A magnetic resonance imaging-based prognostic scoring system to predict outcome in transplant-eligible patients with multiple myeloma

Diffuse and focal bone marrow infiltration patterns detected by magnetic resonance imaging have been shown to be of prognostic significance in all stages of monoclonal plasma cell disorders and have, therefore, been incorporated into the definition of the disease. The aim of this retrospective analysis was to develop a rapidly evaluable prognostic scoring system, incorporating the most significant information acquired from magnetic resonance imaging. Therefore, the impact of bone marrow infiltration patterns on progression-free and overall survival in 161 transplant-eligible myeloma patients was evaluated. Compared to salt and pepper/minimal diffuse infiltration, moderate/severe diffuse infiltration had a negative prognostic impact on both progression-free survival (P<0.001) and overall survival (P=0.003). More than 25 focal lesions on whole-body magnetic resonance imaging or more than seven on axial magnetic resonance imaging were associated with an adverse prognosis (progression-free survival: P=0.001/0.003 and overall survival: P=0.04/0.02). A magnetic resonance imaging-based prognostic scoring system, combining grouped diffuse and focal infiltration patterns, was formulated and is applicable to whole-body as well as axial magnetic resonance imaging. The score identified high-risk patients with median progression-free and overall survival of 23.4 and 55.9 months, respectively (whole-body-based). Multivariate analyses demonstrated that the magnetic resonance imaging-based prognostic score stage III (high-risk) and adverse cytogenetics are independent prognostic factors for both progression-free and overall survival (whole-body-based, progression-free survival: hazard ratio=3.65, P<0.001; overall survival: hazard ratio=5.19, P=0.005). In conclusion, we suggest a magnetic resonance imaging-based prognostic scoring system which is a robust, easy to assess and interpret parameter summarizing significant magnetic resonance imaging findings in transplant-eligible patients with multiple myeloma.

[1]  Jian Hou,et al.  Role of magnetic resonance imaging in the management of patients with multiple myeloma: a consensus statement. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[2]  Hans Erik Johnsen,et al.  International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. , 2014, The Lancet. Oncology.

[3]  H. Goldschmidt,et al.  Combination of international scoring system 3, high lactate dehydrogenase, and t(4;14) and/or del(17p) identifies patients with multiple myeloma (MM) treated with front-line autologous stem-cell transplantation at high risk of early MM progression-related death. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[4]  H. Goldschmidt,et al.  Infiltration patterns in monoclonal plasma cell disorders: correlation of magnetic resonance imaging with matched bone marrow histology. , 2014, European journal of radiology.

[5]  R. Hustinx,et al.  The role of positron emission tomography-computed tomography and magnetic resonance imaging in diagnosis and follow up of multiple myeloma , 2014, Haematologica.

[6]  S. Vincent Rajkumar,et al.  Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients , 2013, Leukemia.

[7]  T Hielscher,et al.  Predictive value of longitudinal whole-body magnetic resonance imaging in patients with smoldering multiple myeloma , 2014, Leukemia.

[8]  T Hielscher,et al.  Prognostic significance of whole-body MRI in patients with monoclonal gammopathy of undetermined significance , 2014, Leukemia.

[9]  C. Nanni,et al.  Contrast enhanced MRI and ¹⁸F-FDG PET-CT in the assessment of multiple myeloma: a comparison of results in different phases of the disease. , 2012, European journal of radiology.

[10]  D. Hose,et al.  Changes in magnetic resonance imaging before and after autologous stem cell transplantation correlate with response and survival in multiple myeloma , 2012, Haematologica.

[11]  M. Dimopoulos,et al.  Diffuse pattern of bone marrow involvement on magnetic resonance imaging is associated with high risk cytogenetics and poor outcome in newly diagnosed, symptomatic patients with multiple myeloma: A single center experience on 228 patients , 2012, American journal of hematology.

[12]  M. Kersten,et al.  Bortezomib induction and maintenance treatment in patients with newly diagnosed multiple myeloma: results of the randomized phase III HOVON-65/ GMMG-HD4 trial. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[13]  D. Hose,et al.  Administration of bortezomib before and after autologous stem cell transplantation improves outcome in multiple myeloma patients with deletion 17p. , 2012, Blood.

[14]  G. Morgan,et al.  A compendium of myeloma-associated chromosomal copy number abnormalities and their prognostic value. , 2010, Blood.

[15]  D. Hose,et al.  Combining information regarding chromosomal aberrations t(4;14) and del(17p13) with the International Staging System classification allows stratification of myeloma patients undergoing autologous stem cell transplantation , 2010, Haematologica.

[16]  M. Dimopoulos,et al.  Diffuse MRI marrow pattern correlates with increased angiogenesis, advanced disease features and poor prognosis in newly diagnosed myeloma treated with novel agents , 2010, Leukemia.

[17]  Tobias Bäuerle,et al.  Prognostic significance of focal lesions in whole-body magnetic resonance imaging in patients with asymptomatic multiple myeloma. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[18]  H. Kauczor,et al.  Multiple myeloma and monoclonal gammopathy of undetermined significance: importance of whole-body versus spinal MR imaging. , 2009, Radiology.

[19]  E Terpos,et al.  International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple Myeloma , 2009, Leukemia.

[20]  B. Barlogie,et al.  Magnetic resonance imaging in multiple myeloma: diagnostic and clinical implications. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[21]  R. Fanin,et al.  A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma. , 2007, Haematologica.

[22]  L. Moulopoulos,et al.  Prognostic significance of magnetic resonance imaging of bone marrow in previously untreated patients with multiple myeloma. , 2005, Annals of oncology : official journal of the European Society for Medical Oncology.

[23]  J. Crowley,et al.  International staging system for multiple myeloma. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[24]  Sunil J Rao,et al.  Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis , 2003 .

[25]  M. Reiser,et al.  Magnetic resonance imaging as a supplement for the clinical staging system of Durie and Salmon? , 2002, Cancer.

[26]  M. Dimopoulos,et al.  Magnetic resonance imaging of the bone marrow in hematologic malignancies. , 1997, Blood.

[27]  M. Reiser,et al.  Contrast enhancement and quantitative signal analysis in MR imaging of multiple myeloma: assessment of focal and diffuse growth patterns in marrow correlated with biopsies and survival rates. , 1996, AJR. American journal of roentgenology.

[28]  M. Dimopoulos,et al.  Multiple myeloma: MR patterns of response to treatment. , 1994, Radiology.

[29]  A. Rahmouni,et al.  Normal age-related patterns of cellular and fatty bone marrow distribution in the axial skeleton: MR imaging study. , 1990, Radiology.

[30]  A. Neuhold,et al.  MAGNETIC RESONANCE IMAGING OF THE SPINE IN MULTIPLE MYELOMA , 1987, The Lancet.

[31]  S. Holm.  A Simple Sequentially Rejective Multiple Test Procedure , 1979 .

[32]  O. Cope,et al.  Multiple myeloma. , 1948, The New England journal of medicine.