PROGNOSTIC SIGNIFICANCE OF EXTRAMEDULLARY DISEASE DETECTED BY PET/CT ON OUTCOMES OF AUTOLOGOUS TRANSPLANT IN MULTIPLE MYELOMA PATIENTS
(Abstract release date: 05/19/16)
EHA Library. Yanamandra U. 06/09/16; 134862; PB1962
Dr. Uday Yanamandra
Contributions
Contributions
Abstract
Abstract: PB1962
Type: Publication Only
Background
Multiple myeloma is a heterogenous disorder with varied responses to transplantation. In the past investigators have reported numerous staging systems, risk stratification models based on laboratory/clinical parameters and genetic information to predict these heterogenous responses. But the disease mostly negative by biochemical tests before transplantation making it a poor choice to predict responses. 18F-FDG-PET/CT has numerous advantages in terms of ability to assess extra medullary disease in addition to the extent of active disease. The relevance of extramedullary disease in predicting response is scarce and evolving.
Aims
To study the role of pre-transplant EMD in the prognostication of multiple myeloma patients post autologous transplant.
Methods
All autologous transplant patients underwent 18F-FDG-PET/CT as part of the pre-transplant workup. The conditioning and treatment protocols were not modified based on PET/CT findings. Extramedullary disease (EMD) on PET/CT was defined as FDG uptake more than Liver SUVmax at any extramedullary site (including soft tissues or lymphoreticular structures including spleen) of at least 5mm in size. We aimed at identifying the prognostic value of the pre-transplant type of lesions on PET/CT in predicting biochemical/ clinical progression-free survival (PFS) and overall survival (OS). We also correlated the EMD status with pre-transplant biochemical markers (SPEP, UPEP, SIFE, SFLC, β2M and LDH). The revised IMWG criteria were used for defining progression.
Results
A total of 43 patients underwent pre-transplant PET/CT evaluation of which seven patients had EMD. On Cox proportional regression hazard model EMD had a hazard for post-transplant all-cause mortality of 5.46 times in patients than the medullary disease (p-0.045) (Fig 1A).The 6-year median OS in patients with medullary and extramedullary PET lesions were 80.6%, and 57.1% respectively as shown Fig. 1B. Kaplan-Meier analysis showed poorer OS in patients with EMD χ2 (1-0.496, p-0.481). There was no significant difference in clinical or biochemical EFS among patients with EMD. The median PFS (Clinical) in patients with medullary and extramedullary PET lesions were 77.8%, and 71.4% respectively (p-0.997). The median PFS (Biochemical) in patients with medullary and extramedullary PET lesions were 55.6%, and 57.1% respectively (p-0.352).Engraftment was delayed in patients with EMD (Neutrophil – 11.57 Vs 10.83 days, platelet engraftment - 13.0 Vs 12.63 days) though the results were not significant (p-0.274, 0.85).Pre-transplant β2M and LDH were significantly higher in patients with EMD (p-0.036). A chi-square test was performed and no relationship was found between the PET positivity and pre-transplant UPEP, SPEP and SIFE with χ2 (1, 42)-0.737, p-0.391, χ2 (1, 43)-0.632, p-0.580 and χ2 (1, 42)-0.305, p-0.580 respectively.
Conclusion
EMD detected on 18F-FDG-PET/CT has a higher hazard for mortality and significantly correlated with pre-transplant higher β2M and LDH levels. The Smaller sample size was a major limitation of the study and was responsible for certain differences in measured variables not being statistically significant. To conclude, detection of EMD by pre-transplant 18F-FDG-PET/CT has a significant prognostic role in multiple myeloma patients undergoing autologous peripheral blood stem cell transplant.
Session topic: E-poster
Keyword(s): Multiple myeloma, PET, Prognosis, Transplant
Type: Publication Only
Background
Multiple myeloma is a heterogenous disorder with varied responses to transplantation. In the past investigators have reported numerous staging systems, risk stratification models based on laboratory/clinical parameters and genetic information to predict these heterogenous responses. But the disease mostly negative by biochemical tests before transplantation making it a poor choice to predict responses. 18F-FDG-PET/CT has numerous advantages in terms of ability to assess extra medullary disease in addition to the extent of active disease. The relevance of extramedullary disease in predicting response is scarce and evolving.
Aims
To study the role of pre-transplant EMD in the prognostication of multiple myeloma patients post autologous transplant.
