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Standardized Assessment of Measurable Residual Disease Via FDG-PET/CT in Myeloma

By: Julia Fiederlein Cipriano, MS
Posted: Tuesday, September 26, 2023

According to Elena Zamagni, MD, PhD, of Università degli Studi di Bologna, Italy, and colleagues, 18F-fluorodeoxyglucose (FDG)-PET/CT after therapy is a reliable predictor of long-term outcomes in patients with newly diagnosed, transplant-eligible multiple myeloma. The results of an imaging substudy of the phase II FORTE trial, which were published in eClinicalMedicine (part of The Lancet Discovery Science), also underscore the applicability of a recently standardized assessment of measurable residual disease (MRD)—the PET Deauville scale—to define complete metabolic response, as well as its complementary relationship with multiparameter flow cytometry at the bone marrow level.

The investigators focused on 109 patients who underwent paired PET/CT scans (at baseline and after treatment) and multiparameter flow cytometry evaluation at a sensitivity threshold of 10-5 cells. Complete metabolic responses were defined by Deauville scores of less than 4.

A total of 93% and 99% of patients had focal lesions within the bones and increased bone marrow uptake, respectively, at baseline. Complete metabolic responses were achieved in 63% of patients after treatment; based on univariate (hazard ratio [HR] = 0.40; P = .0065) and Cox multivariate (HR = 0.31; P = .0023) analyses, such outcomes at this time point were predictive of prolonged durations of progression-free survival. Regarding overall survival, a trend in favor of complete metabolic response was seen in both univariate (HR = 0.44; P = .094) and Cox multivariate (HR = 0.17; P = .0037) models. Univariate (HR = 0.45; P = .020) and multivariate (HR = 0.41; P = .015) analyses revealed significantly prolonged durations of progression-free survival in patients who achieved both a PET/CT complete metabolic response and multiparameter flow cytometry negativity after treatment.

“We propose to consider the adoption of hepatic uptake as a simple and reproducible reference for defining the negativity of PET after therapy, both in the context of clinical trials and in daily clinical practice,” the investigators concluded.

Disclosure: For full disclosures of the study authors, visit

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