P-138: Frequent magnetic resonance imaging partially reduces the development of end organ damage in patients with smoldering myeloma

Abstract

Background Osteolytic lesions are a hallmark of multiple myeloma (MM) and are present in 80% of patients at first diagnosis. Since they can lead to instabilities, fractures, and pain they go along with a significant impact on the quality of life of patients. By definition, patients with smoldering multiple myeloma (SMM) don’t have osteolytic lesions yet. Modern diagnostic technologies like magnetic resonance imaging (MRI) or positron emission tomography with computed tomography (PET/CT) allow for detection of focal accumulations of myeloma cells before the actual bone has been destroyed. In SMM the presence of these lesions has been identified as risk factor for progression into symptomatic disease and has together with a free light chain ratio of ≥100 and a plasma cell infiltration of the bone marrow of >/=60% been identified as “biomarkers of malignancy” indicating necessity of systemic treatment. Methods To investigate if frequent, longitudinal whole body (WB) MRI helps to predict the development of MM in general and osteolytic lesions in particular the current prospective study has enrolled 96 evaluable patients with SMM and has followed them with WBMRI every 6 months and clinical and serological markers every 3 months. Bone marrow biopsies were only performed when clinically indicated. Results The 1-, 2-, and 3-year progression rates with application of the current diagnostic criteria were 10%, 19% and 25%, respectively. Of 22 patients progressing into MM, 7 showed biomarkers of malignancy only without associated end organ damage. Four of those progressed with >1 focal lesion (FL) in MRI or a growing FL without osteolytic lesion (OL), and 3 due to a serum free light-chain ratio ≥100. The remaining 15 patients (68%) who progressed into MM still suffered from end-organ damage at progression. In all but 1 patient, OL showed a corresponding FL in WBMRI at time of diagnosis of the respective OL. The time between first appearance of a FL and the diagnosis of the OL was highly variable. Conclusion Applying biomarkers of malignancy and frequent WBMRIs reduced the proportion of patients suffering from end-organ damage at progression to 68%. This supports the current development to initiate therapeutic or preventive treatment in patients with high risk SMM identified by markers beyond the biomarkers of malignancy in the current disease definition. Osteolytic lesions are a hallmark of multiple myeloma (MM) and are present in 80% of patients at first diagnosis. Since they can lead to instabilities, fractures, and pain they go along with a significant impact on the quality of life of patients. By definition, patients with smoldering multiple myeloma (SMM) don’t have osteolytic lesions yet. Modern diagnostic technologies like magnetic resonance imaging (MRI) or positron emission tomography with computed tomography (PET/CT) allow for detection of focal accumulations of myeloma cells before the actual bone has been destroyed. In SMM the presence of these lesions has been identified as risk factor for progression into symptomatic disease and has together with a free light chain ratio of ≥100 and a plasma cell infiltration of the bone marrow of >/=60% been identified as “biomarkers of malignancy” indicating necessity of systemic treatment. To investigate if frequent, longitudinal whole body (WB) MRI helps to predict the development of MM in general and osteolytic lesions in particular the current prospective study has enrolled 96 evaluable patients with SMM and has followed them with WBMRI every 6 months and clinical and serological markers every 3 months. Bone marrow biopsies were only performed when clinically indicated. The 1-, 2-, and 3-year progression rates with application of the current diagnostic criteria were 10%, 19% and 25%, respectively. Of 22 patients progressing into MM, 7 showed biomarkers of malignancy only without associated end organ damage. Four of those progressed with >1 focal lesion (FL) in MRI or a growing FL without osteolytic lesion (OL), and 3 due to a serum free light-chain ratio ≥100. The remaining 15 patients (68%) who progressed into MM still suffered from end-organ damage at progression. In all but 1 patient, OL showed a corresponding FL in WBMRI at time of diagnosis of the respective OL. The time between first appearance of a FL and the diagnosis of the OL was highly variable. Applying biomarkers of malignancy and frequent WBMRIs reduced the proportion of patients suffering from end-organ damage at progression to 68%. This supports the current development to initiate therapeutic or preventive treatment in patients with high risk SMM identified by markers beyond the biomarkers of malignancy in the current disease definition.