The Role of 18F-FDG PET/CT in Multiple Myeloma Staging according to IMPeTUs: Comparison of the Durie-Salmon Plus and Other Staging Systems.

Shengming Deng,Yeye Zhou,Shibiao Sang,Xin Xu,Jihui Li,Wei Zhang,Bin Zhang

doi:10.1155/2018/4198673

Abstract

We aimed at comparing the Durie–Salmon Plus (DS Plus) staging system based on Italian Myeloma criteria for PET USe (IMPeTUs) with other two staging systems in predicting prognosis of patients with all stages of newly diagnosed multiple myeloma (MM). A total of 33 MM patients were enrolled in this retrospective study. The variation between the DS Plus classification and Durie–Salmon staging system (DSS) or Revised International Staging System (RISS) classification was assessed. When staged by the DSS, patients in stage I and stage II did not reach the median overall survival (OS), and the median OS was 33 months for stage III (p=0.3621). When staged by the DS Plus, patients in stage I did not reach the median OS of stage I, and the median OS for stages II and III was 38 and nine months, respectively (p=0.0064). When staged by the RISS, patients in stage I did not reach the median OS, and the median OS was 33 and 16 months for stage II and stage III, respectively (p=0.0319). The concordances between two staging systems were 0.07 (DS Plus versus DSS) and 0.37 (DS Plus versus RISS), respectively. Multivariate analysis revealed that DS Plus stage III (HR: 11.539, p=0.021) and the Deauville score of bone marrow ≥4 (HR: 3.487, p=0.031) were independent prognostic factors associated with OS. Both the DS Plus based on IMPeTUs and RISS possessed a better potential in characterizing and stratifying MM patients compared with the DSS. Moreover, DS Plus stage III and the Deauville score of bone marrow ≥4 were reliable prognostic factors in newly diagnosed MM patients.

Highlights

As a clonal hematologic malignancy, multiple myeloma (MM) is characterized by bone marrow plasma cell in ltration and the presence of serum and urine monoclonal immunoglobulins.e prognosis of MM patients is highly variable; a reliable staging system is extremely important to optimize appropriate treatment as quickly as possible and avoid irreversible organ damage [1]. e most widely applied staging systems in MM patients include the International Staging System (ISS) and Durie–Salmon staging system (DSS) [2]
18F-FDG positron emission tomography/ computed tomography (PET/CT) has been proved to be prognostically valuable in staging different groups [15,16,17], only few studies have been reported on Durie–Salmon Plus (DS Plus) based on 18F-FDG PET/CT [18]
One of the reasons is that no standard interpretation criteria have been proposed for the evaluation of 18F-FDG PET/CT scans in MM. erefore, Italian Myeloma criteria for PET USe (IMPeTUs) has been proposed to standardize image interpretation criteria in order to make clinical trial results applicable and reproducible

Summary

Introduction

As a clonal hematologic malignancy, multiple myeloma (MM) is characterized by bone marrow plasma cell in ltration and the presence of serum and urine monoclonal immunoglobulins.e prognosis of MM patients is highly variable; a reliable staging system is extremely important to optimize appropriate treatment as quickly as possible and avoid irreversible organ damage [1]. e most widely applied staging systems in MM patients include the International Staging System (ISS) and Durie–Salmon staging system (DSS) [2]. E most widely applied staging systems in MM patients include the International Staging System (ISS) and Durie–Salmon staging system (DSS) [2]. Both of these two staging systems have some limitations. As a powerful and reproducible stage classi cation, the ISS segregates patients into three di erent groups based on the levels of β2-microglobulin and serum albumin. E DSS relies on a combination of clinical factors, such as the number of lytic bone lesions on a skeletal radiographic survey, serum calcium, level of hemoglobin, amount of M protein, and renal function [4]. The DSS has a poor reproducibility because its classi cation based on the extent and number of bone lesions found by X-ray is observer-dependent [5]

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Results

Conclusion