18 F-FDG and 11 C-Methionine PET/CT in Newly Diagnosed Multiple Myeloma Patients: Comparison of Volume-Based PET Biomarkers
Maria I Morales-Lozano (1) , Oliver Viering (2) , Samuel Samnick (2) , Paula Rodriguez-Otero (3) , Andreas K Buck (2) , Maria Marcos-Jubilar (3) , Leo Rasche (4), Elena Prieto (1) , K Martin Kortüm (4) , Jesus San-Miguel (3) , Maria J Garcia-Velloso (1) , Constantin Lapa (2, 5)
(1) Department of Nuclear Medicine, University Clinic of Navarra, Center of Applied Medical Research (CIMA), Navarra Institute for Health Research (IDISNA), 31008 Pamplona, Spain.
(2) Department of Nuclear Medicine, University Hospital Würzburg, 97080 Würzburg, Germany.
(3) Department of Hematology, University Clinic of Navarra, CIMA, CIBERONC, IDISNA, 31008 Pamplona, Spain.
(4) Department of Internal Medicine II, University Hospital Würzburg, 97080 Würzburg, Germany.
(5) Nuclear Medicine, Medical Faculty, University of Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany.
11C-methionine (11C-MET) is a new positron emission tomography (PET) tracer for the assessment of disease activity in multiple myeloma (MM) patients, with preliminary data suggesting higher sensitivity and specificity than 18F-fluorodeoxyglucose (18F-FDG). However, the value of tumor burden biomarkers has yet to be investigated.
Our goals were to corroborate the superiority of 11C-MET for MM staging and to compare its suitability for the assessment of metabolic tumor burden biomarkers in comparison to 18F-FDG.
Twenty-two patients with newly diagnosed, treatment-naïve symptomatic MM who had undergone 11C-MET and 18F-FDG PET/CT were evaluated. Standardized uptake values (SUV) were determined and compared with total metabolic tumor volume (TMTV) for both tracers: total lesion glycolysis (TLG) and total lesion 11C-MET uptake (TLMU). PET-derived values were compared to Revised International Staging System (R-ISS), cytogenetic, and serologic MM markers such as M component, beta 2 microglobulin (B2M), serum free light chains (FLC), albumin, and lactate dehydrogenase (LDH). In 11 patients (50%), 11C-MET detected more focal lesions (FL) than FDG (p < 0.01).
SUVmax, SUVmean, SUVpeak, TMTV, and TLMU were also significantly higher in 11C-MET than in 18F-FDG (p < 0.05, respectively). 11C-MET PET biomarkers had a better correlation with tumor burden (bone marrow plasma cell infiltration, M component; p < 0.05 versus p = n.s. respectively).
This pilot study suggests that 11C-MET PET/CT is a more sensitive marker for the assessment of myeloma tumor burden than 18F-FDG. Its implications for prognosis evaluation need further investigation.
CITA DEL ARTÍCULO Cancers (Basel) . 2020 Apr 23;12(4):1042. doi: 10.3390/cancers12041042.