Methods
All autologous transplant patients underwent 18F-FDG-PET/CT as part of the pre-transplant workup. The conditioning and treatment protocols were not modified based on PET/CT findings. Extramedullary disease (EMD) on PET/CT was defined as FDG uptake more than Liver SUVmax at any extramedullary site (including soft tissues or lymphoreticular structures including spleen) of at least 5mm in size. We aimed at identifying the prognostic value of the pre-transplant type of lesions on PET/CT in predicting biochemical/ clinical progression-free survival (PFS) and overall survival (OS). We also correlated the EMD status with pre-transplant biochemical markers (SPEP, UPEP, SIFE, SFLC, β2M and LDH). The revised IMWG criteria were used for defining progression.
Results
A total of 43 patients underwent pre-transplant PET/CT evaluation of which seven patients had EMD. On Cox proportional regression hazard model EMD had a hazard for post-transplant all-cause mortality of 5.46 times in patients than the medullary disease (p-0.045) (Fig 1A).The 6-year median OS in patients with medullary and extramedullary PET lesions were 80.6%, and 57.1% respectively as shown Fig. 1B. Kaplan-Meier analysis showed poorer OS in patients with EMD χ2 (1-0.496, p-0.481). There was no significant difference in clinical or biochemical EFS among patients with EMD. The median PFS (Clinical) in patients with medullary and extramedullary PET lesions were 77.8%, and 71.4% respectively (p-0.997). The median PFS (Biochemical) in patients with medullary and extramedullary PET lesions were 55.6%, and 57.1% respectively (p-0.352).Engraftment was delayed in patients with EMD (Neutrophil – 11.57 Vs 10.83 days, platelet engraftment - 13.0 Vs 12.63 days) though the results were not significant (p-0.274, 0.85).Pre-transplant β2M and LDH were significantly higher in patients with EMD (p-0.036). A chi-square test was performed and no relationship was found between the PET positivity and pre-transplant UPEP, SPEP and SIFE with χ2 (1, 42)-0.737, p-0.391, χ2 (1, 43)-0.632, p-0.580 and χ2 (1, 42)-0.305, p-0.580 respectively.
Conclusion
EMD detected on 18F-FDG-PET/CT has a higher hazard for mortality and significantly correlated with pre-transplant higher β2M and LDH levels. The Smaller sample size was a major limitation of the study and was responsible for certain differences in measured variables not being statistically significant. To conclude, detection of EMD by pre-transplant 18F-FDG-PET/CT has a significant prognostic role in multiple myeloma patients undergoing autologous peripheral blood stem cell transplant.
Session topic: E-poster
Keyword(s): Multiple myeloma, PET, Prognosis, Transplant
Abstract: PB1962
Type: Publication Only
Background
Multiple myeloma is a heterogenous disorder with varied responses to transplantation. In the past investigators have reported numerous staging systems, risk stratification models based on laboratory/clinical parameters and genetic information to predict these heterogenous responses. But the disease mostly negative by biochemical tests before transplantation making it a poor choice to predict responses. 18F-FDG-PET/CT has numerous advantages in terms of ability to assess extra medullary disease in addition to the extent of active disease. The relevance of extramedullary disease in predicting response is scarce and evolving.
Aims
To study the role of pre-transplant EMD in the prognostication of multiple myeloma patients post autologous transplant.
Methods
All autologous transplant patients underwent 18F-FDG-PET/CT as part of the pre-transplant workup. The conditioning and treatment protocols were not modified based on PET/CT findings. Extramedullary disease (EMD) on PET/CT was defined as FDG uptake more than Liver SUVmax at any extramedullary site (including soft tissues or lymphoreticular structures including spleen) of at least 5mm in size. We aimed at identifying the prognostic value of the pre-transplant type of lesions on PET/CT in predicting biochemical/ clinical progression-free survival (PFS) and overall survival (OS). We also correlated the EMD status with pre-transplant biochemical markers (SPEP, UPEP, SIFE, SFLC, β2M and LDH). The revised IMWG criteria were used for defining progression.
