Patriarca Francesca, Carobolante Francesca, Zamagni Elena, Montefusco Vittorio, Bruno Benedetto, Englaro Emanuaela, Nanni Cristina, Geatti Onelio, Isola Miriam, Sperotto Alessandra, Buttignol Silvia, Stocchi Raffaella, Corradini Paolo, Cavo Michele, Fanin Renato
Hematology, DISM, University of Udine, Italy.
Hematology, DISM, University of Udine, Italy.
Biol Blood Marrow Transplant. 2015 Jun;21(6):1068-73. doi: 10.1016/j.bbmt.2015.03.001. Epub 2015 Mar 6.
Positron emission tomography (PET) integrated with computed tomography (PET/CT) has been reported to be useful for screening myelomatous lesions at diagnosis in patients with multiple myeloma (MM) and for monitoring response to autologous stem cell transplantation (auto-SCT). The aim of the study was to evaluate the prognostic significance of PET/CT in MM patients who received allogeneic stem cell transplantation (allo-SCT). Patients who underwent upfront auto-SCT followed by allo-SCT, either as consolidation or salvage treatment, were studied with PET/CT before and/or within 6 months after allo-SCT. The number, the maximum standard uptake value (SUV), and the location (medullary or extramedullary) of focal lesions (FLs) were recorded and investigated as predictors of progression-free survival (PFS) and overall survival (OS) by univariate and multivariate analyses. Fifty-four patients had a PET/CT scan before allo-SCT. Of these, 22 patients (41%) had a negative PET/CT scan, 11 patients (20%) showed 1 to 3 FLs, and 21 patients (39%) had either a diffuse bone marrow involvement or more than 3 FLs. SUV was >4.2 in 21 patients (39%) and extramedullary disease (EMD) was present in 6 patients (11%). Multivariate analysis of prognostic factors before allo-SCT showed that persistence of EMD at transplantation was an independent predictor of poor PFS, whereas OS was negatively influenced by unrelated donor and SUV > 4.2. Fifty-nine patients had a PET/CT scan within 6 months after allo-SCT. Multivariate analysis of post-treatment variables showed that persistence of EMD and failure to obtain complete response or very good partial response after allo-SCT were strongly associated with shorter PFS and OS. Of the 46 patients with evaluable PET/CT scans both before and 6 months after allo-SCT, the 23 patients who maintained or reached a PET complete remission showed a significantly prolonged PFS and OS compared with the 23 patients with persistence of any PET positivity (2-year PFS: 51% versus 25%, P = .03; 2-year OS: 81% versus 47%, P = .001). This study indicates that PET/CT imaging before and after allo-SCT is significantly associated with the outcome, suggesting the utility of this technique for MM staging before allo-SCT and for response monitoring after the transplantation.
据报道，正电子发射断层扫描（PET）与计算机断层扫描相结合（PET/CT），对于多发性骨髓瘤（MM）患者诊断时筛查骨髓瘤病灶以及监测自体干细胞移植（auto-SCT）的疗效很有用。本研究的目的是评估PET/CT在接受异基因干细胞移植（allo-SCT）的MM患者中的预后意义。对接受前期auto-SCT后再进行allo-SCT（作为巩固治疗或挽救治疗）的患者，在allo-SCT前和/或allo-SCT后6个月内进行PET/CT检查。记录局灶性病变（FLs）的数量、最大标准摄取值（SUV）和位置（髓内或髓外），并通过单因素和多因素分析将其作为无进展生存期（PFS）和总生存期（OS）的预测指标进行研究。54例患者在allo-SCT前进行了PET/CT扫描。其中，22例患者（41%）PET/CT扫描结果为阴性，11例患者（20%）显示1至3个FLs，21例患者（39%）有弥漫性骨髓受累或超过3个FLs。21例患者（39%）的SUV>4.2，6例患者（11%）存在髓外病变（EMD）。allo-SCT前预后因素的多因素分析显示，移植时EMD的持续存在是PFS不良的独立预测因素，而无关供体和SUV>4.2对OS有负面影响。59例患者在allo-SCT后6个月内进行了PET/CT扫描。治疗后变量的多因素分析显示，EMD的持续存在以及allo-SCT后未获得完全缓解或非常好的部分缓解与较短的PFS和OS密切相关。在allo-SCT前和后6个月均有可评估PET/CT扫描结果的46例患者中，与23例PET仍呈阳性的患者相比，23例维持或达到PET完全缓解的患者的PFS和OS显著延长（2年PFS：51%对25%，P = 0.03；2年OS：81%对47%，P = 0.001）。本研究表明，allo-SCT前后的PET/CT成像与预后显著相关，提示该技术在allo-SCT前用于MM分期以及移植后用于疗效监测的实用性。
