SpringerLink
Log in

Visual and volumetric parameters by 18F-FDG-PET/CT: a head to head comparison for the prediction of outcome in patients with multiple myeloma

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

In multiple myeloma (MM) patients, 18F-FDG-PET/CT allows either the detection of disease spread by using visual parameters based on the Italian Myeloma criteria for PET Use (IMPeTUs) or the direct measurement of metabolic tumor burden by volume-based parameters such as metabolic tumor volume (MTV). The purpose is to evaluate the contribution of visual and volumetric parameters in the prediction of progression-free survival (PFS) and overall survival (OS) in MM patients. Forty-seven patients in stage IIIA who had undergone whole-body 18F-FDG-PET/CT were retrospectively evaluated. In each patient, visual parameters were determined and compared with volumetric parameters for PFS and OS prediction after a mean follow-up period of 53 months. Among the visual and volumetric parameters tested, a statistically significant difference was found between maximum standardized uptake value, MTV, total lesion glycolysis, and number of lytic lesions of patients with (n = 26) or without (n = 21) progression (p = 0.0400, p = 0.0065, p = 0.015, and p = 0.0220, respectively) and of dead (n = 24) vs survivors (n = 23) (p = 0.0171, p = 0.0037, p = 0.0060, and p = 0.0270, respectively). At univariate and multivariate analysis, MTV and hemoglobin were predictive of both PFS (p = 0.008) and OS (p = 0.0026). The best MTV discriminative value assessed by receiver operating characteristic curve analysis for predicting both PFS and OS was 39.4 ml. By Kaplan-Meier analysis and log-rank test, PFS and OS were significantly better in patients with MTV ≤ 39.4 ml (p = 0.0004 and p = 0.0001, respectively) as compared with those having an MTV higher than the cutoff. The volume-based parameter MTV determined by 18F-FDG-PET/CT may be used in the prediction of PFS and OS in myeloma patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Chantry A, Kazmi M, Barrington S, Goh V, Mulholland N, Streetly M, Lai M, Pratt G, British Society for Haematology G (2017) Guidelines for the use of imaging in the management of patients with myeloma. Br J Haematol 178:380–393

    Article  Google Scholar 

  2. Rajkumar SV (2018) Multiple myeloma: 2018 update on diagnosis, risk-stratification, and management. Am J Hematol 93:981–1114

    Article  CAS  Google Scholar 

  3. Durie BG, Salmon SE (1975) A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer 36:842–854

    Article  CAS  Google Scholar 

  4. Greipp PR, San Miguel J, Durie BG, Crowley JJ, Barlogie B, Blade J, Boccadoro M, Child JA, Avet-Loiseau H, Kyle RA, Lahuerta JJ, Ludwig H, Morgan G, Powles R, Shimizu K, Shustik C, Sonneveld P, Tosi P, Turesson I, Westin J (2005) International staging system for multiple myeloma. J Clin Oncol 23:3412–3420

    Article  Google Scholar 

  5. Palumbo A, Avet-Loiseau H, Oliva S, Lokhorst HM, Goldschmidt H, Rosinol L, Richardson P, Caltagirone S, Lahuerta JJ, Facon T, Bringhen S, Gay F, Attal M, Passera R, Spencer A, Offidani M, Kumar S, Musto P, Lonial S, Petrucci MT, Orlowski RZ, Zamagni E, Morgan G, Dimopoulos MA, Durie BG, Anderson KC, Sonneveld P, San Miguel J, Cavo M, Rajkumar SV, Moreau P (2015) Revised international staging system for multiple myeloma: a report from International Myeloma Working Group. J Clin Oncol 33:2863–2869

    Article  CAS  Google Scholar 

  6. Jung SH, Kwon SY, Min JJ, Bom HS, Ahn SY, Jung SY, Lee SS, Park MR, Yang DH, Ahn JS, Kim HJ, Lee JJ (2019) (18)F-FDG PET/CT is useful for determining survival outcomes of patients with multiple myeloma classified as stage II and III with the Revised International Staging System. Eur J Nucl Med Mol Imaging 46:107–115

    Article  Google Scholar 

  7. Hillengass J, Usmani S, Rajkumar SV, Durie BGM, Mateos MV, Lonial S, Joao C, Anderson KC, Garcia-Sanz R, Riva E, Du J, van de Donk N, Berdeja JG, Terpos E, Zamagni E, Kyle RA, San Miguel J, Goldschmidt H, Giralt S, Kumar S, Raje N, Ludwig H, Ocio E, Schots R, Einsele H, Schjesvold F, Chen WM, Abildgaard N, Lipe BC, Dytfeld D, Wirk BM, Drake M, Cavo M, Lahuerta JJ, Lentzsch S (2019) International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders. Lancet Oncol 20:e302–e312

