Update on Diagnostic Criteria and Imaging Techniques in Multiple Myeloma
Posted: Monday, January 25, 2021
As patients continue to live longer with multiple myeloma, quality of life has become increasingly important. Earlier treatment may improve the prognosis of patients who suffer from symptoms such as bone destruction, kidney failure, and anemia, according to Jens Hillengass, MD, of Roswell Park Comprehensive Cancer Center, Buffalo, New York, during his presentation at the NCCN 2020 Annual Congress: Hematologic Malignancies. Highlights of this presentation were published in JNCCN–Journal of the National Comprehensive Cancer Network.
Dr. Hillengass described the updated diagnostic criteria by the International Myeloma Working Group, listed imaging techniques that are critical for accurate diagnosis, and reviewed the rationale for developing the Revised International Staging System (R-ISS) for multiple myeloma.
One major development in diagnostic imaging is the replacement of x-rays with CT, explained Dr. Hillengass. A study of the International Myeloma Working Group found that 25% of patients with a negative x-ray were positive for osteolytic lesions with CT. When combined with PET, PET-CT imaging is also useful for treatment response assessment, as the disappearance of focal lesions is an important prognostic factor. As for MRI, Dr. Hillengass noted it is worthwhile to identify different infiltration patterns, critical for accurate diagnoses. MRI is helpful in patients who have osteoporosis as well.
Finally, the R-ISS for multiple myeloma has incorporated additional prognostic markers of aggressive disease: fluorescence in situ hybridization (FISH) testing and lactate dehydrogenase assessment. The former can be used to guide treatment, said Dr. Hillengass, with bortezomib-based regimens outperforming thalidomide-based treatment in patients with high-risk FISH cytogenetics. Other markers associated with an adverse prognosis have also recently been published: gain (1q) and deletion (1p).
The risk-adapted treatment has also been shown to improve survival, Dr. Hillengass commented, and it’s not only about high-risk patients. For example, in certain patients with translocation (11;14), venetoclax has been shown to work better.
Disclosure: Dr. Hillengass has received honoraria from Amgen and Janssen and research funding from Celgene. He serves on the advisory boards of Adaptive, Amgen, Bristol Myers Squibb, GSK, Janssen, and Oncotracker.