Prospective Evaluation of Magnetic Resonance Imaging and [18F]Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography at Diagnosis and Before Maintenance Therapy in Symptomatic Patients With Multiple Myeloma Included in the IFM/DFCI 2009 Trial: Results of the IMAJEM Study
Philippe Moreau
(1)
,
Michel Attal
(2)
,
Denis Caillot
(3)
,
Margaret Macro
(4)
,
Lionel Karlin
(5)
,
Laurent Garderet
(6)
,
Thierry Facon
(7)
,
Lotfi Benboubker
(8)
,
Martine Escoffre-Barbe
(9)
,
Anne-Marie Stoppa
(10)
,
Kamel Laribi
(11)
,
Cyrille Hulin
(12)
,
Aurore Perrot
(13)
,
Gerald Marit
(12)
,
Jean-Richard Eveillard
(14)
,
Florence Caillon
(1)
,
Caroline Bodet-Milin
(1)
,
Brigitte Pegourie
(15)
,
Veronique Dorvaux
(16)
,
Carine Chaleteix
(17)
,
Kenneth Anderson
(18)
,
Paul Richardson
(18)
,
Nikhil C. Munshi
(18)
,
Herve Avet-Loiseau
(2)
,
Aurelie Gaultier
(1)
,
Jean-Michel Nguyen
(1)
,
Benoit Dupas
(1)
,
Eric Frampas
(1)
,
Françoise Kraeber-Bodere
(1)
1
CHU Nantes -
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
2 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
3 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
4 CHU Caen
5 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
6 CHU Saint-Antoine [AP-HP]
7 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
8 CHU Trousseau [Tours]
9 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
10 IPC - Institut Paoli-Calmettes
11 Centre Hospitalier Le Mans (CH Le Mans)
12 CHU Bordeaux
13 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
14 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
15 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
16 CHR Metz-Thionville - Centre hospitalier régional Metz-Thionville
17 CHU Clermont-Ferrand
18 Dana-Farber Cancer Institute [Boston]
2 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
3 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
4 CHU Caen
5 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
6 CHU Saint-Antoine [AP-HP]
7 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
8 CHU Trousseau [Tours]
9 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
10 IPC - Institut Paoli-Calmettes
11 Centre Hospitalier Le Mans (CH Le Mans)
12 CHU Bordeaux
13 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
14 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
15 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
16 CHR Metz-Thionville - Centre hospitalier régional Metz-Thionville
17 CHU Clermont-Ferrand
18 Dana-Farber Cancer Institute [Boston]
Philippe Moreau
- Fonction : Auteur
- PersonId : 759214
- ORCID : 0000-0003-1780-8746
Laurent Garderet
- Fonction : Auteur
- PersonId : 761986
- ORCID : 0000-0002-6138-8112
Kamel Laribi
- Fonction : Auteur
- PersonId : 771192
- ORCID : 0000-0001-5302-9921
Aurore Perrot
- Fonction : Auteur
- PersonId : 769019
- IdRef : 139420215
Caroline Bodet-Milin
- Fonction : Auteur
- PersonId : 763128
- ORCID : 0000-0002-8219-3592
Herve Avet-Loiseau
- Fonction : Auteur
- PersonId : 948224
- ORCID : 0000-0002-3050-0140
Résumé
Purpose Magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) are important imaging techniques in multiple myeloma (MM). We conducted a prospective trial in patients with MM aimed at comparing MRI and PET-CT with respect to the detection of bone lesions at diagnosis and the prognostic value of the techniques. Patients and Methods One hundred thirty-four patients received a combination of lenalidomide, bortezomib, and dexamethasone (RVD) with or without autologous stem-cell transplantation, followed by lenalidomide maintenance. PET-CT and MRI were performed at diagnosis, after three cycles of RVD, and before maintenance therapy. The primary end point was the detection of bone lesions at diagnosis by MRI versus PET-CT. Secondary end points included the prognostic impact of MRI and PET-CT regarding progression-free (PFS) and overall survival (OS). Results At diagnosis, MRI results were positive in 127 of 134 patients (95%), and PET-CT results were positive in 122 of 134 patients (91%; P = .33). Normalization of MRI after three cycles of RVD and before maintenance was not predictive of PFS or OS. PET-CT became normal after three cycles of RVD in 32% of the patients with a positive evaluation at baseline, and PFS was improved in this group (30-month PFS, 78.7% v 56.8%, respectively). PET-CT normalization before maintenance was described in 62% of the patients who were positive at baseline. This was associated with better PFS and OS. Extramedullary disease at diagnosis was an independent prognostic factor for PFS and OS, whereas PET-CT normalization before maintenance was an independent prognostic factor for PFS. Conclusion There is no difference in the detection of bone lesions at diagnosis when comparing PET-CT and MRI. PET-CT is a powerful tool to evaluate the prognosis of de novo myeloma.