Comparison of MRI vs PET-CT in Multiple Myeloma
A study reported by Moreau et al in the Journal of Clinical Oncology indicated no difference between magnetic resonance imaging (MRI) and positron-emission tomography–computed tomography (PET-CT) in detecting bone lesions at diagnosis in patients with multiple myeloma. PET-CT normalization after induction therapy and prior to maintenance therapy was associated with improved outcome.
Study Details
Patients in the IMAJEM study were a subgroup of 134 patients from French centers involved in the international IFM/DFCI 2009 study assessing the front-line combination of eight cycles of lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone (RVD) vs RVD plus autologous stem cell transplantation, followed by lenalidomide maintenance. In this subgroup, [18F]fluorodeoxyglucose PET-CT and MRI were performed at diagnosis, after three cycles of RVD, and before maintenance therapy. The primary endpoint was the detection of bone lesions at diagnosis.
Detection of Bone Lesions and Prognostic Ability
Results at diagnosis were positive on MRI in 127 patients (95%) and on PET-CT in 122 patients (91%; P = .33). Normalization of MRI after three cycles of RVD and before maintenance was not predictive of progression-free or overall survival. PET-CT became normal after three cycles of RVD in 32% of the patients; this group had a trend toward improved 30-month progression-free survival vs those without normalization (78.7% vs 56.8%, P = .08), with no significant effect of normalization observed for overall survival. PET-CT normalization before maintenance was observed in 62% of patients, with these patients having improved 2-year progression-free survival (72.0% vs 56.8%, P = .011) and overall survival (94.2% vs 72.9%, P = .033).
On multivariate analysis, extramedullary disease at diagnosis was an independent prognostic factor for progression-free and overall survival, and PET-CT normalization before maintenance was an independent prognostic factor for progression-free survival (P < .001).
The investigators concluded: “There is no difference in the detection of bone lesions at diagnosis when comparing PET-CT and MRI. PET-CT is a powerful tool to evaluate the prognosis of de novo myeloma.”
The study was supported by the French Ministry of Health, Soutien aux Techniques Innovantes Côuteuses 2010 Cancer STIC 10/03, and National Institutes of Health grants.
Philippe Moreau, MD, of the University Hospital Hôtel-Dieu, Nantes, is the corresponding author of the Journal of Clinical Oncology article.
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