[F]FDG-PET/CT 在异基因造血细胞移植前后多发性骨髓瘤患者中的预后价值。
Prognostic value of [F]FDG-PET/CT in multiple myeloma patients before and after allogeneic hematopoietic cell transplantation.
机构信息
Department of Nuclear Medicine, University Hospital Würzburg, Medical Center, Würzburg, Germany.
Department of Molecular & Medical Pharmacology, Ahmanson Translational Imaging Division, University of California Los Angeles, Los Angeles, USA.
出版信息
Eur J Nucl Med Mol Imaging. 2018 Sep;45(10):1694-1704. doi: 10.1007/s00259-018-3997-0. Epub 2018 Apr 2.
PURPOSE
Despite improved treatment options, multiple myeloma (MM) remains an incurable disease. The aim of this study was to investigate the prognostic value of positron emission tomography/computed tomography (PET/CT) using F-2'-deoxy-2'-fluorodeoxyglucose ([F]FDG) in MM patients shortly before and ~100 days after allogeneic hematopoietic cell transplantation (allo-HCT).
METHODS
In this retrospective analysis, we evaluated [F]FDG-PET/CT-scans of 45 heavily pre-treated MM patients before and 27 patients after scheduled allo-HCT. All scans were qualitatively and semi-quantitatively assessed for the presence of active disease. Serological response was recorded according to International Myeloma Working Group (IMWG) criteria. Progression-free (PFS) and overall survival (OS) were correlated with different PET/CT-derived parameters, such as presence, number and maximum standardized uptake value (SUV) of focal myeloma lesions. The impact of extramedullary disease on patient outcome was also assessed.
RESULTS
PET/CT negativity -prior to or following allo-HCT- was a favorable prognostic factor for progression-free and overall survival (both, PFS and OS: pre-HSCT p < 0.001, post-HCT p < 0.005). High FDG-uptake (SUV > 6.5) revealed a significantly shortened survival compared to patients with a lower SUV (<6.5) (OS, 5.0 ± 1.1 m vs. not reached - longest 122.0 m; p < 0.001). Moreover, our data prove that a higher number (>3) of focal lesions (pre-HCT: both PFS and OS: p < 0.001; post-HCT PFS: p < 0.001, OS: p = 0.139) as well as the presence of extramedullary disease serve as adverse prognostic factors prior to and after allo-HCT. At response assessment after allo-HCT, [F]FDG-PET/CT had a complementary value in prognostication in addition to IMWG criteria alone.
CONCLUSION
[F]FDG-PET/CT before and shortly after allogeneic HCT is a powerful predictor for progression-free and overall survival in MM patients.
目的
尽管治疗选择有所改善，但多发性骨髓瘤（MM）仍然是一种无法治愈的疾病。本研究旨在探讨氟脱氧葡萄糖（[F]FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）在同种异体造血细胞移植（allo-HCT）前后不久对 MM 患者的预后价值。
方法
在这项回顾性分析中，我们评估了 45 名接受过大量预处理的 MM 患者在 allo-HCT 前后的[F]FDG-PET/CT 扫描。所有扫描均进行定性和半定量评估以确定是否存在活动性疾病。根据国际骨髓瘤工作组（IMWG）标准记录血清学反应。无进展生存期（PFS）和总生存期（OS）与不同的 PET/CT 衍生参数相关，例如局灶性骨髓瘤病变的存在、数量和最大标准化摄取值（SUV）。还评估了骨髓外疾病对患者预后的影响。
结果
allo-HCT 前后的 PET/CT 阴性-是无进展和总生存的有利预后因素（均为 PFS 和 OS：前 HSCT p<0.001，后 HSCT p<0.005）。高 FDG 摄取（SUV>6.5）与 SUV<6.5 的患者相比，生存时间明显缩短（OS，5.0±1.1 m 与未达到-最长 122.0 m；p<0.001）。此外，我们的数据证明，较高数量（>3）的局灶性病变（前 HSCT：PFS 和 OS 均为 p<0.001；后 HSCT PFS：p<0.001，OS：p=0.139）以及骨髓外疾病的存在是 allo-HCT 前后的不良预后因素。在 allo-HCT 后进行反应评估时，[F]FDG-PET/CT 在单独使用 IMWG 标准的基础上具有补充预后价值。
结论
allo-HCT 前后的[F]FDG-PET/CT 是 MM 患者无进展和总生存的有力预测指标。
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