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Prognostic significance of 68Ga-Pentixafor PET/CT in multiple myeloma recurrence: a comparison to 18F-FDG PET/CT and laboratory results

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Abstract

Purpose

This study investigates the prognostic value of 68Ga-Pentixafor PET/CT using PET-derived quantitative in multiple myeloma (MM) patients with suspected recurrence in comparison to 18F-FDG PET/CT and clinical data.

Methods

Twenty-four MM patients with suspicion for relapse who underwent 68Ga-Pentixafor and 18F-FDG PET/CT were retrospectively evaluated. Total bone marrow glycolysis for 18F-FDG (TBMFDG) and total bone marrow uptake for 68Ga-Pentixafor PET/CT (TBMCXCR4) were calculated using whole-body metabolic tumor burden obtained by dedicated software (MIM 7.0.6). The patients were followed for 19–24 months, and the association of PET-derived quantitative data with overall survival (OS) was analyzed.

Results

68Ga-Pentixafor PET/CT was positive in 17 patients, of which 13 were also positive on 18F-FDG PET/CT, whereas 7 patients were negative on both scans. The positive rate of 68Ga-Pentixafor and 18F-FDG PET/CT on a patient-based approach was 70.8% and 54.1%, respectively. 68Ga-Pentixafor positivity was significantly associated with OS (p = 0.009), and 18F-FDG positivity was at the margin of statistical significance (p = 0.056). TBMCXCR4 and TBMFDG were negatively correlated with OS (r = −0.457, p = 0.025 and r = −0.617, p = 0.001, respectively). The OS was negatively correlated with beta-2-microglobulin levels (r = −0.511, p = 0.01) and CRAB score (r = −0.592, p = 0.002) as an indicator of the end-organ disease, which confirmed these results. Serum beta-2-microglobulin levels and CRAB score were also correlated with TBMCXCR4 (r = 0.442, p = 0.039 and r = 0.573, p = 0.003, respectively) and TBMFDG (r = 0.543, p = 0.009 and r = -0.424, p = 0.003, respectively).

Conclusion

68Ga-Pentixafor PET/CT positivity is a negative prognostic factor in the survival outcome of MM patients. Complementary 68Ga-Pentixafor PET/CT has the potential to overcome 18F-FDG PET/CT limitations and helps a more precise risk stratification.

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Acknowledgements

The authors thank Prof. Dr. Hans-Jürgen Wester for his support. The authors thank Istanbul Development Agency for their support in the theranostic research infrastructure of our department and radiopharmacy laboratory

Funding

The authors disclose that they did not receive any personal or financial support for this study.

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Authors and Affiliations

  1. Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul, Turkey

    Serkan Kuyumcu, Emine Goknur Isik, Duygu Has-Simsek, Yasemin Sanli, Fikret Buyukkaya, Zeynep Gözde Özkan & Seher Nilgun Unal

  2. Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey

    Tarik Onur Tiryaki & Sevgi Kalayoglu-Besisik

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  1. Serkan Kuyumcu
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Correspondence to Serkan Kuyumcu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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12149_2021_1652_MOESM1_ESM.png

Supplementary Fig. 1 18F-FDG and 68Ga-Pentixafor-PET maximum intensity projection images showing tumor burden of patient #24 obtained using dedicated software (MIM 7.0.6 Lesion ID) for segmentation (PNG 455 KB)

Supplementary Fig. 2 Visual presentation of PET/CT findings (PNG 308 KB)

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Kuyumcu, S., Isik, E.G., Tiryaki, T.O. et al. Prognostic significance of 68Ga-Pentixafor PET/CT in multiple myeloma recurrence: a comparison to 18F-FDG PET/CT and laboratory results. Ann Nucl Med 35, 1147–1156 (2021). https://doi.org/10.1007/s12149-021-01652-1

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  • DOI: https://doi.org/10.1007/s12149-021-01652-1

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