Blood Journal
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Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation

  1. Elena Zamagni1,
  2. Francesca Patriarca2,
  3. Cristina Nanni3,
  4. Beatrice Zannetti1,
  5. Emanuela Englaro4,
  6. Annalisa Pezzi1,
  7. Paola Tacchetti1,
  8. Silvia Buttignol2,
  9. Giulia Perrone1,
  10. Annamaria Brioli1,
  11. Lucia Pantani1,
  12. Carolina Terragna1,
  13. Francesca Carobolante2,
  14. Michele Baccarani1,
  15. Renato Fanin2,
  16. Stefano Fanti3, and
  17. Michele Cavo1
  1. 1“Seràgnoli” Institute of Hematology, Bologna University School of Medicine, Bologna, Italy;
  2. 2Hematologic Clinic, Department of Experimental and Clinical Medical Sciences, Udine University, Udine, Italy;
  3. 3Institute of Nuclear Medicine, Bologna University School of Medicine, Bologna, Italy; and
  4. 4Institute of Nuclear Medicine, S. Maria della Misericordia Hospital, Udine, Italy
This article has an Erratum 120(11):2349


We prospectively analyzed the prognostic relevance of positron emission tomography–computed tomography (PET/CT) at diagnosis, after thalidomide-dexamethasone (TD) induction therapy and double autotransplantation (ASCT) in 192 newly diagnosed multiple myeloma (MM) patients. Presence at baseline of at least 3 focal lesions (FLs; 44% of cases), a standardized uptake value (SUV) > 4.2 (46%), and extramedullary disease (EMD; 6%) adversely affected 4-year estimates of progression-free survival (PFS; ≥ 3 FLs: 50%; SUV > 4.2: 43%; presence of EMD: 28%). SUV > 4.2 and EMD were also correlated with shorter overall survival (OS; 4-year rates: 77% and 66%, respectively). Persistence of SUV > 4.2 after TD induction was an early predictor for shorter PFS. Three months after ASCT, PET/CT was negative in 65% of patients whose 4-year rates of PFS and OS were superior to those of PET-positive patients (PFS: 66% and OS: 89%). In a multivariate analysis, both EMD and SUV > 4.2 at baseline and persistence of fluorodeoxyglucose (FDG) uptake after ASCT were independent variables adversely affecting PFS. PET/CT involvement at diagnosis, after novel agent-based induction and subsequent ASCT is a reliable predictor of prognosis in MM patients. This study is registered at as NTC01341262.

  • Submitted June 16, 2011.
  • Accepted August 8, 2011.
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