Prognostic impact of metabolic tumor volume and total lesion glycolysis in multiple myeloma
Öz
Purpose: 18F-2′-deoxy-2′-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is a critical imaging tool for diagnosing multiple myeloma (MM), providing comprehensive insights into tumor burden and disease proliferation capacity. We evaluated the value of pretreatment 18F-FDG PET parameters in forecasting survival in patients with MM.
Materials and methods: Between October 2019 and March 2024, a cohort of 41 patients with MM who received pretreatment 18F-FDG PET scans was retrospectively analyzed. Clinical characteristics, treatment response, and survival data were systematically evaluated.
Results: The median progression-free survival (PFS) was 28.51±3.82 months, while the median overall survival (OS) was calculated as 34.57±3.9 months. The presence of extramedullary disease (EMD), high metabolic tumor volume (MTV), and elevated total lesion glycolysis (TLG) were significantly associated with an increased risk of progression (p<0.05), establishing them as poor prognostic factors for PFS. Similarly, high MTV, maximum standardized uptake value (SUVmax, SUVmean, and TLG were strongly correlated with an increased mortality risk (p<0.05) and were identified as adverse prognostic factors for overall survival. In multivariate analysis, MTV and TLG were confirmed to be independent prognostic factors for OS, supporting their role in predicting prognosis in MM.
Conclusion: MTV and TLG were found to have important prognostic implications in multiple myeloma. Since these parameters reflect volumetric and metabolic tumor burden, their integration into the International Staging System (ISS) may improve risk stratification and prognosis assessment.
Anahtar Kelimeler
Multiple myeloma, prognosis, extramedullary disease, metabolic tumor volume, total lesion glycolysis
Destekleyen Kurum
All authors declare that they have no relevant financial or non-financial interests, whether directly or indirectly related to the submitted work, to disclose. This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Etik Beyan
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Pamukkale University and written informed consents were obtained from each patient or first-degree relatives of the patient.
Teşekkür
The authors would like to express their gratitude to all those involved in reporting patients and collecting data.
Kaynakça
- Rajkumar SV. Multiple myeloma: 2022 update on diagnosis, risk stratification, and management. Am J Hematol. 2022;97(8):1086-1107. doi:10.1002/ajh.26590
- Cavo M, Terpos E, Nanni C, et al. Role of 18F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. Lancet Oncol. 2017;18(4):e206-e217. doi:10.1016/S1470-2045(17)30189-4
- Greipp PR, San Miguel J, Durie BG, et al. International staging system for multiple myeloma. J Clin Oncol. 2005;23(15):3412-3420. doi:10.1200/JCO.2005.04.242
- Rajkumar SV. Updated Diagnostic Criteria and Staging System for Multiple Myeloma. Am Soc Clin Oncol Educ Book. 2016;35:e418-e423. doi:10.1200/EDBK_159009
- Marchiori S, Cousin F, Papadopoulos I, et al. Prognostic value of visual IMPeTUs criteria and metabolic tumor burden at baseline [18F]FDG PET/CT in patients with newly diagnosed multiple myeloma. EJNMMI Res. 2024;14(1):51. doi:10.1186/s13550-024-01113-6
- Tirumani SH, Sakellis C, Jacene H, et al. Role of FDG-PET/CT in Extramedullary Multiple Myeloma: Correlation of FDG-PET/CT Findings With Clinical Outcome. Clin Nucl Med. 2016;41(1):e7-e13. doi:10.1097/RLU.0000000000000902
- Lapa C, Lückerath K, Malzahn U, et al. 18 FDG-PET/CT for prognostic stratification of patients with multiple myeloma relapse after stem cell transplantation. Oncotarget. 2014;5(17):7381-7391. doi:10.18632/oncotarget.2290
- Haznedar R, Akı SZ, Akdemir OU, et al. Value of 18F-fluorodeoxyglucose uptake in positron emission tomography/computed tomography in predicting survival in multiple myeloma. Eur J Nucl Med Mol Imaging. 2011;38(6):1046-1053. doi:10.1007/s00259-011-1738-8
- Zamagni E, Patriarca F, Nanni C, et al. Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation. Blood. 2011;118(23):5989-5995. doi:10.1182/blood-2011-06-361386
- McDonald JE, Kessler MM, Gardner MW, et al. Assessment of Total Lesion Glycolysis by 18F FDG PET/CT Significantly Improves Prognostic Value of GEP and ISS in Myeloma. Clin Cancer Res. 2017;23(8):1981-1987. doi:10.1158/1078-0432.CCR-16-0235
