Imaging B cell maturation antigen in multiple myeloma

Multiple myeloma is a systemic and spatially heterogeneous cancer of plasma cells. Available methods for diagnosing and monitoring disease do not fully capture its heterogeneity. For instance, bone marrow sampling is anatomically limited and [18F]FDG PET/CT reflects glucose metabolism rather than a specific target. In this issue of JCI, Gu et al. reported a prospective phase I study of [68Ga]Ga-PFBC01, a nanobody tracer targeting B cell maturation antigen (BCMA). The study presents a coherent translational pathway for [68Ga]Ga-PFBC01 PET and demonstrates high sensitivity, associations with tissue and circulating disease measures, and clinical management impact. By shifting myeloma imaging from metabolic assessment toward target biology, [68Ga]Ga-PFBC01 PET may visualize whole-body disease distribution and actionable target expression, while blood-pool activity may reflect systemic antigen biology (Figure 1).