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[68Ga]Pentixafor PET/CT for staging and prognostic assessment of newly diagnosed multiple myeloma: comparison to [18F]FDG PET/CT

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Abstract

Purpose

To evaluate the prognostic performance of [68Ga]Pentixafor PET/CT at baseline for staging of patients with newly diagnosed multiple myeloma (MM) and to compare it with [18F]FDG PET/CT and the Revised-International Staging System (R-ISS).

Methods

Patients who underwent [68Ga]Pentixafor and [18F]FDG PET/CT imaging were retrospectively included. Patient staging was performed according to the Durie-Salmon PLUS staging system based on [68Ga]Pentixafor PET/CT and [18F]FDG PET/CT images, and the R-ISS. Progression-free survival (PFS) at patient follow-up was estimated using the Kaplan–Meier estimator and compared using the log-rank test. Area under the receiver operating characteristic curve (AUC) was calculated to assess predictive performance.

Results

Fifty-five MM patients were evaluated. Compared with [18F]FDG PET, [68Ga]Pentixafor PET detected 25 patients as the same stage, while 26 patients were upstaged and 4 patients were downstaged (P = 0.001). After considering the low-dose CT data, there was no statistically significant difference in the number of patients classified in each stage using [68Ga]Pentixafor PET/CT and [18F]FDG PET/CT (P = 0.091). [68Ga]Pentixafor PET/CT-based staging discriminated PFS outcomes in patients with different disease stages (stage I vs. stage II, stage I vs. stage III, and stage II vs. stage III; all P < 0.05), whereas for [18F]FDG PET/CT, there was only a difference in median PFS between stage I and III (P = 0.021). When staged by R-ISS, the median PFS for stage III was significantly lower than that for stage I and II (P = 0.008 and 0.035, respectively). When predicting 2-year PFS based on staging, the AUC of [68Ga]Pentixafor PET/CT was significantly higher than that of [68Ga]Pentixafor PET (0.923 vs. 0.821, P = 0.002), [18F]FDG PET (0.923 vs. 0.752 P = 0.002), and R-ISS (0.923 vs. 0.776, P = 0.005).

Conclusions

[68Ga]Pentixafor PET/CT-based staging possesses substantial potential to predict disease progression in newly diagnosed MM patients.

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Funding

This study was funded in part by the Innovation of Science and Technology, Fujian Province (no. 2021Y9134) and Natural Science Foundation of Fujian Province (nos. 2022J01213, 2020J01120429, and 2022J02036).

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Author notes

  1. Zhenying Chen and Apeng Yang contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China

    Zhenying Chen, Aihong Chen, Chao Huang, Jiaying Zhang, Huimin Liu & Weibing Miao

  2. Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China

    Zhenying Chen, Aihong Chen, Chao Huang, Jiaying Zhang, Huimin Liu & Weibing Miao

  3. Department of Hematology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China

    Apeng Yang, Jinfeng Dong, Junfang Lin & Zhiyong Zeng

  4. Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China

    Weibing Miao

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Contributions

Experimental design: Zhenying Chen and Weibing Miao; patient recruitment: Zhenying Chen, Apeng Yang, Aihong Chen, Jinfeng Dong, Junfang Lin, Huimin Liu, and Zhiyong Zeng; radiopharmaceutical preparation: Jiaying Zhang; PET imaging analyses: Zhenying Chen, Aihong Chen, and Weibing Miao; response analyses: Zhenying Chen, Apeng Yang, Jinfeng Dong, Junfang Lin, and Zhiyong Zeng; statistical analyses: Zhenying Chen and Chao Huang; manuscript writing: Zhenying Chen, Apeng Yang, and Aihong Chen; manuscript revision: Zhiyong Zeng and Weibing Miao. All authors have seen and approved the manuscript. Zhenying Chen and Apeng Yang did the equal contribution to this study.

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Correspondence to Zhiyong Zeng or Weibing Miao.

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All procedures involving human participants were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any experiments with animals.

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Chen, Z., Yang, A., Chen, A. et al. [68Ga]Pentixafor PET/CT for staging and prognostic assessment of newly diagnosed multiple myeloma: comparison to [18F]FDG PET/CT. Eur J Nucl Med Mol Imaging (2024). https://doi.org/10.1007/s00259-024-06621-0

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