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  • Original Article
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Multiple Myeloma, Gammopathies

18F-FDG PET/CT focal, but not osteolytic, lesions predict the progression of smoldering myeloma to active disease

Leukemia volume 30, pages 417–422 (2016)Cite this article

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Abstract

Identification of patient sub-groups with smoldering multiple myeloma (SMM) at high risk of progression to active disease (MM) is an important goal. 18F-FDG PET/CT (positron emission tomography (PET) integrated with computed tomography (PET/CT) using glucose labelled with the positron-emitting radionuclide 18F) allows for assessing early skeletal involvement. Identification of osteolytic lesions by this technique has recently been incorporated into the updated International Myeloma Working Group criteria for MM diagnosis. However, no data are available regarding the impact of focal lesions (FLs) without underlying osteolysis on time to progression (TTP) to MM. We hence prospectively studied a cohort of 120 SMM patients with PET/CT. PET/CT was positive in 16% of patients (1 FL: 8, 2 FLs: 3, >3 FLs: 6, diffuse bone marrow involvement: 2). With a median follow-up of 2.2 years, 38% of patients progressed to MM, in a median time of 4 years, including 21% with skeletal involvement. The risk of progression of those with positive PET/CT was 3.00 (95% confidence interval 1.58–5.69, P=0.001), with a median TTP of 1.1 versus 4.5 years for PET/CT-negative patients. The probability of progression within 2 years was 58% for positive versus 33% for negative patients. In conclusion, PET/CT positivity significantly increased the risk of progression of SMM to MM. PET/CT could become a new tool to define high-risk SMM.

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Acknowledgements

The study was partly supported by the Fondazione del Monte of Bologna and Ravenna by a research grant to EZ.

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Authors and Affiliations

  1. 'Seràgnoli' Institute of Hematology, Bologna University School of Medicine, Bologna, Italy

    E Zamagni, A Pezzi, P Tacchetti, L Pantani, B Zannetti, K Mancuso, S Rocchi, G Marzocchi & M Cavo

  2. Institute of Nuclear Medicine, Bologna University School of Medicine, Bologna, Italy

    C Nanni, I Rambaldi, P Ghedini & S Fanti

  3. Division of Hematology, Myeloma Unit, University of Turin, Torino, Italy

    F Gay, V Magarotto & A Palumbo

  4. Department of Clinical and Morphological Research, Hematologic Clinic, Udine University, Udine, Italy

    F Patriarca & F Carobolante

  5. Department of Imaging, Institute of Nuclear Medicine, University of Turin, Torino, Italy

    M Bellò & M Balma

  6. Department of Hematology and Oncology, University of Heidelberg, Heidelberg, Germany

    J Hillengass

  7. Department of Oncology, Hematology Unit, Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy

    B Gamberi

  8. Institute of Nuclear Medicine, Azienda Ospedaliera ASMN, IRCCS, Reggio Emilia, Italy

    A Versari

  9. Hematology Clinic, AOU Ospedali Riuniti di Ancona, Ancona, Italy

    M Offidani

  10. Hematology Unit, IRCCS Referral Cancer Centre of Basilicata, Rionero in Vulture, Italy

    P Musto

  11. Institute of Nuclear Medicine, S. Maria della Misericordia Hospital, Udine, Italy

    M Rensi

  12. Department of Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany

    A Dimitrakopoulou-Strauss

  13. Medical Physics Department, Santa Croce and Carlo Hospital, Cuneo, Italy

    S Chauviè

  14. Department of Radiology, German Cancer Research Center, Heidelberg, Germany

    N Fard

  15. Unit of Nuclear Medicine, IRCCS Referral Cancer Centre of Basilicata, Rionero in Vulture, Italy

    G Storto

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  1. E Zamagni
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Correspondence to E Zamagni.

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Zamagni, E., Nanni, C., Gay, F. et al. 18F-FDG PET/CT focal, but not osteolytic, lesions predict the progression of smoldering myeloma to active disease. Leukemia 30, 417–422 (2016). https://doi.org/10.1038/leu.2015.291

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