Department of Haematology-Oncology, Pusan National University Hospital Medical Research Institute, Busan, Korea.
Br J Haematol. 2014 Jun;165(6):777-85. doi: 10.1111/bjh.12820. Epub 2014 Mar 15.
We investigated the prognostic value of the magnetic resonance imaging (MRI) pattern of bone marrow involvement in patients with multiple myeloma (MM) eligible for autologous stem cell transplantation (ASCT). 126 patients with untreated MM indicated for ASCT underwent spine MRI and cytogenetic analysis at diagnosis. All patients received ASCT after induction therapy of VAD (vincristine, doxorubicin, dexamethasone; n = 55) or a thalidomide-based regimen (TCD; n = 71). Thalidomide maintenance therapy was performed in 68 patients. The MRI pattern was normal in 27, focal in 47, and diffuse/variegated in 52 patients. Patients with the diffuse/variegated pattern showed significantly higher stage (P = 0·038), higher β-2 microglobulin level (P = 0·001) and severe anaemia (P = 0·015). However, the cytogenetics were not different among the MRI patterns (P = 0·890). Progression-free survival (PFS) was lower in the diffuse/variegated pattern (P = 0·002) than other patterns, but not overall survival (OS) (P = 0·058). Thalidomide maintenance therapy was correlated only with PFS (P = 0·001). High-risk cytogenetics were associated with both poorer PFS (P < 0·001) and OS (P = 0·003). In a multivariate analysis, the diffuse/variegated MRI pattern was an independent predictor of disease progression (Hazard Ratio, 1·922; 95% confidence interval, 1·185-3·118; P = 0·008). The diffuse/variegated MRI pattern is a novel prognostic factor for disease progression in MM patients eligible for ASCT.
我们研究了磁共振成像（MRI）骨髓受累模式对适合自体干细胞移植（ASCT）的多发性骨髓瘤（MM）患者的预后价值。126 名接受 ASCT 治疗的初治 MM 患者在诊断时接受了脊柱 MRI 和细胞遗传学分析。所有患者在诱导治疗 VAD（长春新碱、阿霉素、地塞米松；n=55）或沙利度胺为基础的方案（TCD；n=71）后接受 ASCT。68 名患者接受了沙利度胺维持治疗。27 名患者 MRI 模式正常，47 名患者局灶性受累，52 名患者弥漫性/斑驳性受累。弥漫性/斑驳性受累患者的分期显著较高（P=0.038），β-2 微球蛋白水平显著较高（P=0.001），贫血严重（P=0.015）。然而，MRI 模式之间的细胞遗传学并无差异（P=0.890）。弥漫性/斑驳性受累患者的无进展生存期（PFS）显著低于其他模式（P=0.002），但总生存期（OS）无差异（P=0.058）。沙利度胺维持治疗仅与 PFS 相关（P=0.001）。高危细胞遗传学与较差的 PFS（P<0.001）和 OS（P=0.003）均相关。多变量分析显示，弥漫性/斑驳性 MRI 模式是疾病进展的独立预测因素（危险比，1.922；95%置信区间，1.185-3.118；P=0.008）。弥漫性/斑驳性 MRI 模式是适合 ASCT 的 MM 患者疾病进展的新的预后因素。