    Article  Google Scholar 

  8. Ripani D, Caldarella C, Za T, Pizzuto DA, Rossi E, De Stefano V, Giordano A (2019) Prognostic significance of normalized FDG-PET parameters in patients with multiple myeloma undergoing induction chemotherapy and autologous hematopoietic stem cell transplantation: a retrospective single-center evaluation. Eur J Nucl Med Mol Imaging 46:116–128

    Article  CAS  Google Scholar 

  9. Kyle RA, Rajkumar SV (2009) Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia 23:3–9

    Article  CAS  Google Scholar 

  10. Bartel TB, Haessler J, Brown TL, Shaughnessy JD Jr, van Rhee F, Anaissie E, Alpe T, Angtuaco E, Walker R, Epstein J, Crowley J, Barlogie B (2009) F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma. Blood 114:2068–2076

    Article  CAS  Google Scholar 

  11. Mesguich C, Fardanesh R, Tanenbaum L, Chari A, Jagannath S, Kostakoglu L (2014) State of the art imaging of multiple myeloma: comparative review of FDG PET/CT imaging in various clinical settings. Eur J Radiol 83:2203–2223

    Article  Google Scholar 

  12. Li Y, Liu J, Huang B, Chen M, Diao X, Li J (2017) Application of PET/CT in treatment response evaluation and recurrence prediction in patients with newly-diagnosed multiple myeloma. Oncotarget 8:25637–25649

    PubMed  Google Scholar 

  13. Nanni C, Zamagni E, Versari A, Chauvie S, Bianchi A, Rensi M, Bello M, Rambaldi I, Gallamini A, Patriarca F, Gay F, Gamberi B, Cavo M, Fanti S (2016) Image interpretation criteria for FDG PET/CT in multiple myeloma: a new proposal from an Italian expert panel. IMPeTUs (Italian Myeloma criteria for PET USe). Eur J Nucl Med Mol Imaging 43:414–421

    Article  CAS  Google Scholar 

  14. Nanni C, Versari A, Chauvie S, Bertone E, Bianchi A, Rensi M, Bello M, Gallamini A, Patriarca F, Gay F, Gamberi B, Ghedini P, Cavo M, Fanti S, Zamagni E (2018) Interpretation criteria for FDG PET/CT in multiple myeloma (IMPeTUs): final results. IMPeTUs (Italian myeloma criteria for PET USe). Eur J Nucl Med Mol Imaging 45:712–719

    Article  Google Scholar 

  15. Barrington SF, Kluge R (2017) FDG PET for therapy monitoring in Hodgkin and non-Hodgkin lymphomas. Eur J Nucl Med Mol Imaging 44:97–110

    Article  Google Scholar 

  16. Zamagni E, Nanni C, Dozza L, Carlier T, Tacchetti P, Versari A, Chauvie S, Gallamini A, Attal M, Gamberi B, Caillot D, Patriarca F, Macro M, Boccadoro M, Garderet L, Fanti S, Perrot A, Gay F, Sonneveld P, Karlin L, Cavo M, Bodet-Milin C, Moreau P, Kraeber-Bodere F. Standardization of 18F-FDG PET/CT according to Deauville criteria for MRD evaluation in newly diagnosed transplant eligible multiple myeloma patients: joined analysis of two prospective randomized phase III trials. Blood 2018

  17. Haznedar R, Aki SZ, Akdemir OU, Ozkurt ZN, Ceneli O, Yagci M, Sucak GT, Unlu M (2011) Value of 18F-fluorodeoxyglucose uptake in positron emission tomography/computed tomography in predicting survival in multiple myeloma. Eur J Nucl Med Mol Imaging 38:1046–1053

    Article  CAS  Google Scholar 

  18. Zamagni E, Cavo M (2012) The role of imaging techniques in the management of multiple myeloma. Br J Haematol 159:499–513

    PubMed  Google Scholar 

  19. Fonti R, Pace L, Cerchione C, Catalano L, Salvatore B, De Luca S, Pane F, Salvatore M, Del Vecchio S (2015) 18F-FDG PET/CT, 99mTc-MIBI, and MRI in the prediction of outcome of patients with multiple myeloma: a comparative study. Clin Nucl Med 40:303–308

