Favorable Long-Term Outcomes with Autologous Stem Cell Transplantation for High-Risk Multiple Myeloma Patients with a Positive Result On 18F-FDG PET/CT at Baseline

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2022-02, Vol.22 (2), p.113-120
• Main Authors: Cho, Hee Jeong, Baek, Dong Won, Kim, Ju-Hyung, Lee, Jungmin, Chung, Yu Kyung, Jung, Sung-Hoon, Song, Ga-young, Ahn, Seo-Yeon, Ahn, Jae-Sook, Yang, Deok-Hwan, Lee, Je-Jung, Kim, Hyeoung-Joon, Hong, Chae Moon, Jeong, Shin Young, Min, Jung-Joon, Sohn, Sang-Kyun, Moon, Joon Ho
• Format: Article
• Language: English
• Subjects: 18F-FDG PET/CT; Autologous stem cell transplantation; Focal lesions; Long-term outcomes; Newly diagnosed multiple myeloma
• ISSN: 2152-2650; 2152-2669
• DOI: 10.1016/j.clml.2021.08.012

18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a useful tool for identifying high-risk features in patients with newly diagnosed multiple myeloma (NDMM). This study evaluated the role of autologous stem cell transplantation (ASCT) in patients presenting with positive results on PET/CT scans. The medical records of 210 patients who underwent PET/CT at diagnosis were retrospectively reviewed. Eligible patients for transplantation proceeded to upfront ASCT with high-dose chemotherapy (HDT) after induction therapy with novel agents. The presence of a number of focal lesions (FL) >3 and extramedullary disease (EMD) occurred in 111 and 35 patients, respectively. ASCT was performed in 54 patients. Among patients with FL > 3, those treated with ASCT showed a prolonged 2-year progression-free survival (PFS) and overall survival (OS) rates compared to those not treated with ASCT (PFS, 60.2% vs. 23.5%, P < 0.001; OS, 91.7% vs. 63.6%, P = 0.005). In patients with FL ≤ 3, treatment by ASCT was associated with a higher 2-year PFS rate than no treatment by ASCT (74.0% vs. 54.9%, P = 0.040). The OS of patients treated with ASCT was not significantly longer than that of patients not treated with ASCT (P = 0.115). In multivariate analysis, FL > 3, Revised International Staging System (R-ISS), and upfront ASCT were independent prognostic factors for PFS and OS. Presenting FL > 3 on baseline PET/CT represents a high-risk feature in patients with NDMM. Frontline ASCT with HDT prolonged the survival of patients with FL > 3. To evaluate the role of autologous stem cell transplantation (ASCT) in multiple myeloma patients with a number of focal lesions (FL) >3 on baseline positron emission tomography/computed tomography (PET/CT), we analyzed the medical records of 210 patients. The results showed that patients with FL >3 receiving upfront ASCT have improved survival outcomes compared to those not receiving ASCT.