Standardization of 18F-FDG PET/CT According to Deauville Criteria for MRD Evaluation in MM Patients

F-18-fluorodeoxyglucose positron emission tomography integrated with computed tomography (FDG-PET/CT) is actually considered as the standard technique to assess and monitor the metabolic response to therapy and to define minimal residual disease (MRD) status outside the bone marrow (BM) in multiple myeloma (MM) patients. In this regard, standardization of image criteria and definition of cut-offs for positivity/negativity is of highly importance.

Aim of the present study was to prospectively evaluate FDG-PET/CT at diagnosis and prior to maintenance therapy in a joined analysis of a sub-group of patients with newly diagnosed transplant-eligible MM, enrolled in 2 independent European randomized phase III trials (EMN02/HO95 and IFM2009) (Cavo M et al, Blood 2017 abs; Attal M et al, NEJM 2017). The primary end-point was to standardize PET/CT evaluation by centralized imaging and revision and to define criteria for PET negativity after therapy (MRD definition).

Conclusion: 

FDG PET/CT was confirmed to be a reliable predictor of outcomes in newly diagnosed MM, regardless of treatment. Reduction of FDG uptake lower than the liver after therapy, both in the FLs and in the BM (FS and BMS), was an independent predictor for improved PFS and OS. Findings from this analysis could be proposed as standardized criteria to define PET negativity after therapy, confirming the value of Deauville scores in MM.

Authors:

Elena Zamagni, MD, Cristina Nanni, Luca Dozza, MSc, Thomas Carlier, Paola Tacchetti, MD, PhD, Annibale Versari, Stephane Chauvie, Andrea Gallamini, MD, Michel Attal, Barbara Gamberi, MD, Denis Caillot, Francesca Patriarca, MD, Margaret Macro, Mario Boccadoro, MD, Laurent Garderet, Stefano Fanti, Aurore Perrot, Francesca Gay, MD, Pieter Sonneveld, Lionel Karlin, MD, Michele Cavo, MD, Caroline Bodet-Milin, Philippe Moreau and Francoise Kraeber-Bodere