Results
A total of 43 patients underwent pre-transplant PET/CT evaluation of which seven patients had EMD. On Cox proportional regression hazard model EMD had a hazard for post-transplant all-cause mortality of 5.46 times in patients than the medullary disease (p-0.045) (Fig 1A).The 6-year median OS in patients with medullary and extramedullary PET lesions were 80.6%, and 57.1% respectively as shown Fig. 1B. Kaplan-Meier analysis showed poorer OS in patients with EMD χ2 (1-0.496, p-0.481). There was no significant difference in clinical or biochemical EFS among patients with EMD. The median PFS (Clinical) in patients with medullary and extramedullary PET lesions were 77.8%, and 71.4% respectively (p-0.997). The median PFS (Biochemical) in patients with medullary and extramedullary PET lesions were 55.6%, and 57.1% respectively (p-0.352).Engraftment was delayed in patients with EMD (Neutrophil – 11.57 Vs 10.83 days, platelet engraftment - 13.0 Vs 12.63 days) though the results were not significant (p-0.274, 0.85).Pre-transplant β2M and LDH were significantly higher in patients with EMD (p-0.036). A chi-square test was performed and no relationship was found between the PET positivity and pre-transplant UPEP, SPEP and SIFE with χ2 (1, 42)-0.737, p-0.391, χ2 (1, 43)-0.632, p-0.580 and χ2 (1, 42)-0.305, p-0.580 respectively.
Conclusion
EMD detected on 18F-FDG-PET/CT has a higher hazard for mortality and significantly correlated with pre-transplant higher β2M and LDH levels. The Smaller sample size was a major limitation of the study and was responsible for certain differences in measured variables not being statistically significant. To conclude, detection of EMD by pre-transplant 18F-FDG-PET/CT has a significant prognostic role in multiple myeloma patients undergoing autologous peripheral blood stem cell transplant.
Session topic: E-poster
Keyword(s): Multiple myeloma, PET, Prognosis, Transplant
Type: Publication Only
Background
Multiple myeloma is a heterogenous disorder with varied responses to transplantation. In the past investigators have reported numerous staging systems, risk stratification models based on laboratory/clinical parameters and genetic information to predict these heterogenous responses. But the disease mostly negative by biochemical tests before transplantation making it a poor choice to predict responses. 18F-FDG-PET/CT has numerous advantages in terms of ability to assess extra medullary disease in addition to the extent of active disease. The relevance of extramedullary disease in predicting response is scarce and evolving.
Aims
To study the role of pre-transplant EMD in the prognostication of multiple myeloma patients post autologous transplant.
Methods
All autologous transplant patients underwent 18F-FDG-PET/CT as part of the pre-transplant workup. The conditioning and treatment protocols were not modified based on PET/CT findings. Extramedullary disease (EMD) on PET/CT was defined as FDG uptake more than Liver SUVmax at any extramedullary site (including soft tissues or lymphoreticular structures including spleen) of at least 5mm in size. We aimed at identifying the prognostic value of the pre-transplant type of lesions on PET/CT in predicting biochemical/ clinical progression-free survival (PFS) and overall survival (OS). We also correlated the EMD status with pre-transplant biochemical markers (SPEP, UPEP, SIFE, SFLC, β2M and LDH). The revised IMWG criteria were used for defining progression.
Results
A total of 43 patients underwent pre-transplant PET/CT evaluation of which seven patients had EMD. On Cox proportional regression hazard model EMD had a hazard for post-transplant all-cause mortality of 5.46 times in patients than the medullary disease (p-0.045) (Fig 1A).The 6-year median OS in patients with medullary and extramedullary PET lesions were 80.6%, and 57.1% respectively as shown Fig. 1B. Kaplan-Meier analysis showed poorer OS in patients with EMD χ2 (1-0.496, p-0.481). There was no significant difference in clinical or biochemical EFS among patients with EMD. The median PFS (Clinical) in patients with medullary and extramedullary PET lesions were 77.8%, and 71.4% respectively (p-0.997). The median PFS (Biochemical) in patients with medullary and extramedullary PET lesions were 55.6%, and 57.1% respectively (p-0.352).Engraftment was delayed in patients with EMD (Neutrophil – 11.57 Vs 10.83 days, platelet engraftment - 13.0 Vs 12.63 days) though the results were not significant (p-0.274, 0.85).Pre-transplant β2M and LDH were significantly higher in patients with EMD (p-0.036). A chi-square test was performed and no relationship was found between the PET positivity and pre-transplant UPEP, SPEP and SIFE with χ2 (1, 42)-0.737, p-0.391, χ2 (1, 43)-0.632, p-0.580 and χ2 (1, 42)-0.305, p-0.580 respectively.
Conclusion
EMD detected on 18F-FDG-PET/CT has a higher hazard for mortality and significantly correlated with pre-transplant higher β2M and LDH levels. The Smaller sample size was a major limitation of the study and was responsible for certain differences in measured variables not being statistically significant. To conclude, detection of EMD by pre-transplant 18F-FDG-PET/CT has a significant prognostic role in multiple myeloma patients undergoing autologous peripheral blood stem cell transplant.
Session topic: E-poster
Keyword(s): Multiple myeloma, PET, Prognosis, Transplant
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