Hillengass Jens, Wasser Klaus, Delorme Stefan, Kiessling Fabian, Zechmann Christian, Benner Axel, Kauczor Hans-Ulrich, Ho Anthony D, Goldschmidt Hartmut, Moehler Thomas M
Department of Hematology, Oncology, and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
Clin Cancer Res. 2007 Jan 15;13(2 Pt 1):475-81. doi: 10.1158/1078-0432.CCR-06-0061.
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with high temporal resolution enables the detection of microcirculation variables amplitude A and exchange rate constant k(ep). In this study, the prognostic value of the DCE-MRI variables for overall survival and event-free survival in patients with progressive multiple myeloma was investigated.
Between 1999 and 2001, 65 patients with progressive or relapse of multiple myeloma requiring therapy were investigated with DCE-MRI of the lumbar spine before start of therapy. The contrast uptake was quantified using a two-compartment model with the output variables amplitude A and exchange rate constant k(ep) reflecting bone marrow microcirculation. The estimated median follow-up was 56 months. Event-free survival and overall survival were investigated for DCE-MRI variables and for established prognosis variables (beta(2)-microglobulin, lactate dehydrogenase, albumin, and age).
Using a multivariate Cox regression model, beta(2)-microglobulin and amplitude A of DCE-MRI were identified as statistically significant prognostic variable of event-free survival with Ps of 0.01 and 0.02, respectively. A statistical correlation of DCE-MRI variables with overall survival could not be found. The multivariate analysis of beta(2)-microglobulin, age, lactate dehydrogenase, and albumin revealed beta(2)-microglobulin as statistically significant prognostic factor for overall survival in this group of patients (P < 0.001).
This analysis identifies contrast-enhanced DCE-MRI variable amplitude A reflecting increased bone marrow microcirculation and angiogenesis as a novel and possibly useful prognostic factor in patients with multiple myeloma. Prospective studies are currently done to further investigate this functional variable for prognosis and stratification of myeloma patients.
具有高时间分辨率的动态对比增强磁共振成像（DCE-MRI）能够检测微循环变量幅度A和交换率常数k(ep)。在本研究中，调查了DCE-MRI变量对进展性多发性骨髓瘤患者总生存期和无事件生存期的预后价值。
1999年至2001年间，对65例需要治疗的进展性或复发性多发性骨髓瘤患者在治疗开始前进行腰椎的DCE-MRI检查。使用双室模型对造影剂摄取进行定量，输出变量幅度A和交换率常数k(ep)反映骨髓微循环。估计的中位随访时间为56个月。对DCE-MRI变量以及既定的预后变量（β2-微球蛋白、乳酸脱氢酶、白蛋白和年龄）进行无事件生存期和总生存期的调查。
使用多变量Cox回归模型，DCE-MRI的β2-微球蛋白和幅度A被确定为无事件生存期的统计学显著预后变量，P值分别为0.01和0.02。未发现DCE-MRI变量与总生存期之间存在统计学相关性。对β2-微球蛋白、年龄、乳酸脱氢酶和白蛋白的多变量分析显示，β2-微球蛋白是该组患者总生存期的统计学显著预后因素（P < 0.001）。
该分析确定反映骨髓微循环和血管生成增加的对比增强DCE-MRI变量幅度A是多发性骨髓瘤患者的一种新的且可能有用的预后因素。目前正在进行前瞻性研究，以进一步调查该功能变量对骨髓瘤患者预后和分层的作用。
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