全身（18）F-FDG PET可识别高危骨髓瘤。

Whole-body (18)F-FDG PET identifies high-risk myeloma.

作者信息

Durie Brian G M, Waxman Alan D, D'Agnolo Allesandro, Williams Cindy M

机构信息

Division of Hematology/Oncology, Department of Medicine, Cedars-Sinai Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California, USA.

出版信息

J Nucl Med. 2002 Nov;43(11):1457-63.

PMID:12411548

Abstract

UNLABELLED

The purpose of this study was to evaluate the clinical utility of whole-body PET with (18)F-FDG in patients with multiple myeloma and related monoclonal diseases.

METHODS

Between July 1, 1996, and July 2000, 98 (18)F-FDG PET scans were obtained for 66 patients, with 25 patients having 2 or more scans. The results were compared with routine clinical and staging information, including CT and MRI scans, as indicated. Of the 66 patients, 16 had previously untreated active myeloma, 14 had monoclonal gammopathy of undetermined significance (MGUS), 10 had disease in remission, and 26 had relapsing disease.

RESULTS

Negative whole-body (18)F-FDG PET findings reliably predicted stable MGUS. Of the 14 MGUS patients with follow-up of 3-43+ mo, myeloma has developed in only 1 (7%), at 8 mo. Conversely, the 16 previously untreated patients with active myeloma all had focal or diffusely positive scan findings. Four (25%) of 16 previously untreated patients with positive (18)F-FDG PET findings had negative full radiologic surveys. Another 4 (25%) of 16 patients had focal extramedullary disease. This was confirmed by biopsy or other imaging techniques. Extramedullary uptake also occurred in 6 (23%) of 26 patients with relapse. This extramedullary uptake was a very poor prognostic factor both before treatment and at relapse. For example, median survival was 7 mo for patients with disease relapse. Persistent positive (18)F-FDG PET findings after induction therapy predicted early relapse. In 13 (81%) of 16 patients with relapsing disease, new sites of disease were identified. The (18)F-FDG PET results were especially helpful in identifying focal recurrent disease in patients with nonsecretory or hyposecretory disease amenable to local irradiation therapy, which was used in 6 patients.

CONCLUSION

Whole-body (18)F-FDG PET provides important prognostic information, which is clinically useful and complementary to conventional methods of evaluating plasma cell disorders. (18)F-FDG PET is a unique tool for evaluation of nonsecretory myeloma. Residual or recurrent disease after therapy, especially extramedullary disease, is a poor prognostic factor.

摘要

未标注

本研究的目的是评估全身（18）F-FDG PET在多发性骨髓瘤及相关单克隆疾病患者中的临床应用价值。

方法

1996年7月1日至2000年7月期间，对66例患者进行了98次（18）F-FDG PET扫描，其中25例患者进行了2次或更多次扫描。将结果与常规临床和分期信息（包括CT和MRI扫描）进行比较。66例患者中，16例为未经治疗的活动性骨髓瘤，14例为意义未明的单克隆丙种球蛋白病（MGUS），10例为疾病缓解期，26例为复发疾病。

结果

全身（18）F-FDG PET检查结果为阴性可可靠地预测MGUS病情稳定。14例MGUS患者随访3至43 +个月，仅1例（7%）在8个月时发展为骨髓瘤。相反，16例未经治疗的活动性骨髓瘤患者的扫描结果均为局灶性或弥漫性阳性。16例（18）F-FDG PET检查结果为阳性的未经治疗患者中，4例（25%）的全面放射学检查结果为阴性。16例患者中的另外4例（25%）有局灶性髓外疾病。这通过活检或其他影像学技术得到证实。26例复发患者中有6例（23%）也出现了髓外摄取。这种髓外摄取在治疗前和复发时都是一个非常差的预后因素。例如，疾病复发患者的中位生存期为7个月。诱导治疗后（18）F-FDG PET检查结果持续阳性预示着早期复发。16例复发疾病患者中有13例（81%）发现了新的疾病部位。（18）F-FDG PET结果在识别适合局部放疗的非分泌性或低分泌性疾病患者的局灶性复发性疾病方面特别有帮助，6例患者接受了局部放疗。