Fallahi Babak, Beiki Davood, Mousavi Seyed Asadollah, Gholamrezanezhad Ali, Eftekhari Mohammad, Fard-Esfahani Armaghan, Alimoghaddam Kamran, Mirpour Sahar, Eskandarian Alireza, Saghari Mohsen
Research Institute for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Hell J Nucl Med. 2009 Sep-Dec;12(3):255-9.
Multi-drug resistance (MDR) is a major challenge in the treatment of multiple myeloma (MM). There is low sensitivity of technetium-99m methoxy isobutyl isonitrile ((99m)Tc-MIBI) whole body scan (WBS) in the detection of active MM lesions, because (99m)Tc-MIBI is washed out from malignant cells in the presence of P-glycoprotein (PGP). The objective of the present cohort study was to evaluate of (99m)Tc-MIBI WBS in the prediction of MDR in MM patients during a course of one year follow up. Thirty four patients with MM (25 male, 9 female of mean age 54.12+/-11.46 years) entered the study. Thirteen patients had no previous history of treatment and 21 had a history of previous chemo-radiotherapy. The diagnosis and staging of the disease were based upon routine laboratory and clinical criteria like bone marrow plasma cell count, serum M component, calcium, albumin, beta(2)-microglobulin. Measurements of PGP and WBS using (99m)Tc-MIBI were performed before initialization of treatment and the response to treatment was assessed one year later. The baseline (99m)Tc-MIBI WBS were considered positive for the detection of active lesions when at least one area of non-physiologic increased activity was noted. The follow up (99m)Tc-MIBI WBS was positive for MDR when the patient had active disease but normal WBS. Our results showed that for WBS, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy in active state for the diagnosis of MDR were 38.9%, 62.5%, 70%, 31.2% and 46.1%, respectively. Also the above values for the detection of MDR, using PGP values were 50%, 50%, 69.2%, 30.8% and 50%, respectively. The relative risk of resistant to multiple regimens of chemotherapy after one year follow up in patients with negative to patients with positive (99m)Tc-MIBI WBS was 1.02 (0.60-1.72). In conclusion, we found a low sensitivity of WBS and of PGP in the detection of MDR in patients with active MM. However, both WBS and PGP have 70% and 69% positive predictive value for MDR.
多药耐药（MDR）是多发性骨髓瘤（MM）治疗中的一项重大挑战。锝-99m甲氧基异丁基异腈（（99m）Tc-MIBI）全身扫描（WBS）在检测活动性MM病灶时敏感性较低，因为在存在P-糖蛋白（PGP）的情况下，（99m）Tc-MIBI会从恶性细胞中洗脱。本队列研究的目的是评估（99m）Tc-MIBI WBS在MM患者一年随访过程中对MDR的预测价值。34例MM患者（25例男性，9例女性，平均年龄54.12±11.46岁）进入研究。13例患者既往无治疗史，21例有既往放化疗史。疾病的诊断和分期基于常规实验室和临床标准，如骨髓浆细胞计数、血清M成分、钙、白蛋白、β2-微球蛋白。在治疗开始前进行PGP和使用（99m）Tc-MIBI的WBS测量，并在一年后评估治疗反应。当至少发现一个非生理性活性增加区域时，基线（99m）Tc-MIBI WBS被认为对活动性病灶检测呈阳性。当患者患有活动性疾病但WBS正常时，随访（99m）Tc-MIBI WBS对MDR呈阳性。我们的结果显示，对于WBS，诊断MDR的活性状态下的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为38.9%、62.5%、70%、31.2%和46.1%。同样，使用PGP值检测MDR的上述值分别为50%、50%、69.2%、30.8%和50%。（99m）Tc-MIBI WBS阴性患者与阳性患者在一年随访后对多种化疗方案耐药的相对风险为1.02（0.60-1.72）。总之，我们发现WBS和PGP在检测活动性MM患者的MDR时敏感性较低。然而，WBS和PGP对MDR的阳性预测值分别为70%和69%。
