Related Experiment Video
Updated: Sep 28, 2025
Gene Regulation and Targeted Therapy in Gastric Cancer Peritoneal Metastasis: Radiological Findings from Dual Energy CT and PET/CT
Published on: January 22, 2018
18F-FDG-PET/CT in relapsed multiple myeloma: Are prognostic thresholds different from first-line therapy?
Romans Zukovs1, Christina Antke2, Eduards Mamlins2
1Department for Hematology, Oncology and Clinical Immunology, Medical Faculty, Heinrich Heine University Dusseldorf, Moorenstr. 5, 40225, Dusseldorf, Germany. Romans.Zukovs@med.uni-duesseldorf.de.
Purpose:
While 18F-FDG PET/CT yields valuable prognostic information for patients in first-line therapy of multiple myeloma (MM), its prognostic relevance in relapse is not established. Available studies of relapsed MM describe prognostic thresholds for frequently used PET/CT parameters that are significantly higher than those identified in the first-line setting. The purpose of this study was to evaluate the prognostic role of PET/CT in relapsed MM, based on parameters used in the first-line setting.
Methods:
Our retrospective study included 36 patients with MM who had received autologous or allogeneic stem cell transplantation, suffered at least one relapse, and underwent FDG-PET/CT at relapse. Number of focal bone lesions (FL), maximal standardised uptake value (SUVmax), and presence of PET-positive extramedullary lesions (EMD) were analysed.
Results:
For the number of FLs, the prognostic value was demonstrated with a cut-off of > 3 (median OS 3.8 months vs. not reached, p = 0.003). Median OS of patients with SUVmax ≤ 4 was not reached, while it was 3.9 months in patients with SUVmax > 4 (p = 0.014). Presence of EMD was a significant prognostic parameter too, with median OS of 3.6 months versus not reached (p = 0.004). The above-mentioned parameters showed prognostic significance for PFS as well. Combination of higher ISS stage and PET/CT parameters identified patients with particularly short OS (3.7 months vs. not reached, p < 0.001) and PFS (3.6 vs. 11.7 months p < 0.001).
Conclusion:
The PET/CT parameters SUVmax > 4, nFL > 3, and presence of EMD identify patients with poor prognosis not only in the first-line setting but also in relapsed MM.
Insights
18F-FDG PET/CT parameters like SUVmax > 4, more than 3 focal lesions, and extramedullary disease predict poor outcomes in relapsed multiple myeloma. These findings are consistent with those in the first-line setting.
Area of Science:
- Nuclear Medicine
- Oncology
- Radiology
Background:
- 18F-FDG PET/CT is valuable for prognosis in first-line multiple myeloma (MM) therapy.
- Prognostic relevance of PET/CT in relapsed MM is not well-established.
- Existing studies suggest higher prognostic thresholds for PET/CT parameters in relapsed MM compared to first-line settings.
Purpose of the Study:
- To evaluate the prognostic role of 18F-FDG PET/CT in patients with relapsed multiple myeloma.
- To assess if PET/CT parameters used in the first-line setting retain prognostic significance in relapsed MM.
Main Methods:
- Retrospective analysis of 36 patients with relapsed MM post-stem cell transplantation.
- Analysis of 18F-FDG PET/CT parameters at relapse: number of focal bone lesions (FL), maximal standardized uptake value (SUVmax), and presence of PET-positive extramedullary lesions (EMD).
Main Results:
- A cut-off of >3 FLs was associated with significantly shorter overall survival (OS) (3.8 months vs. not reached).
- SUVmax > 4 indicated shorter OS (3.9 months vs. not reached).
- Presence of EMD was also a significant negative prognostic factor for OS (3.6 months vs. not reached).
- All analyzed PET/CT parameters demonstrated prognostic significance for progression-free survival (PFS).
- Combination of high ISS stage and PET/CT parameters identified patients with particularly poor OS and PFS.
Conclusions:
- PET/CT parameters (SUVmax > 4, nFL > 3, EMD) are significant predictors of poor prognosis in relapsed multiple myeloma.
- These prognostic thresholds are consistent with those identified in the first-line setting for MM.
- PET/CT imaging provides crucial prognostic information for managing relapsed MM patients.
More Related Videos
10:04Analysis of 18FDG PET/CT Imaging as a Tool for Studying Mycobacterium tuberculosis Infection and Treatment in Non-human Primates
Published on: September 5, 2017
05:32Multimodal Bioluminescent and Positronic-emission Tomography/Computational Tomography Imaging of Multiple Myeloma Bone Marrow Xenografts in NOG Mice
Published on: January 7, 2019