    Article  Google Scholar 

  20. Tu H, He Y, Huang T, Choe S, Lan X, Duan X, Sattar H, Li C, Zhou F (2018) Predictive value of (18) F-FDG PET/CT scanning in combination with clinical parameters in patients with newly diagnosed multiple myeloma. Eur J Haematol 100:189–197

    Article  CAS  Google Scholar 

  21. Fonti R, Larobina M, Del Vecchio S, De Luca S, Fabbricini R, Catalano L, Pane F, Salvatore M, Pace L (2012) Metabolic tumor volume assessed by 18F-FDG PET/CT for the prediction of outcome in patients with multiple myeloma. J Nucl Med 53:1829–1835

    Article  CAS  Google Scholar 

  22. McDonald JE, Kessler MM, Gardner MW, Buros AF, Ntambi JA, Waheed S, van Rhee F, Zangari M, Heuck CJ, Petty N, Schinke C, Thanendrarajan S, Mitchell A, Hoering A, Barlogie B, Morgan GJ, Davies FE (2017) Assessment of Total lesion glycolysis by (18)F FDG PET/CT significantly improves prognostic value of GEP and ISS in myeloma. Clin Cancer Res 23:1981–1987

    Article  CAS  Google Scholar 

  23. Durie BG, Kyle RA, Belch A, Bensinger W, Blade J, Boccadoro M, Child JA, Comenzo R, Djulbegovic B, Fantl D, Gahrton G, Harousseau JL, Hungria V, Joshua D, Ludwig H, Mehta J, Morales AR, Morgan G, Nouel A, Oken M, Powles R, Roodman D, San Miguel J, Shimizu K, Singhal S, Sirohi B, Sonneveld P, Tricot G, Van Ness B, Scientific Advisors of the International Myeloma F (2003) Myeloma management guidelines: a consensus report from the Scientific Advisors of the International Myeloma Foundation. Hematol J 4:379–398

    Article  Google Scholar 

  24. Smith A, Wisloff F, Samson D, UKM F, Nordic Myeloma Study G, British Committee for Standards in H (2006) Guidelines on the diagnosis and management of multiple myeloma 2005. Br J Haematol 132:410–451

    Article  Google Scholar 

  25. Terpos E, Moulopoulos LA, Dimopoulos MA (2011) Advances in imaging and the management of myeloma bone disease. J Clin Oncol 29:1907–1915

    Article  Google Scholar 

  26. Zamagni E, Patriarca F, Nanni C, Zannetti B, Englaro E, Pezzi A, Tacchetti P, Buttignol S, Perrone G, Brioli A, Pantani L, Terragna C, Carobolante F, Baccarani M, Fanin R, Fanti S, Cavo M (2011) Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation. Blood 118:5989–5995

    Article  CAS  Google Scholar 

  27. Fonti R, Salvatore B, Quarantelli M, Sirignano C, Segreto S, Petruzziello F, Catalano L, Liuzzi R, Rotoli B, Del Vecchio S, Pace L, Salvatore M (2008) 18F-FDG PET/CT, 99mTc-MIBI, and MRI in evaluation of patients with multiple myeloma. J Nucl Med 49:195–200

    Article  Google Scholar 

  28. Kumar SK, Callander NS, Alsina M, Atanackovic D, Biermann JS, Chandler JC, Costello C, Faiman M, Fung HC, Gasparetto C, Godby K, Hofmeister C, Holmberg L, Holstein S, Huff CA, Kassim A, Liedtke M, Martin T, Omel J, Raje N, Reu FJ, Singhal S, Somlo G, Stockerl-Goldstein K, Treon SP, Weber D, Yahalom J, Shead DA, Kumar R (2017) Multiple Myeloma, Version 3.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 15:230–269

    Article  Google Scholar 

  29. Caers J, Garderet L, Kortum KM, O’Dwyer ME, van de Donk N, Binder M, Dold SM, Gay F, Corre J, Beguin Y, Ludwig H, Larocca A, Driessen C, Dimopoulos MA, Boccadoro M, Gramatzki M, Zweegman S, Einsele H, Cavo M, Goldschmidt H, Sonneveld P, Delforge M, Auner HW, Terpos E, Engelhardt M (2018) European Myeloma Network recommendations on tools for the diagnosis and monitoring of multiple myeloma: what to use and when. Haematologica 103:1772–1784

