Prognostic Significance of Focal Lesions in Whole-Body Magnetic Resonance Imaging in Patients With Asymptomatic Multiple Myeloma

Department of Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany.
Journal of Clinical Oncology (Impact Factor: 18.43). 02/2010; 28(9):1606-10. DOI: 10.1200/JCO.2009.25.5356
Source: PubMed


With whole-body magnetic resonance imaging (wb-MRI), almost the whole bone marrow compartment can be examined in patients with monoclonal plasma cell disease. Focal lesions (FLs) detected by spinal MRI have been of prognostic significance in symptomatic multiple myeloma (sMM). In this study, we investigated the prognostic significance of FLs in wb-MRI in patients with asymptomatic multiple myeloma (aMM).
Wb-MRI was performed in 149 patients with aMM. The prognostic significance of the presence and absence, as well as the number, of FLs for progression into sMM was analyzed.
FLs were present in 28% of patients. The presence per se of FLs and a number of greater than one FL were the strongest adverse prognostic factors for progression into sMM (P < .001) in multivariate analysis. A diffuse infiltration pattern in MRI, a monoclonal protein of 40 g/L or greater, and a plasma cell infiltration in bone marrow of 20% or greater were other adverse prognostic factors for progression-free survival in univariate analysis.
We recommend use of wb-MRI for risk stratification of patients with asymptomatic multiple myeloma.

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    • "18 F-FDG PET/CT is a modality that is sensitive in detecting osseous lesions and can differentiate between active and inactive MM lesions, serving therefore as a powerful treatment response evaluation tool [3] [7] [8] [9] [10] [11]. Moreover, focal lesions detected by PET/CT or MRI are of prognostic significance in all stages of monoclonal plasma cell disease [5] [11] [12]. However, to date, no routine use of 18 F-FDG PET in MM outside of clinical trials is recommended [13] [14]. "
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    • "Moulopoulos et al (1995) reported that patients with conventionally defined asymptomatic MM and abnormal MRI findings progressed to symptomatic disease more quickly than those with normal MRI. In a recent report on 149 patients with smouldering MM, the presence of FLs on WB-MRI was the strongest adverse prognostic factor for subsequent progression to symptomatic MM (Hillengass et al, 2010). In the light of such observations, (WB)-MRI should be planned in patients with smouldering MM, as it may help assess the risk of progression and lead to a better definition of symptomatic disease (Table I). "
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    • "The prognostic significance of the number and presence of those lesions has been shown recently (Hillengass, et al 2010, Walker, et al 2007). Diffuse infiltration, which can be detected in nearly the same proportion of patients, has also been demonstrated to be of prognostic as well as pathophysiologic significance (Hillengass, et al 2010, Moulopoulos, et al 2010, Moulopoulos, et al 2005), but it is hard to assess and impossible to quantify. "
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