Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group
¹⁸F-FDG PET/CT is a valuable tool in the diagnosis, management, and monitoring of multiple myeloma, smouldering multiple myeloma, and solitary plasmacytoma. It can assess bone damage, detect extramedullary sites of clonal plasma cells, and provide prognostic information. The technique is superior to whole-body X-ray in detecting bone lesions and can detect bone changes outside the field of view of MRI. It correlates with the percentage of bone marrow plasma cells. Standardized interpretation criteria are needed for ¹⁸F-FDG PET/CT scans in multiple myeloma. The document also mentions the potential of other PET/CT tracers and future advancements in molecular imaging for multiple myeloma.
Important Points:
- Advances in novel drugs for multiple myeloma have led to the definition of new response categories.
- Interest in detecting and monitoring minimal residual disease (MRD) has grown.
- ¹⁸F-FDG PET/CT is a powerful tool for evaluating tumor activity and metabolic response to therapy.
- Negative ¹⁸F-FDG PET/CT scans after treatment predict better outcomes in patients who achieved complete response after autologous stem-cell transplantation (ASCT).
- The value of ¹⁸F-FDG PET/CT in detecting MRD remains an open question.
- ¹⁸F-FDG PET/CT is recommended for evaluating and monitoring metabolic response to therapy in multiple myeloma.
- Patients with smouldering multiple myeloma and lytic lesions on ¹⁸F-FDG PET/CT should be defined as having multiple myeloma that requires therapy.
- ¹⁸F-FDG PET/CT is recommended to distinguish smouldering multiple myeloma from active multiple myeloma if whole-body X-ray is negative and whole-body MRI is unavailable.
- ¹⁸F-FDG PET/CT is of high value in the diagnosis and assessment of solitary plasmacytoma.
- Integration of novel functional imaging techniques, including ¹⁸F-FDG PET/CT, is warranted in the diagnostic procedures for suspected solitary plasmacytoma.
- Standardization of interpretation criteria for ¹⁸F-FDG PET/CT scans in multiple myeloma is needed.
- Several open issues regarding the use of ¹⁸F-FDG PET/CT in plasma cell disorders need to be addressed in future clinical trials.
- ¹⁸F-FDG PET/CT is a valuable tool in the initial work-up, assessment of response to therapy, and prognostication of multiple myeloma, smouldering multiple myeloma, and solitary plasmacytoma.
- Whole-body low-dose CT is the preferred method for detecting lytic bone lesions in multiple myeloma.
- ¹⁸F-FDG PET/CT can distinguish active from smoldering multiple myeloma when WBXR is negative and whole-body MRI is unavailable.
- The number of focal lesions and the presence of extramedullary disease (EMD) detected by ¹⁸F-FDG PET/CT are associated with adverse prognostic factors and shorter survival.
- ¹⁸F-FDG PET/CT findings predict outcomes in patients receiving stem-cell transplantation.
- Persistence of focal lesions on ¹⁸F-FDG PET/CT is associated with shorter survival.
- Negative ¹⁸F-FDG PET/CT scans correlate well with high quality response to therapy.
- ¹⁸F-FDG PET/CT scans show complete response earlier than conventional methods.
- Normalization of ¹⁸F-FDG PET/CT scans after induction therapy is associated with improved survival.
- ¹⁸F-FDG PET/CT combined with laboratory data predicts the risk of progression after therapy.
- ¹⁸F-FDG PET/CT is helpful in predicting progression-free survival and identifying patients who benefit from therapy.
- ¹⁸F-FDG PET/CT is concordant with whole-body MRI in detecting residual lesions after therapy.
- ¹⁸F-FDG PET/CT is valuable in assessing the extent of response to treatment and detecting disease recurrence early in multiple myeloma patients.
- ¹⁸F-FDG PET/CT is recommended for the work-up of newly diagnosed and relapsed or refractory multiple myeloma.
- It is also recommended for confirming a suspected diagnosis of solitary plasmacytoma and distinguishing between smouldering and active multiple myeloma.
- ¹⁸F-FDG PET/CT is the preferred functional imaging modality for evaluating and monitoring the effect of therapy on myeloma-cell metabolism.
- Changes in FDG avidity can predict outcomes, particularly for patients eligible for autologous stem-cell transplantation.
- ¹⁸F-FDG PET/CT can be coupled with sensitive bone marrow-based techniques to detect minimal residual disease (MRD) inside and outside the bone marrow.
- It helps to identify patients with imaging MRD negativity.
- Other PET/CT tracers have been investigated, but no data consistently support their superiority over ¹⁸F-FDG.
- Hybrid systems integrating MRI with PET/CT platforms and targeted radioimmunotherapy are being explored for future advancements in molecular imaging and precision medicine therapy for multiple myeloma.
- ¹⁸F-FDG PET/CT has a sensitivity and specificity of 80-100% in detecting bone damage in multiple myeloma.
- ¹⁸F-FDG PET/CT is superior to WBXR for detecting bone lesions.
- MRI is more sensitive than ¹⁸F-FDG PET/CT for detecting diffuse bone marrow plasma-cell infiltration.
- ¹⁸F-FDG PET/CT can detect bone changes outside the MRI field of view in a third of patients.
- PET/CT and MRI are equally effective in detecting focal lesions.
- SUV values and kinetics of the tracer in multiple myeloma lesions correlate with the percentage of bone marrow plasma cells.
- MRI is considered the gold standard for assessing diffuse bone marrow involvement of the spine.
- PET/CT is more sensitive than WBXR for detecting bone lesions.
- There is no significant difference between PET/CT and MRI in terms of sensitivity and specificity for detecting bone damage in multiple myeloma patients.
Authors:
Prof Michele Cavo, MD, Prof Evangelos Terpos, MD, Cristina Nanni, MD, Prof Philippe Moreau, MD, Suzanne Lentzsch, MD, Prof Sonja Zweegman, MD, Prof Jens Hillengass, MD, Prof Monika Engelhardt, MD, Prof Saad Z Usmani, MD, Prof David H Vesole, MD, Prof Jesus San-Miguel, MD, Prof Shaji K Kumar, MD, Prof Paul G Richardson, MD, Joseph R Mikhael, MD, Fernando Leal da Costa, MD, Prof Meletios-Athanassios Dimopoulos, MD, Chiara Zingaretti, PhD, Prof Niels Abildgaard, MD, Prof Hartmut Goldschmidt, MD, Prof Robert Z Orlowski, MD, Prof Wee Joo Chng, MD, Prof Hermann Einsele, MD, Prof Sagar Lonial, MD, Prof Bart Barlogie, MD, Prof Kenneth C Anderson, MD, Prof S Vincent Rajkumar, MD, Brian G M Durie, MD, Elena Zamagni, MD
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DOI: http://dx.doi.org/10.1016/S1470-2045(17)30189-4