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The Value of 18F-FDG PET/CT after Autologous Stem Cell Transplantation (ASCT) in Patients Affected by Multiple Myeloma (MM): Experience With 77 Patients

Nanni, Cristina*; Zamagni, Elena; Celli, Monica*; Caroli, Paola*; Ambrosini, Valentina*; Tacchetti, Paola; Brioli, Annamaria; Zannetti, Beatrice; Pezzi, Annalisa; Pantani, Lucia; Perrone, Giulia; Zompatori, Maurizio; Cavo, Michele; Colletti, Patrick M.§; Rubello, Domenico; Fanti, Stefano*

doi: 10.1097/RLU.0b013e318266cee2
Original Articles

Aim The objective of this study was to analyze the prognostic value of 18F-FDG PET/CT after therapy in patients with multiple myeloma (MM).

Patients and Methods One hundred seven patients prospectively recruited with MM had FDG PET/CT at staging 3 months after therapy (autologous stem cell transplantation) and every 6 to 12 months during the follow-up (mean 41 months). Patients were divided into group 1 (relapsed) and group 2 (nonrelapsed). In group 1, PET results and SUVmax were compared to the time to relapse (TTR). In group 2, the presence of PET finding changes during follow-up was analyzed to identify typical patterns of disease behavior (ie, late responders or stabilized disease). Patients with a negative PET at staging were excluded from further evaluation.

Results Forty-seven out of 107 (44%) patients relapsed: 10 were excluded because of a negative PET at staging. In group 1, 22 patients had a negative posttherapy PET (59%, mean TTR = 27.6 months) and 15 had a positive posttherapy PET (41%, mean TTR = 18 months). There was a significant difference between the TTR of the two subgroups (t test P = 0.05). In patients with a positive posttherapy PET, the SUVmax was inversely correlated to the TTR (correlation coefficient = −0.7; P < 0.01).

Sixty out of 107 (56%) patients did not relapse. Twenty patients were excluded because of a negative PET at staging. In group 2, 27 patients had a negative posttherapy PET (68%) and 13 had a positive posttherapy PET (32%). None of nonrelapsed patients showed a progressive increase in SUVmax during the follow-up. There was no significant difference between relapsed and nonrelapsed patients in terms of SUVmax at posttherapy PET/CT (t test P = 0.7).

Conclusion In our series of MM patients, a negative posttherapy PET was predictive for nonrelapse or a long disease-free survival. In contrast, a persistent significantly increased SUVmax after therapy was correlated to a short TTR.

From the *Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna; †Seràgnoli Institute of Hematology, and ‡Department of Radiology, Bologna University School of Medicine, Bologna, Italy; §Department of Radiology, University of Southern California, Los Angeles, CA; and ∥Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.

Received for publication May 8, 2012; revision accepted June 6, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Domenico Rubello, MD, Department of Imaging, Nuclear Medicine and PET/CT Centre, Santa Maria della Misericordia Hospital, Via Tre Martiri 140, 35100 Rovigo, Italy. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.