Abstract
This study aimed to explore the correlation between imaging patterns and clinical features in patients with smoldering multiple myeloma (SMM) who simultaneously underwent 18F-FDG, 11C-Methionine, and 68Ga-Pentixafor positron emission tomography/computed tomography (PET/CT). We retrieved and analyzed clinical characteristics and PET imaging data of 10 patients with SMM. We found a significant correlation between bone marrow (BM) plasma cell (PC) infiltration and mean standardized uptake values (SUVmean) of lumbar vertebrae L2-L4 on 11C-Methionine PET/CT scans (r = 0.676, p = 0.031) and 68Ga-Pentixafor PET/CT scans (r = 0.839, p = 0.002). However, there was no significant correlation between BM involvement and SUVmean of lumbar vertebrae L2-L4 on 18F-FDG PET/CT scans (r = 0.558, p = 0.093). Similarly, mean target-to-background ratios (TBRmean) of lumbar vertebrae L2-L4 also correlated with bone marrow plasma cell (BMPC) infiltration in 11C-Methionine PET/CT (r = 0.789, p = 0.007) and 68Ga-Pentixafor PET/CT (r = 0.724, p = 0.018) PET/CT. In contrast, we did not observe a significant correlation between BMPC infiltration rate and TBRmean in 18F-FDG PET/CT (r = 0.355, p = 0.313). Additionally, on 11C-Methionine PET/CT scans, we found a significant correlation between BMPC infiltration and TBRmax of lumbar vertebrae L2-L4 (r = 0.642, p = 0.045). In conclusion, 11C-Methionine and 68Ga-Pentixafor PET/CT demonstrate higher sensitivity than 18F-FDG PET/CT in detecting BM involvement in SMM.
Highlights
Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell (PC) proliferative disorder, which is characterized by presence of monoclonal protein in serum and/or bone marrow (BM) PC infiltration of 10% to 60%, but in comparison to multiple myeloma (MM) without CRABCancers 2020, 12, 2333; doi:10.3390/cancers12082333 www.mdpi.com/journal/cancersCancers 2020, 12, 2333 features or myeloma-defining events (with bone marrow plasma cell (BMPC) infiltration ≥ 60%, serum involved/uninvolved free light chain (FLC)ratio ≥ 100, and ≥ 1 focal lesion, which is larger than 5 mm in size on Magnetic Resonance Imaging (MRI)) [1,2]
We further explored the correlation between BMPC infiltration rates and standardized uptake values for mean medullary uptake (SUVmean) or TBRmean of lumbar vertebrae L2-L4 on 11C-Methionine, 68Ga-Pentixafor, and 18F-FDG positron emission tomography/computed tomography (PET/computer tomography (CT)) scans
We found a significant correlation between BMPC infiltration and SUVmean of lumbar vertebrae L2-L4 on
Summary
Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell (PC) proliferative disorder, which is characterized by presence of monoclonal protein in serum and/or bone marrow (BM) PC infiltration of 10% to 60%, but in comparison to multiple myeloma (MM) without CRABCancers 2020, 12, 2333; doi:10.3390/cancers12082333 www.mdpi.com/journal/cancersCancers 2020, 12, 2333 features (hypercalcemia, renal failure, anemia, and bone lesions) or myeloma-defining events (with bone marrow plasma cell (BMPC) infiltration ≥ 60%, serum involved/uninvolved free light chain (FLC)ratio ≥ 100, and ≥ 1 focal lesion, which is larger than 5 mm in size on Magnetic Resonance Imaging (MRI)) [1,2]. Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell (PC) proliferative disorder, which is characterized by presence of monoclonal protein in serum and/or bone marrow (BM) PC infiltration of 10% to 60%, but in comparison to multiple myeloma (MM) without CRAB. In a study of Kyle et al, more than 70% of the patients with SMM progressed to MM after a follow-up period of 15 years [4] It has been reported in a variety of risk-stratification models that high BMPC infiltration rate is associated with shorter time to progression (TTP) in SMM patients [4,5,6]. The current International Myeloma Working Group (IMWG) guidelines recommend whole-body computer tomography (CT) as the primary imaging modality to screen for osteolytic bone lesions in SMM and, if the whole-body CT is negative, whole-body MRI should be performed to exclude focal lesions as myeloma-defining events [7]. 18F-fluorodeoxyglucose (18F-FDG) is the most widely used PET tracer in plasma cell disorders [7]
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