Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation
Menée sur 192 patients atteints d'un myélome multiple nouvellement diagnostiqué, cette étude analyse la valeur pronostique d'une tomographie par émission de positrons (PET) après thérapie d'induction et double greffe autologue
We prospectively analyzed the prognostic relevance of PET/CT at diagnosis, after thalidomide-dexamethasone (TD) induction therapy and double autotransplantation (ASCT) in 192 newly diagnosed multiple myeloma (MM) patients. Presence at baseline of at least 3 focal lesions (FLs, 44% of cases), a SUV > 4.2 (46%) and extramedullary disease (EMD, 6%) adversely affected 4-year estimates of PFS (≥ 3 FLs: 50%; SUV > 4.2: 43%; presence of EMD: 28%). SUV > 4.2 and EMD were also correlated with shorter OS (4-year rates: 77% and 66%, respectively). Persistence of SUV > 4.2 after TD induction was an early predictor for shorter PFS. Three months after ASCT, PET/CT was negative in 65% of patients, whose 4-year rates of PFS and OS were superior to those of PET-positive patients (PFS: 66% and OS: 89%). In a multivariate analysis, both EMD and SUV > 4.2 at baseline and persistence of FDG uptake after ASCT were independent variables adversely affecting PFS (EMD, HR: 9.35; SUV > 4.2, HR: 2.13; FDG uptake after ASCT, HR: 1.93) and OS (EMD, HR: 6.99; post ASCT FDG uptake, HR: 3.57). PET/CT involvement at diagnosis, after novel agent-based induction and subsequent ASCT is a reliable predictor of prognosis in MM patients. This study is registered at www.clinicaltrials.gov as NTC01341262.
Blood , résumé, 2011