Advertisement

FDG PET in Multiple Myeloma

  • Bastien JametEmail author
  • Clément Bailly
  • Thomas Carlier
  • Anne-Victoire Michaud
  • Cyrille Touzeau
  • Philippe Moreau
  • Caroline Bodet-Milin
  • Françoise Kraeber-Bodéré
Chapter
  • 207 Downloads

Abstract

The potential of 18Fluoro-deoxyglucose (FDG) positron emission tomography (PET) for the treatment of multiple myeloma has recently been evaluated. FDG-PET is a powerful imaging tool for the detection of bone lesions at initial diagnosis with high sensitivity and specificity values. The presence of extra-medullary lesions affects the prognosis. During therapeutic evaluation, FDG-PET is the reference imaging technique, because it can be performed much earlier than an MRI which lacks specificity. The negativity of FDG-PET before and after autologous stem cell transplantation is an independent favorable prognostic factor, especially for patients with a complete biological response.

In patients with smoldering multiple myeloma, the presence of one or more hyper-metabolic lytic lesions on FDG-PET may be considered as a criterion for initiating therapy. In the event of a suspect solitary plasmacytoma, the completion of a PET-FDG is indicated so as to not disregard other bone or extra-medullary localizations. The challenge of future multi-center prospective studies will be to standardize the interpretation criteria of FDG-PET, especially in the therapeutic evaluation.

Keywords

Multiple myeloma FDG-PET/CT Review Prognosis 

Notes

Acknowledgments

“This work has been supported in part by grants from the French National Agency for Research called “Investissements d’Avenir” IRON Labex n° ANR-11-LABX-0018-01 and ArronaxPlus Equipex n° ANR-11-EQPX-0004, and by a grant INCa-DGOS-Inserm_12558 (SIRIC ILIAD).”

