A proposed index of diffuse bone marrow [18F]-FDG uptake and PET skeletal patterns correlate with myeloma prognostic mar
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ORIGINAL ARTICLE
A proposed index of diffuse bone marrow [18F]-FDG uptake and PET skeletal patterns correlate with myeloma prognostic markers, plasma cell morphology, and response to therapy A. Paschali 1 & E. Panagiotidis 1 & T. Triantafyllou 2 & V. Palaska 2 & K. Tsirou 2 & E. Verrou 2 & E. Υiannaki 3 & D. Markala 3 & A. Papanikolaou 4 & A. Pouli 5 & P. Konstantinidou 2 & V. Chatzipavlidou 1 & E. Terpos 6 & E. Katodritou 2 Received: 10 September 2020 / Accepted: 15 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The investigation of a semi-quantitative index in the pelvis to assess for diffuse bone marrow (BM) [18F]-FDG uptake and the investigation of PET skeletal patterns in multiple myeloma (MM) patients, in accordance with prognostic markers, clonal plasma cell (cPC) morphology, and response to therapy. Methods We prospectively analyzed [18F]-FDG PET/CT in 90 MM patients (newly diagnosed, 60; relapsed/refractory, 30). Among other PET/CT parameters, we calculated the ratio SUVmax pelvis/liver and examined for correlations with known MM prognostic parameters, cPC morphology (good vs. low/intermediate differentiation), and response to therapy. Results SUVmax pelvis/liver ratio was significantly lower for the group of good differentiation vs. intermediate/low differentiation cPCs (p < 0.001) and showed a positive correlation with BM infiltration rate, β2 microglobulin, serum ferritin, international staging system (ISS), and revised ISS; no significant correlation was found with hemoglobin. A cutoff value of 1.1 showed an excellent specificity (99%) and high sensitivity (76%) for diffuse BM involvement (AUC 0.94; p < 0.001). Mixed pattern and appendicular involvement correlated with poor prognostic features while normal pattern, found in 30% of patients, correlated with good prognostic features. Presence of ≥ 10 focal lesions negatively predicted for overall response (p < 0.05; OR 4.8). The CT component improved the diagnostic performance of PET. Conclusion This study showed, for the first time, that cPC morphology and markers related with MM biology, correlate with SUVmax pelvis/liver index, which could be used as a surrogate marker for BM assessment and disease prognosis; PET patterns correlate with MM prognostic features and response rates. Keywords Multiple myeloma . [18F]-FDG . PET/CT . Plasma cell morphology . Prognostic markers This article is part of the Topical Collection on Hematology * A. Paschali [email protected] 1
Department of Nuclear Medicine, Theagenion Cancer Hospital, Thessaloniki, Greece
2
Department of Hematology, Theagenion Cancer Hospital, Thessaloniki, Greece
3
Hematology/Flow cytometry Lab, Theagenion Cancer Hospital, Thessaloniki, Greece
4
Hematopathology Department, Evangelismos General Hospital, Athens, Greece
5
Hematology Department, “St Savvas” Oncology Hospital, Athens, Greece
6
Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Introduction Multiple myelo
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