Korean J Radiol.  2018 Jun;19(3):481-488. 10.3348/kjr.2018.19.3.481.

Prognostic Value of Baseline ¹⁸F-Fluorodeoxyglucose PET/CT in Patients with Multiple Myeloma: A Multicenter Cohort Study

• Moon SH
• Choi WH
• Yoo IR
• Lee SJ
• Paeng JC
• Jeong SY
• Lee SW
• Kim K
• Choi JY

• KMID: 2410819
• DOI: http://doi.org/10.3348/kjr.2018.19.3.481

Abstract

OBJECTIVE
We investigated the prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with multiple myeloma (MM).
MATERIALS AND METHODS
Subjects were 76 patients with newly diagnosed myeloma and pretreatment with 18F-FDG PET/CT from four hospitals. The PET/CT features were evaluated and the clinical characteristics were reviewed. Prognostic factors related to poor progression-free survival (PFS) and overall survival (OS) were identified using a Cox proportional hazards regression model and a prediction scale was developed based on the identified factors.
RESULTS
Multivariate analysis showed that the presence of 18F-FDG-avid focal bone lesions (≥ 3) was a significant and independent predictor of PFS (hazard ratio [HR] = 3.28, p = 0.007) and OS (HR = 11.78, p = 0.001). The presence of extramedullary disease on PET/CT scan was also a significant predictor of poor PFS (HR = 2.79, p = 0.006) and OS (HR = 3.89, p = 0.003). A prognostic scale was developed using these two predictors. An increase in score on the scale corresponded to a significantly increased risk of poor OS (p = 0.005). In addition, Kaplan-Meier analysis demonstrated that patient survival varied significantly according to the scale (p < 0.001 for OS and p = 0.001 for PFS).
CONCLUSION
18F-FDG-avid focal lesions and the presence of extramedullary disease on PET/CT scan are significantly associated with poor OS in MM patients. The scale developed according to these predictors represents a potential prognostic tool for evaluation of patients with MM.

Keyword

Multiple myeloma; ¹⁸F-FDG; PET/CT; Prognosis

MeSH Terms

Cohort Studies*
Disease-Free Survival
Electrons
Fluorodeoxyglucose F18
Humans
Kaplan-Meier Estimate
Multiple Myeloma*
Multivariate Analysis
Positron-Emission Tomography and Computed Tomography*
Prognosis
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 Kaplan-Meier analysis shows OS and progression-free survival.A. OS according to developed PET-based scale (mean OS: 1.7 years; [95% CI, 1.2–2.3] in patients with scale score 3; 4.8 years, [95% CI, 3.5–6.1] in patients with score 2; and 7.3 years, [95% CI, 6.5–8.1] in patients with score ≤ 1; pp < 0.001). B. PFS according to developed PET-based scale (mean PFS: 1.3 years, [95% CI, 0.8–1.8] in patients with score 3; 4.1 years, [95% CI, 2.7–5.5] in atients with score 2; and 5.3 years, [95% CI, 4.1–6.5] in patients with score ≤ 1; p = 0.001). CI = confidence interval, OS = overall survival, PFS = progression-free survival

• 

  Fig. 2 Representative images of patients with scores 0 and 3.A. 56-year-old female patient had 4 osteolytic lesions in left scapula, T-spines, and sacrum. Among these lesions, left scapular was only PET positive (black arrow). This patient had score of 0 and has been alive for 7.8 years. B. 50-year-old female patient had multiple PET positive lesions in right scapula, lumbar spine, right pubic bone, left ilium, and both femurs (black arrows). C. Left iliac bone lesion showed direct extension to adjacent muscles (white arrows). This patient had score of 3 and died 4.8 months after treatment.

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