 43 patients underwent pre-transplant PET/CT evaluation. The staging was validated in this cohort. Further using model-1, PET negative patients had better PFS (88.2 vs 69.2%, p-0.65) and better OS (94.1 vs 65.4%, p-0.01). The hazard of all-cause mortality was 22.445 times higher for PET positive individuals (p-0.02). Using model-2, only statistically significant result was delayed neutrophil engraftment in PET-positive patients (11.69 vs 10.5d, p-0.02). There was good agreement between two models, but model-1 had significantly higher sensitivity and slightly lower specificity as compared to model-2 for predicting survival. Inter-observer variability was 0.02 for PIPET staging. Also, there was good agreement between the PIPET model -1 and MRD by FCM with Cohen’s Kappa - 0.599,(p < 0.0005). Levels of β2M and LDH were higher in the patients with PET positivity defined based on PIPET model 1, (Abnormal β2M - χ2 (1, 42)-0.842, p-0.017, Abnormal LDH - χ2 (1, 42)-0.762, p-0.037). There was no correlation of PET positivity with pre-transplant SPEP/UPEP/SIFE/SFLCA total of 43 patients underwent pre-transplant PET/CT evaluation. The staging was validated in this cohort. Further using model-1, PET negative patients had better PFS (88.2 vs 69.2%, p-0.65) and better OS (94.1 vs 65.4%, p-0.01). The hazard of all-cause mortality was 22.445 times higher for PET positive individuals (p-0.02). Using model-2, only statistically significant result was delayed neutrophil engraftment in PET-positive patients (11.69 vs 10.5d, p-0.02). There was good agreement between two models, but model-1 had significantly higher sensitivity and slightly lower specificity as compared to model-2 for predicting survival. Inter-observer variability was 0.02 for PIPET staging. Also, there was good agreement between the PIPET model -1 and MRD by FCM with Cohen’s Kappa - 0.599, (p < 0.0005). Levels of β2M and LDH were higher in the patients with PET positivity defined based on PIPET model 1, (p-0.017 and 0.037 respectively). There was no correlation of PET positivity with pre-transplant SPEP/UPEP/SIFE/SFLC.
Conclusion
Utilizing PET stages based on this newly proposed staging model is clinically relevant to predict post-transplant OS.
Session topic: E-poster
Keyword(s): Autologous hematopoietic stem cell transplantation, Multiple myeloma, PET, Prognosis
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