Comparing diagnostic PET versus response PET at the 16th week induction and it’s correlation with MFC MRD: a deeper look into myeloma genomics

Vedanta Ray; Uddiptya Goswami; Mages Sarvanen; Ramya Ananthakrishnan; Kumanan Jayaraman; Raja Thirumalairaj

doi:10.18203/2320-6012.ijrms20250242

Authors

Vedanta Ray Department of Medical Oncology, Apollo Cancer Centre, Chennai, India
Uddiptya Goswami Department of Nuclear Medicine, Apollo Cancer Centre, Chennai, India
Mages Sarvanen Department of Nuclear Medicine, Apollo Cancer Centre, Chennai, India
Ramya Ananthakrishnan Department of Medical Oncology, Apollo Cancer Centre, Chennai, India
Kumanan Jayaraman Department of Medical Oncology, Apollo Cancer Centre, Chennai, India
Raja Thirumalairaj Department of Medical Oncology, Apollo Cancer Centre, Chennai, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20250242

Keywords:

Induction, Minimal residual disease, Newly diagnosed multiple myeloma, PET/CT

Abstract

Background: Multiple Myeloma is a heterogenous disease. A homogenous approach to a heterogeneous disease is discouraged as more and more data evolves. Diagnostic PET is recorded for measuring the disease burden along with metabolic uptake of the burden. Minimal residual disease (MRD) measurement at the end of induction, consolidation and pre-maintenance have been looked into by multiple authors. Also, follow-up PET is done at multiple time points by multiple authors and has been correlated with molecular response. In this study, we shall correlate PET response post 16 weeks of induction and MRD assay.

Methods: We have a retrospective analysis of the newly diagnosed multiple Myeloma (NDMM) with all the baseline data available at our centre and received the standard induction regimen for 16 weeks and the follow-up data was analyzed.

Results: At the end of the 16th week of induction, 41 patients were in complete resolution in PET. Of them, 26 had MRD detected and 15 had no MRD detected. Ten patients had stable disease, with all of them positive for MRD. One patient with positive MRD was having a partial response. Four patients with detectable MRD had progressive disease on PET, with (p=0.058).

Conclusions: MRD should be correlated with follow-up FDG PET/CT for a comprehensive evaluation of treatment response. We firmly believe that the genome of the disease drives the disease and definitely, MRD-PET correlation should be attributed to genomics.

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References

Heider M, Nickel K, Högner M, Bassermann F. Multiple myeloma: molecular pathogenesis and disease evolution. Oncol Res Treat. 2021;44(12):672–81. DOI: https://doi.org/10.1159/000520312

Kumar S, Fonseca R, Ketterling RP, Dispenzieri A, Lacy MQ, Gertz MA, et al. Trisomies in multiple Myeloma: impact on survival in patients with high-risk cytogenetics. Blood. 2012;119(9):2100–5. DOI: https://doi.org/10.1182/blood-2011-11-390658

Kostopoulos IV, Ntanasis-Stathopoulos I, Gavriatopoulou M, Tsitsilonis OE, Terpos E. Minimal residual disease in multiple myeloma: current landscape and future applications with immunotherapeutic approaches. Front Oncol. 2020;10:860. DOI: https://doi.org/10.3389/fonc.2020.00860

Zamagni E, Patriarca F, Nanni C, Zannetti B, Englaro E, Pezzi A, et al. Prognostic relevance of 18-F FDG PET/CT in newly diagnosed multiple myeloma patients treated with up-front autologous transplantation. Blood. 2011;118(23):5989–95. DOI: https://doi.org/10.1182/blood-2011-06-361386

Zamagni E, Oliva S, Gay F, Capra A, Rota-Scalabrini D, D'Agostino M, et al. Impact of minimal residual disease standardised assessment by FDG-PET/CT in transplant-eligible patients with newly diagnosed multiple Myeloma enrolled in the imaging sub-study of the FORTE trial. E Clinical Medicine. 2023;60:102017. DOI: https://doi.org/10.1016/j.eclinm.2023.102017

Costa LJ, Derman BA, Bal S, Sidana S, Chhabra S, Silbermann R, et al. International harmonization in performing and reporting minimal residual disease assessment in multiple myeloma trials. Leukemia. 2021;35(1):18–30. DOI: https://doi.org/10.1038/s41375-020-01012-4

Boellaard R, Delgado-Bolton R, Oyen WJ, Giammarile F, Tatsch K, Eschner W, Verzijlbergen FJ, Barrington SF, Pike LC, Weber WA, Stroobants S. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. European J Nucl Med and Molec Imag. 2015;42:328-54. DOI: https://doi.org/10.1007/s00259-014-2961-x

Zamagni E, Nanni C, Dozza L, Carlier T, Bailly C, Tacchetti P, et al. Standardization of 18F-FDG-PET/CT According to deauville criteria for metabolic complete response definition in newly diagnosed multiple myeloma. J Clin Oncol Off J Am Soc Clin Oncol. 2021;10;39(2):116–25. DOI: https://doi.org/10.1200/JCO.20.00386

Zamagni E, Nanni C, Gay F, Dozza L, Rota Scalabrini D, Omedé P, et al. MRD Evaluation By PET/CT according to deauville criteria combined with multiparameter flow cytometry in newly diagnosed transplant eligible multiple myeloma (MM). Blood. 2019;134(1):4321. DOI: https://doi.org/10.1182/blood-2019-125134

Paiva B, Corchete LA, Vidriales MB, Puig N, Maiso P, Rodriguez I, et al. Phenotypic and genomic analysis of multiple myeloma minimal patients enrolled in the phase ii randomized forte trial residual disease tumor cells: a new model to understand chemoresistance. Blood. 2016;127(15):1896–906. DOI: https://doi.org/10.1182/blood-2015-08-665679