STUDY USE OF 18-F FDG PET / CT SCANNING INTO THE FIRST FOLLOW UP OF PATIENTS WITH MULTIPLE MYELOMA AND ASSOCIATION WITH BIOCHEMICAL RESPONSE
(Abstract release date: 05/18/17)
EHA Library. Vallejo Luna K. 05/18/17; 182729; PB2015
Karla Vallejo Luna
Contributions
Contributions
Abstract
Abstract: PB2015
Type: Publication Only
Background
Positron computed tomography (PET / CT) with 18F fluorodeoxyglucose-labeled glucose (FDG) is a reliable technique with high sensitivity and specificity for assessing skeletal involvement and recent studies propose it as a method for predicting treatment response in multiple myeloma. Conventionally, the response is measurable by the monoclonal component in both serum and urine and Minimal residual disease (MRD) by flow cytometry has been established as a mandatory tool. The studies are aimed at combining the measurement of paraprotein with imaging tests that help to promptly define response or failure to the treatment.
Aims
The primary endpoint was the correlation of the biochemical response with the FDG PET/CT in a second evaluation after first line treatment
The secondary endpoint was the correlation between MRD and with second FDF PET/CT.
Methods
We included in this retrospective and observational study at Universitary Hospital of Vall d’ Hebron, all patients with newly MM and PET/CT before to start a first line treatment and a second PET/CT when completing treatment.
PET/CT were analyzed by the department of Nuclear Medicine with experience to grade the lesions in MM, were evaluated and categorized into positive or negative according to the criteria proposed by Zamagni, et. al.
The biochemical response was defined according to the standard IMWG response criteria.
Results
Eighteen patients ( 8 males and 10 females) with untreated MM entered, seven patients were classified with ISS III, fifteen had a good performance status, none presented renal lesion, only 16 % had hypercalcemia and 66% showed immunoparesis.
Ten patients were IgG isotype, six were classified as light chains myeloma and two patients were oligosecretors. Seventeen patients had bone marrow infiltration with a median of 42 % plasmatic cells. Two patients had a extramedullary plasmocytoma and nine had an anormal ratio of light chains.
Seventeen patients were treated with bortezomib-based regimens, (median 5.5 cycles) included VTD, MPV, VLD and VD. After treatment fourteen patients achieved completed response, two partial response and two had progressive disease.
PET/CT was positive in all patients pretreatment, 15 focal lesions, 2 diffuse bone marrow involvement plus focal lesions and 1 involvement of bone marrow alone. Twelve patients had more than 3 focal lesions and two had extramedullary disease.
At the end of first line treatment, PET/CT was negative in eight patients (44%) and fourteen had complete biochemical response (78%). 62% of the patients with negative PET/CT showed negative flow minimal residual disease (MRD) and biochemical complete response .
Two patients had PET/CT with progression disease and corresponded to a biochemical progression.
Conclusion
The correlation between PET/CT and biochemical response obtained after treatment was positive in patients with complete response. We found discordant data in two patients with oligosecretory myeloma. No correlation was shown between PET/CT and flow MRD.
Are necessary more long term studies that include greater number of patients to confirm that the PET/CT negative is an image technique that could be a tool to follow up patients after the first line treatment added to the evaluation of the biochemical response.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): PET, Multiple Myeloma
Abstract: PB2015
Type: Publication Only
Background
Positron computed tomography (PET / CT) with 18F fluorodeoxyglucose-labeled glucose (FDG) is a reliable technique with high sensitivity and specificity for assessing skeletal involvement and recent studies propose it as a method for predicting treatment response in multiple myeloma. Conventionally, the response is measurable by the monoclonal component in both serum and urine and Minimal residual disease (MRD) by flow cytometry has been established as a mandatory tool. The studies are aimed at combining the measurement of paraprotein with imaging tests that help to promptly define response or failure to the treatment.
Aims
The primary endpoint was the correlation of the biochemical response with the FDG PET/CT in a second evaluation after first line treatment
The secondary endpoint was the correlation between MRD and with second FDF PET/CT.
Methods
We included in this retrospective and observational study at Universitary Hospital of Vall d’ Hebron, all patients with newly MM and PET/CT before to start a first line treatment and a second PET/CT when completing treatment.
PET/CT were analyzed by the department of Nuclear Medicine with experience to grade the lesions in MM, were evaluated and categorized into positive or negative according to the criteria proposed by Zamagni, et. al.
The biochemical response was defined according to the standard IMWG response criteria.
Results
Eighteen patients ( 8 males and 10 females) with untreated MM entered, seven patients were classified with ISS III, fifteen had a good performance status, none presented renal lesion, only 16 % had hypercalcemia and 66% showed immunoparesis.
Ten patients were IgG isotype, six were classified as light chains myeloma and two patients were oligosecretors. Seventeen patients had bone marrow infiltration with a median of 42 % plasmatic cells. Two patients had a extramedullary plasmocytoma and nine had an anormal ratio of light chains.
Seventeen patients were treated with bortezomib-based regimens, (median 5.5 cycles) included VTD, MPV, VLD and VD. After treatment fourteen patients achieved completed response, two partial response and two had progressive disease.
PET/CT was positive in all patients pretreatment, 15 focal lesions, 2 diffuse bone marrow involvement plus focal lesions and 1 involvement of bone marrow alone. Twelve patients had more than 3 focal lesions and two had extramedullary disease.
At the end of first line treatment, PET/CT was negative in eight patients (44%) and fourteen had complete biochemical response (78%). 62% of the patients with negative PET/CT showed negative flow minimal residual disease (MRD) and biochemical complete response .
Two patients had PET/CT with progression disease and corresponded to a biochemical progression.
Conclusion
The correlation between PET/CT and biochemical response obtained after treatment was positive in patients with complete response. We found discordant data in two patients with oligosecretory myeloma. No correlation was shown between PET/CT and flow MRD.
Are necessary more long term studies that include greater number of patients to confirm that the PET/CT negative is an image technique that could be a tool to follow up patients after the first line treatment added to the evaluation of the biochemical response.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): PET, Multiple Myeloma
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