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
Cavo M (1), Terpos E (2), Nanni C (3), Moreau P (4), Lentzsch S (5), Zweegman S (6), Hillengass J (7), Engelhardt M (8), Usmani SZ (9), Vesole DH (10), San-Miguel J (11), Kumar SK (12), Richardson PG (13), Mikhael JR (14), da Costa FL (15), Dimopoulos MA (16), Zingaretti C (17), Abildgaard N (18), Goldschmidt H (7), Orlowski RZ (19), Chng WJ (20), Einsele H (21), Lonial S (22), Barlogie B (23), Anderson KC (13), Rajkumar SV (12), Durie BG (24), Zamagni E (25).
(1) Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy. Electronic address: firstname.lastname@example.org.
(2 )Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
(3) Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
(4) Haematology Department, University Hospital of Nantes, Nantes, France.
(5) Columbia University Medical Center, New York, NY, USA.
(6) Department of Hematology, VU University Medical Center, Amsterdam, Netherlands.
(7) Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany.
(8) Department of Medicine, Hematology, Oncology & Stem Cell Transplantation, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
(9) Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA.
(10) John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ, USA.
(11) Clínica Universidad de Navarra, CIMA, IDISNA, Pamplona, Spain.
(12) Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
(13) Jerome Lipper Multiple Myeloma Center, Dana-Farber Cancer Institute, Boston, MA, USA.
(14) Division of Hematology and Oncology, Mayo Clinic, Phoenix, AZ, USA.
(15) Myeloma Clinic, Hematology Department, Instituto Português de Oncologia Francisco Gentil, Lisboa, Portugal.
(16) Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
(17) Biostatistics and Clinical trial Unit, IRST-IRCCS, Meldola, Italy.
(18) Department of Hematology, Odense University Hospital, Odense, Denmark.
(19) The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
(20) National University Cancer Institute, National University Health System, Singapore.
(21) Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany.
(22) Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
(23) Tisch Cancer Institute/Multiple Myeloma Program, Mt. Sinai Cancer Institute, New York, NY, USA.
(24) Cedars-Sinai Comprehensive Cancer Center, Los Angeles, CA, USA.
(25) Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy.
The International Myeloma Working Group consensus aimed to provide recommendations for the optimal use of 18fluorodeoxyglucose (18F-FDG) PET/CT in patients with multiple myeloma and other plasma cell disorders, including smouldering multiple myeloma and solitary plasmacytoma.
18F-FDG PET/CT can be considered a valuable tool for the work-up of patients with both newly diagnosed and relapsed or refractory multiple myeloma because it assesses bone damage with relatively high sensitivity and specificity, and detects extramedullary sites of proliferating clonal plasma cells while providing important prognostic information.
The use of 18F-FDG PET/CT is mandatory to confirm a suspected diagnosis of solitary plasmacytoma, provided that whole-body MRI is unable to be performed, and to distinguish between smouldering and active multiple myeloma, if whole-body X-ray (WBXR) is negative and whole-body MRI is unavailable.
Based on the ability of 18F-FDG PET/CT to distinguish between metabolically active and inactive disease, this technique is now the preferred functional imaging modality to evaluate and to monitor the effect of therapy on myeloma-cell metabolism.
Changes in FDG avidity can provide an earlier evaluation of response to therapy compared to MRI scans, and can predict outcomes, particularly for patients who are eligible to receive autologous stem-cell transplantation. 18F-FDG PET/CT can be coupled with sensitive bone marrow-based techniques to detect minimal residual disease (MRD) inside and outside the bone marrow, helping to identify those patients who are defined as having imaging MRD negativity.
CITATION Lancet Oncol. 2017 Apr;18(4):e206-e217. doi: 10.1016/S1470-2045(17)30189-4