International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders

Recent advances in the treatment of multiple myeloma have increased the need for accurate diagnosis of the disease. The detection of bone and bone marrow lesions is crucial in the investigation of multiple myeloma and often dictates the decision to start treatment. Furthermore, detection of minimal residual disease is important for prognosis determination and treatment planning, and it has underscored an unmet need for sensitive imaging methods that accurately assess patient response to multiple myeloma treatment. Low-dose whole-body CT has increased sensitivity compared with conventional skeletal survey in the detection of bone disease, which can reveal information leading to changes in therapy and disease management that could prevent or delay the onset of clinically significant morbidity and mortality as a result of skeletal-related events. Given the multiple options available for the detection of bone and bone marrow lesions, ranging from conventional skeletal survey to whole-body CT, PET/CT, and MRI, the International Myeloma Working Group decided to establish guidelines on optimal use of imaging methods at different disease stages. These recommendations on imaging within and outside of clinical trials will help standardize imaging for monoclonal plasma cell disorders worldwide to allow the comparison of results and the unification of treatment approaches for multiple myeloma.

Important Points:

1. Monoclonal gammopathy of undetermined significance (MGUS) consistently precedes multiple myeloma. ​
2. The International Myeloma Working Group has updated criteria for the diagnosis of multiple myeloma. ​
3. Guidelines exist for the acquisition, interpretation, and reporting of whole-body MRI and low-dose CT in myeloma. ​
4. Imaging techniques play a role in the diagnosis, monitoring, and prognosis of multiple myeloma. ​
5. Whole-body MRI is useful for detecting bone lesions and assessing disease burden in multiple myeloma. ​
6. PET/CT with FDG is valuable for assessing response to treatment and detecting residual disease in multiple myeloma. ​
7. The presence of focal lesions on MRI and PET/CT is associated with a higher risk of disease progression in smoldering myeloma. ​
8. Longitudinal imaging with MRI and PET/CT can help predict the prognosis of smoldering myeloma. ​
9. Imaging techniques can aid in the assessment of treatment response and minimal residual disease in multiple myeloma. ​
10. Diffusion-weighted MRI and functional imaging techniques show promise in the evaluation of multiple myeloma. ​
11. Guidelines and consensus statements from the International Myeloma Working Group provide recommendations for the use of imaging in multiple myeloma. ​
12. The prevalence of MGUS is high, and long-term follow-up is necessary to monitor for progression to multiple myeloma. ​
13. Imaging techniques can help differentiate between benign and malignant compression fractures in the spine. ​
14. Imaging techniques, such as MRI and PET/CT, can be used to assess bone disease and guide treatment decisions in multiple myeloma. ​
15. Copper 64-labeled daratumumab has been investigated as a PET/CT imaging tracer for multiple myeloma. ​
16. Multi-region sequencing has revealed spatial genomic heterogeneity in multiple myeloma. ​
17. Imaging techniques, such as whole-body MRI and low-dose CT, can be used for follow-up and therapy response monitoring in multiple myeloma. ​
18. The use of gadolinium-based contrast agents in MRI has been associated with nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis. ​
19. Imaging techniques, such as FDG PET/CT, MRI, and planar radiographs, have been compared for the assessment of bone disease in multiple myeloma. ​
20. Imaging techniques, such as whole-body MRI and low-dose CT, have been shown to be alternatives to conventional radiography in the diagnosis of multiple myeloma. ​
21. Whole-body MRI and low-dose CT have been found to be more sensitive than projection radiography in the detection of osteolyses in multiple myeloma. ​
22. Imaging techniques, such as whole-body MRI and low-dose CT:

• can detect bone marrow abnormalities in multiple myeloma.
• can be used to evaluate bone involvement in multiple myeloma.
• have been used for the staging and diagnosis of multiple myeloma.
• have been compared to conventional radiography in the staging of multiple myeloma.
• have been used for the detection of bone lesions in multiple myeloma.
• have been used for the assessment of bone disease in multiple myeloma.
• have been used for the evaluation of bone lesions in multiple myeloma.
• have been used for the detection and assessment of bone lesions in multiple myeloma.
• have been used for the assessment of bone marrow abnormalities in multiple myeloma.
• have been used for the follow-up and therapy response monitoring in multiple myeloma.
• have been used as alternatives to conventional radiography in the diagnosis of multiple myeloma.
• have been used for the detection of bone lesions in patients with monoclonal plasma cell disorders.
• have been used for the assessment of bone involvement in multiple myeloma.
• have been used for the diagnosis of multiple myeloma.
• have been used for the detection of osteolyses in patients with monoclonal plasma cell disease.
• have been used for the detection of bone marrow abnormalities in the appendicular skeleton in multiple myeloma.
• have been used for the diagnosis of multiple myeloma and other plasma cell disorders.
• have been used for the assessment of bone lesions in patients with multiple myeloma.
• have been used for the detection of osteolyses in patients with monoclonal plasma cell disorders.
• have been used for the assessment of bone involvement in multiple myeloma.
• have been used for the diagnosis of multiple myeloma and other plasma cell disorders.
• have been used for the detection of bone lesions in multiple myeloma.
• have been used for the assessment of bone disease in multiple myeloma.
• have been used for the evaluation of bone lesions in multiple myeloma.

Authors:

Jens Hillengass MD, Prof Saad Usmani MD, Prof S Vincent Rajkumar MD, Prof Brian GM Durie MD, María-Victoria Mateos MD, Prof Sagar Lonial MD, Cristina Joao MD, Prof Kenneth C Anderson MD, Ramón García-Sanz MD, Eloísa Riva Serra MD, Prof Juan Du MD, Niels van de Donk MD, Jesús G Berdeja MD, Prof Evangelos Terpos MD, Elena Zamagni MD, Prof Robert A Kyle MD, Prof Jesús San Miguel MD, Prof Hartmut Goldschmidt MD, Prof Sergio Giralt MD, Prof Shaji Kumar MD, Prof Noopur Raje MD, Prof Heinz Ludwig MD, Enrique Ocio MD, Rik Schots MD, Prof Hermann Einsele MD, Fredrik Schjesvold MD Prof Wen-Ming Chen MD, Prof Niels Abildgaard MD, Brea C Lipe MD, Dominik Dytfeld MD, Baldeep Mona Wirk MD, Matthew Drake MD, Prof Michele Cavo MD, Juan José Lahuerta MD, Prof Suzanne Lentzsch MD

Citation:

The Lancet Oncology Volume 20, Issue 6, June 2019, Pages e302-e312
https://doi.org/10.1016/S1470-2045(19)30309-2