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IMWG Consensus Recommendations on Imaging in Monoclonal Plasma Disorders

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Key Points

  • The major change in the new imaging guidelines is that whole-body, low-dose CT replaces conventional skeletal survey as the standard imaging technique recommended for assessing bone destruction.
  • The IMWG team recommends that this more sophisticated technique and others, including PET/CT and MRI be introduced generally into clinical practices.
  • The team found that using only conventional x-ray misses 25% of instances where patients have bone destruction already and need treatment.

Just as newer drugs have significantly improved outcomes for patients with multiple myeloma in the past decade, newer imaging techniques are upgrading detection of the disease, leading to earlier treatment, but standards to help guide clinicians on the optimal use of advanced imaging have lagged behind.

Jens Hillengass, MD, Chief of Myeloma at Roswell Park Comprehensive Cancer Center, led an International Myeloma Working Group (IMWG) effort to compile new recommendations—the first in 10 years—for imaging techniques that offer more sensitive and accurate diagnosis and monitoring for patients with multiple myeloma and other plasma cell disorders. Their findings were published in The Lancet Oncology.

“Use of newer imaging techniques is changing the whole landscape, from diagnosis to treatment to supportive care to survivorship, and all those things are coming into this direction of research in multiple myeloma right now,” said Dr. Hillengass.

Recommendation Highlights

The guidelines are based in part on an examination of results of computed tomography (CT) and x-ray imaging from several countries. The team found that using only conventional x-ray misses 25% of instances where patients have bone destruction already and need treatment.

“There has to be destruction of 30% to 50% of the bone, sometimes up to 70%, before you see anything on x-ray,” said Dr. Hillengass. “More sophisticated imaging is necessary not only in the beginning to assess the disease but also to assess the response and to see what is left after our standard treatment. Myeloma is a disease that can cause focal and diffuse destruction of the bone, and to see that, you need sharp imaging.”

The major change in the new imaging guidelines is that whole-body, low-dose CT replaces conventional skeletal survey as the standard imaging technique recommended for assessing bone destruction. The IMWG team recommends that this more sophisticated technique and others, including positron-emission tomography (PET)/CT and magnetic resonance imaging (MRI) be introduced generally into clinical practices. Dr. Hillengass said he hopes that broader application of these newer techniques will lead to more refined imaging, more accurate diagnoses, earlier treatments, and more patients living longer due to lasting remissions.

“There’s a lot of research underway now exploring whether incorporating more specific traces or dyes into various imaging techniques will be beneficial, and also to figure out how we can assess minimal residual disease or very low tumor burdens after treatment,” he noted in a press release. “Therefore, we need much higher sensitivity and also functional information that cutting-edge imagery can provide. There are important questions still to be asked as these technologies evolve.”

Disclosure: For full disclosures of the study authors, visit thelancet.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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