References

  1. 1.
    Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia. 2009;23:3–9.CrossRefGoogle Scholar
  2. 2.
    Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International myeloma working group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15:538–48.CrossRefGoogle Scholar
  3. 3.
    Dimopoulos M, Hillengass J, Usmani S, et al. Role of magnetic resonance imaging in the Management of Patients with multiple myeloma: a consensus statement. J Clin Oncol. 2015;33:657–64.CrossRefGoogle Scholar
  4. 4.
    Terpos E, Kleber M, Engelhardt M, et al. European myeloma network guidelines for the management of multiple myeloma-related complications. Haematologica. 2015;100(10):1254–66.CrossRefGoogle Scholar
  5. 5.
    Cavo M, Terpos E, Nanni C, et al. Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the international myeloma working group. Lancet Oncol. 2017;18(4):e206–17.CrossRefGoogle Scholar
  6. 6.
    Dammacco F, Rubini G, Ferrari C, et al. 18F-FDG PET/CT: a review of diagnostic and prognostic features in multiple myeloma and related disorders. Clin Exp Med. 2015;15(1):1–18.CrossRefGoogle Scholar
  7. 7.
    Weng W-W, Dong M-J, Zhang J, et al. A systematic review of MRI, scintigraphy, FDG-PET and PET/CT for diagnosis of multiple myeloma related bone disease-which is best? Asian Pac J Cancer Prev. 2014;15(22):9879–84.CrossRefGoogle Scholar
  8. 8.
    Lu YY, Chen JH, Lin WY, et al. FDG PET or PET/CT for detecting intramedullary and extramedullary lesions in multiple Myeloma: a systematic review and meta-analysis. Clin Nucl Med. 2012;37(9):833–7.CrossRefGoogle Scholar
  9. 9.
    Walker RC, Brown TL, Jones-Jackson LB, et al. Imaging of multiple myeloma and related plasma cell dyscrasias. J Nucl Med. 2012;53(7):1091–101.CrossRefGoogle Scholar
  10. 10.
    Sager S, Ergul N, Ciftci H, et al. The value of FDG PET/CT in the initial staging and bone marrow involvement of patients with multiple myeloma. Skelet Radiol. 2011;40(7):843–7.CrossRefGoogle Scholar
  11. 11.
    Mesguich C, Fardanesh R, Tanenbaum L, et al. State of the art imaging of multiple myeloma: comparative review of FDG PET/CT imaging in various clinical settings. Eur J Radiol. 2014;83(12):2203–23.CrossRefGoogle Scholar
  12. 12.
    Rasche L, Angtuaco E, McDonald JE, et al. Low expression of hexokinase-2 is associated with false-negative FDG-positron emission tomography in multiple myeloma. Blood. 2017;130(1):30–4.CrossRefGoogle Scholar
  13. 13.
    Moreau P, Attal M, Caillot D, et al. Prospective evaluation of magnetic resonance imaging and [18F]Fluorodeoxyglucose positron emission tomography-computed tomography at diagnosis and before maintenance therapy in symptomatic patients with multiple myeloma included in the IFM/DFCI 2009 trial: results of the IMAJEM study. J Clin Oncol. 2017;35(25):2911–8.CrossRefGoogle Scholar
  14. 14.
    Nanni C, Versari A, Chauvie S, et al. Interpretation criteria for FDG PET/CT in multiple myeloma (IMPeTUs): final results. IMPeTUs (Italian myeloma criteria for PET USe). Eur J Nucl Med Mol Imaging. 2018;45(5):712–9.CrossRefGoogle Scholar
  15. 15.
    Van Lammeren-Venema D, Regelink JC, Riphagen II, et al. 8F-fluoro-deoxyglucose positron emission tomography in assessment of myeloma-related bone disease: a systematic review. Cancer. 2012;118(8):1971–81.CrossRefGoogle Scholar
  16. 16.
    Zamagni E, Nanni C, Patriarca F, et al. A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma. Haematologica. 2007;92:50–5.CrossRefGoogle Scholar
  17. 17.
    Fonti R, Salvatore B, Quarantelli M, et al. 18F-FDG PET/CT, 99mTc-MIBI, and MRI in evaluation of patients with multiple myeloma. J Nucl Med. 2008;49:195–200.CrossRefGoogle Scholar
  18. 18.
    Fonti R, Pace L, Cerchione C, Catalano L, Salvatore B, De LS, Pane F, Salvatore M, Del VS. 18F-fdg pet/ct, 99mtc-mibi, and mri in the prediction of outcome of patients with multiple myeloma: a comparative study. Clin Nucl Med. 2015;40(4):303–8.CrossRefGoogle Scholar
  19. 19.
    Salaun P-Y, Gastinne T, Frampas E, et al. FDG-positron-emission tomography for staging and therapeutic assessment in patients with plasmacytoma. Haematologica. 2008;93(8):1269–71.CrossRefGoogle Scholar
  20. 20.
    Fouquet G, Guidez S, Herbaux C, et al. Impact of initial FDG-PET/CT and serum-free light chain on transformation of conventionally defined solitary plasmacytoma to multiple myeloma. Clin Cancer Res. 2014;20(12):3254–60.CrossRefGoogle Scholar