    Article  CAS  Google Scholar 

  30. Berghmans T, Dusart M, Paesmans M, Hossein-Foucher C, Buvat I, Castaigne C, Scherpereel A, Mascaux C, Moreau M, Roelandts M, Alard S, Meert AP, Patz EF Jr, Lafitte JJ, Sculier JP, European Lung Cancer Working Party for the ILCSP (2008) Primary tumor standardized uptake value (SUVmax) measured on fluorodeoxyglucose positron emission tomography (FDG-PET) is of prognostic value for survival in non-small cell lung cancer (NSCLC): a systematic review and meta-analysis (MA) by the European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project. J Thorac Oncol 3:6–12

    Article  Google Scholar 

  31. Chatterton BE, Ho Shon I, Baldey A, Lenzo N, Patrikeos A, Kelley B, Wong D, Ramshaw JE, Scott AM (2009) Positron emission tomography changes management and prognostic stratification in patients with oesophageal cancer: results of a multicentre prospective study. Eur J Nucl Med Mol Imaging 36:354–361

    Article  CAS  Google Scholar 

  32. **e P, Li M, Zhao H, Sun X, Fu Z, Yu J (2011) 18F-FDG PET or PET-CT to evaluate prognosis for head and neck cancer: a meta-analysis. J Cancer Res Clin Oncol 137:1085–1093

    Article  Google Scholar 

  33. Namura K, Minamimoto R, Yao M, Makiyama K, Murakami T, Sano F, Hayashi N, Tateishi U, Ishigaki H, Kishida T, Miura T, Kobayashi K, Noguchi S, Inoue T, Kubota Y, Nakaigawa N (2010) Impact of maximum standardized uptake value (SUVmax) evaluated by 18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT) on survival for patients with advanced renal cell carcinoma: a preliminary report. BMC Cancer 10:667

    Article  Google Scholar 

  34. Deng S, Zhang B, Zhou Y, Xu X, Li J, Sang S, Zhang W (2018) The role of (18)F-FDG PET/CT in multiple myeloma staging according to IMPeTUs: comparison of the Durie-Salmon plus and other staging systems. CMMI 2018:4198673

    PubMed  Google Scholar 

  35. Van de Wiele C, Kruse V, Smeets P, Sathekge M, Maes A (2013) Predictive and prognostic value of metabolic tumour volume and total lesion glycolysis in solid tumours. Eur J Nucl Med Mol Imaging 40:290–301

    Article  CAS  Google Scholar 

  36. Barrington SF, Meignan M (2019) Time to prepare for risk adaptation in lymphoma by standardizing measurement of metabolic tumor burden. J Nucl Med 60:1096–1102

    Article  Google Scholar 

  37. Gallamini A (2019) In search of platinum meter bar for measurement of metabolic tumor volume in lymphoma. J Nucl Med 60:1094–1095

    Article  Google Scholar 

  38. Aide N, Lasnon C, Veit-Haibach P, Sera T, Sattler B, Boellaard R (2017) EANM/EARL harmonization strategies in PET quantification: from daily practice to multicentre oncological studies. Eur J Nucl Med Mol Imaging 44:17–31

    Article  CAS  Google Scholar 

Download references

Funding

This work was financially partly supported by Associazione Italiana per la Ricerca sul Cancro (AIRC, project no. IG-17249) and Programma Operativo Regionale POR Campania, Fondo Europeo Sviluppo Regionale 2014/2020.

Author information

Authors and Affiliations

  1. Institute of Biostructures and Bioimages, National Research Council, Via De Amicis 95, 80145, Naples, Italy

    Rosa Fonti

  2. Department of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy

    Sara Pellegrino & Silvana Del Vecchio

  3. Department of Onco-Hematology, University “Federico II”, Naples, Italy

    Lucio Catalano & Fabrizio Pane

  4. Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy

    Leonardo Pace

Authors
  1. Rosa Fonti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara Pellegrino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lucio Catalano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fabrizio Pane
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Silvana Del Vecchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Leonardo Pace
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rosa Fonti.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Institutional Ethics Committee - protocol no. 352/18) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fonti, R., Pellegrino, S., Catalano, L. et al. Visual and volumetric parameters by 18F-FDG-PET/CT: a head to head comparison for the prediction of outcome in patients with multiple myeloma. Ann Hematol 99, 127–135 (2020). https://doi.org/10.1007/s00277-019-03852-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-019-03852-2

Keywords

Search

Navigation