Istituto di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy.
U.O.C. Medicina Nucleare e Centro PET-TC, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
Eur J Nucl Med Mol Imaging. 2019 Jan;46(1):116-128. doi: 10.1007/s00259-018-4108-y. Epub 2018 Jul 27.
The purpose of this study was to determine retrospectively, through a single-center evaluation, whether FDG PET-CT normalized semi-quantitative parameters may predict response to induction chemotherapy (iChT) and hematopoietic stem cell transplantation (HSCT), as well as disease progression and progression-free survival in multiple myeloma (MM) patients, thus becoming a tool of personalized medicine.
Patients undergoing iChT and HSCT with baseline and post-treatment FDG PET-CTs from January 2008 to July 2015 were included. The following baseline and post-treatment parameters were obtained: SUVmax, SUVmean, SUVpeak, MTVsum, TLGsum, rPET (lesion SUVmax/liver SUVmax) and qPET (lesion SUVpeak/liver SUVmean). Baseline-to-post-treatment changes (Δ) were also calculated. Metabolic and clinical laboratory progression or response at follow-up were noted; time-to-metabolic-progression (TMP) was defined as the interval from post-treatment scan to eventual progression at follow-up FDG PET-CTs. Possible association between each functional parameter and metabolic/clinical-laboratory progression or response was determined. Kaplan-Meier curves allowed to depict the TMP trend according to FDG PET-CT parameters.
Twenty-eight patients were included. Significantly higher ΔrPET and ΔqPET values were observed in ten patients with "metabolic response", with respect to 18 patients having "metabolic progression" (median 0.62 [IQR 0.32 - 1.34] vs median 0.00 [IQR -0.25 - 0.49] for ΔrPET; P = 0.045; median 0.51 [IQR 0.32 - 1.13] vs median 0.00 [IQR -0.31 - 0.67] for ΔqPET; P = 0.035). Neither normalized nor non normalized parameters differed significantly between the 20 patients with "clinical-laboratory response" and the eight patients with "clinical-laboratory progression". ΔrPET value lower than 0.38 and ΔqPET value lower than 0.27 predicted a significantly shorter TMP (P = 0.003 and P = 0.005, respectively).
Normalized semi-quantitative parameters are effective in predicting persistent response to treatment and shorter TMP in patients with MM undergoing iChT and HSCT.
本研究旨在通过单中心评估，确定 FDG PET-CT 标准化半定量参数是否可预测多发性骨髓瘤（MM）患者诱导化疗（iChT）和造血干细胞移植（HSCT）的反应，以及疾病进展和无进展生存期，从而成为个体化医学的工具。
纳入 2008 年 1 月至 2015 年 7 月期间接受 iChT 和 HSCT 并具有基线和治疗后 FDG PET-CT 的患者。获得以下基线和治疗后参数：SUVmax、SUVmean、SUVpeak、MTVsum、TLGsum、rPET（病变 SUVmax/肝 SUVmax）和 qPET（病变 SUVpeak/肝 SUVmean）。还计算了基线到治疗后变化（Δ）。随访时记录代谢和临床实验室进展或反应；从治疗后扫描到后续 FDG PET-CT 随访时的最终进展的时间称为代谢进展时间（TMP）。确定每个功能参数与代谢/临床实验室进展或反应之间的可能关联。Kaplan-Meier 曲线根据 FDG PET-CT 参数描绘 TMP 趋势。
共纳入 28 例患者。与 18 例代谢进展患者相比，10 例代谢缓解患者的ΔrPET 和ΔqPET 值明显更高（中位数 0.62 [IQR 0.32-1.34] vs 中位数 0.00 [IQR -0.25-0.49]，P=0.045；中位数 0.51 [IQR 0.32-1.13] vs 中位数 0.00 [IQR -0.31-0.67]，P=0.035）。在 20 例“临床实验室缓解”患者和 8 例“临床实验室进展”患者之间，无论是标准化还是非标准化参数均无显著差异。ΔrPET 值低于 0.38 和ΔqPET 值低于 0.27 可显著预测较短的 TMP（P=0.003 和 P=0.005）。
在接受 iChT 和 HSCT 的 MM 患者中，标准化半定量参数可有效预测治疗后的持续缓解和较短的 TMP。