  21. 21.
    Siontis B, Kumar S, Dispenzieri A, et al. Positron emission tomography-computed tomography in the diagnostic evaluation of smoldering multiple myeloma: identification of patients needing therapy. Blood. 2015;5:e364.  https://doi.org/10.1038/bcj.2015.87.CrossRefGoogle Scholar
  22. 22.
    Zamagni E, Nanni C, Gay F, et al. 18F-FDG PET/CT focal, but not osteolytic, lesions predict the progression of smoldering myeloma to active disease. Leukemia. 2016;30(2):417–22.CrossRefGoogle Scholar
  23. 23.
    Bartel TB, Haessler J, Brown TL, et al. F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma. Blood. 2009;114(10):2068–76.CrossRefGoogle Scholar
  24. 24.
    Zamagni E, Patriarca F, Nanni C, et al. Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation. [Erratum appears in Blood. 2012 Sep 13;120(11):2349]. Blood. 2011;118(23):5989–95.CrossRefGoogle Scholar
  25. 25.
    Haznedar R, Aki SZ, Akdemir OU, et al. Value of 18F-fluorodeoxyglucose uptake in positron emission tomography/computed tomography in predicting survival in multiple myeloma. Eur J Nucl Med Mol Imaging. 2011;38(6):1046–53.CrossRefGoogle Scholar
  26. 26.
    Park S, Lee SJ, Chang WJ, et al. Positive correlation between baseline PET or PET/CT findings and clinical parameters in multiple myeloma patients. Acta Haematol. 2014;131(4):193–9.CrossRefGoogle Scholar
  27. 27.
    Fonti R, Larobina M, Del Vecchio S, et al. Metabolic tumor volume assessed by 18F-FDG PET/CT for the prediction of outcome in patients with multiple myeloma. J Nucl Med. 2012;53(12):1829–35.CrossRefGoogle Scholar
  28. 28.
    McDonald JE, Kessler MM, Gardner MW, et al. Assessment of Total lesion glycolysis by 18F FDG PET/CT significantly improves prognostic value of GEP and ISS in myeloma. Clin Cancer Res. 2017;23(8):1981–7.CrossRefGoogle Scholar
  29. 29.
    Carlier T, Bailly C, Leforestier R, et al. Prognostic added value of PET textural features at diagnosis in symptomatic multiple myeloma. Oral Communication SNM 2017.Google Scholar
  30. 30.
    Kumar S, Paiva B, Anderson KC, et al. International myeloma working group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol. 2016;17(8):e328–46.CrossRefGoogle Scholar
  31. 31.
    Usmani SZ, Mitchell A, Waheed S, et al. Prognostic implications of serial 18-fluoro-deoxyglucose emission tomography in multiple myeloma treated with total therapy 3. Blood. 2013;121(10):1819–23.CrossRefGoogle Scholar
  32. 32.
    Zamagni E, Nanni C, Mancuso K, et al. PET/CT improves the definition of complete response and allows to detect otherwise unidentifiable skeletal progression in multiple myeloma. Clin Cancer Res. 2015;21(19):4384–90.CrossRefGoogle Scholar
  33. 33.
    Bailly C, Carlier T, Jamet B, et al. Interim PET analysis in first line therapy of multiple myeloma: Prognostic value of ΔSUVmax in the FDG-avid patients of the IMAJEM study. Clin Cancer Res. 2018.Google Scholar
  34. 34.
    Nanni C, Zamagni E, Celli M, et al. The value of 18F-FDG PET/CT after autologous stem cell transplantation (ASCT) in patients affected by multiple myeloma (MM): experience with 77 patients. Clin Nucl Med. 2013;38(2):e74–9.CrossRefGoogle Scholar
  35. 35.
    Derlin T, Weber C, Habermann CR, et al. 18F-FDG PET/CT for detection and localization of residual or recurrent disease in patients with multiple myeloma after stem cell transplantation. Eur J Nucl Med Mol Imaging. 2012;39(3):493–500.CrossRefGoogle Scholar
  36. 36.
    Lapa C, Lückerath K, Malzahn U, et al. 18 FDG-PET/CT for prognostic stratification of patients with multiple myeloma relapse after stem cell transplantation. Oncotarget. 2014;5(17):7381–91.CrossRefGoogle Scholar
  37. 37.
    Jamet B, Bailly C, Carlier T, et al. Added prognostic value of FDG-PET/CT in relapsing multiple myeloma patients. Leuk Lymphoma. 2018:1–4.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Bastien Jamet
    • 1
    Email author
  • Clément Bailly
    • 1
    • 2
  • Thomas Carlier
    • 1
    • 2
  • Anne-Victoire Michaud
    • 1
  • Cyrille Touzeau
    • 2
    • 3
  • Philippe Moreau
    • 2
    • 3
  • Caroline Bodet-Milin
    • 1
    • 2
  • Françoise Kraeber-Bodéré
    • 1
    • 2
    • 4
  1. 1.Nuclear Medicine UnitUniversity HospitalNantesFrance
  2. 2.CRCINA, INSERM, CNRS, Angers University, Nantes UniversityNantesFrance
  3. 3.Haematology DepartmentUniversity HospitalNantesFrance
  4. 4.Nuclear Medicine UnitICO-GauducheauNantesFrance

Personalised recommendations