Interim PET analysis in first line therapy of multiple myeloma: Prognostic value of {Delta}SUVmax in the FDG-avid patients of the IMAJEM study

Purpose: To assess the prognostic value of interim FDG-PET analysis using decrease in maximum standardized uptake value (SUVmax) versus visual analysis in patients with multiple myeloma (MM). Experimental Design: We evaluated the prognostic value of FDG-PET after three cycles of lenalidomide, bortezomib and dexamethasone (RVD) in patients with FDG-avid MM included in the French prospective multicenter IMAJEM study. All images were centrally reviewed and interpreted using visual criteria and maximal standardized uptake value reduction (SUVmax). Known prognostic factors, such as the revised International Staging System and biochemical response after three cycles of chemotherapy were also evaluated. Results: In the multivariate analysis, only SUVmax (p<0.001, HR=5.56; 95% CI: 1.96 - 15.81) and biochemical response after three cycles of RVD, (p=0.025, HR=0.29; 95% CI: 0.1 - 0.85) appeared as independent prognostic factors, with a more discriminative HR for SUVmax. SUVmax analysis (>-25 vs ≤-25%) identified patients with improved median PFS (22.6 months and not reached, respectively). Conclusions:SUVmax appears to be a powerful tool for the prediction of long-term outcome in patients with FDG-avid MM. Other prospective studies are needed to further validate this prognostic biomarker.

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