Page 145 - Haematologica June

Plasma Cell Disorders
Treatment to suppression of focal lesions on positron emission tomography-computed tomography is a therapeutic goal in newly diagnosed multiple myeloma
Faith E. Davies,1 Adam Rosenthal,2 Leo Rasche,1 Nathan M. Petty,1
James E. McDonald,3 James A. Ntambi,3 Doug M. Steward,1 Susan B. Panozzo,1 Frits van Rhee,1 Maurizio Zangari,1 Carolina D. Schinke,1 Sharmilan Thanendrarajan,1 Brian Walker,1 Niels Weinhold,1 Bart Barlogie,1 Antje Hoering,2 and Gareth J. Morgan1
1Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, AR; 2Cancer Research and Biostatistics, Seattle, WA and 3Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
ABSTRACT
Fluorine-18 fluorodeoxyglucose positron emission tomography with computed tomography attenuation correction (PET-CT) in myelo- ma can detect and enumerate focal lesions by the quantitative char- acterization of metabolic activity. The aim of this study was to deter- mine the prognostic significance of the suppression of PET-CT activity at a number of time points post therapy initiation: day 7, post induction, post transplant, and at maintenance therapy. As part of the TT4-6 trial series, 596 patients underwent baseline PET-CT and were evaluated seri- ally during their disease course using peak standardized uptake values above background red marrow signal. We demonstrate that the presence of more than 3 focal lesions at presentation identifies a group of patients with an adverse progression-free survival and overall survival. At day 7 of therapy, patients with complete focal lesion signal suppression revert to the same prognosis as those with no lesions at diagnosis. At later time points, the continued suppression of signal remains prognostically important. We conclude that for newly diagnosed patients with focal lesions, treatment until these lesions are suppressed is an important ther- apeutic goal as the prognosis of these patients is the same as those with- out lesions at diagnosis. (clinicaltrials.gov identifiers: 00734877, 02128230, 00869232, 00871013).
Introduction
A key strategy to improve outcomes in myeloma is to customize the treatment used based on the response to therapy. Such an approach is becoming increasingly feasible as the range of treatment options with different mechanisms of action increases. The number of tools available to monitor response to therapy is also increasing, with minimal residual disease (MRD) assessment of the bone marrow (BM) using flow cytometry and next generation sequencing being the most widely used.1,2 Imaging techniques such as magnetic resonance imaging (MRI) and fluo- rine-18 fluorodeoxyglucose positron emission tomography with computed tomog- raphy (FDG PET-CT) have also been used as a method to assess the extent and dis- tribution of disease at presentation and pre and post autologous transplant.3-10 These two imaging approaches rely on different biological features of the tumor and as such offer important complementary information. Both technologies identi- fy focal lesions (FLs), which are anatomical lesions seen during myeloma progres- sion from monoclonal gammopathy of uncertain significance (MGUS) to plasma cell leukemia (PCL). They are more characteristic of the later stages of disease and are associated with adverse prognosis. However, in contrast to PET-CT, where the imaging features respond rapidly to exposure to therapy, classic MRI features are slow to resolve and can remain positive long term. Therefore, PET-CT is a useful monitoring tool for disease response.
Ferrata Storti Foundation
Haematologica 2018 Volume 103(6):1047-1053
Correspondence:
fedavies@uams.edu
Received: July 21, 2017. Accepted: March 8, 2018. Pre-published: March 22, 2018.
doi:10.3324/haematol.2017.177139
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/103/6/1047
©2018 Ferrata Storti Foundation
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