Bone marrow MRI after autologous transplantation and the effect of residual tumor on progression-free survival of multiple myeloma patients

Background . The study of influence of residual tumor mass, determined by magnetic resonance imaging (MRI), on the progression-free survival (PFS) remains an actual problem. Since the visual assessment of tumor bone marrow lesion can be one of the criteria for the subsequent personalized treatment choice in multiple myeloma patients.

The objective of study was to determine the effect of bone marrow lesions detected by MRI after autologous hematopoietic stem cells transplantation (auto-HSCT) on PFS in multiple myeloma patients.

Materials and methods . The prospective study included 60 patients who underwent spine and pelvic bones MRI on the 100 th day after autoHSCT.

Results . Focal bone marrow changes were found in 47 of them – from 1 to 56 lesions (mean 6 ± 9). Significant (p = 0.01) differences of PFS in multiple myeloma patients depending on the presence or absence of tumor mass on 100 th day after auto-HSCT were revealed: with MRI negative status, 2-year PFS was 89 % versus 50 % in a group of patients with residual tumor mass.

Conclusion . MRI-negative status after auto-HSCT is a favorable prognostic factor contributing to prolonged disease-free survival.

1. Roshal M., Flores-Montero J.A., Gao Q. et al. MRD detection in multiple myeloma: comparison between MSKCC 10-color single-tube and EuroFlow 8-color 2-tube methods. Blood 2017;1(12):728–32. DOI: 10.1182/bloodadvances.2016003715. PMID: 29296716.

2. Paiva B., Dongen J.J. M., Orfao A. New criteria for response assessment: role of minimal residual disease in multiple myeloma. Blood 2015;125(20):3059–68. DOI: 10.1182/blood-2014-11-568907. PMID: 25838346.

3. Kumar S., Paiva B., Anderson K.C. et al. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. Lancet Oncol 2016;17(8):e328–46. DOI: 10.1016/S1470-2045(16)30206-6. PMID: 27511158.

4. Flores-Montero J., Sanoja-Flores L., Paiva B. et al. Next Generation Flow for highly sensitive and standardized detection of minimal residual disease in multiple myeloma. Leukemia 2017;31(10):2094– 103. DOI: 10.1038/leu.2017.29. PMID: 28104919.

5. Solovev M., Mendeleeva L., Pokrovskaya O. et al. The duration of MRD-negative status in multiple myeloma (MM) patients after auto-HSCT is a criterion for prolonged remission without maintenance therapy. Blood 2017;130(Suppl. 1):3294.

6. Paiva B., Vidriales M.B., Cerveró J. et al. Multiparameter flow cytometric remission is the most relevant prognostic factor for multiple myeloma patients who undergo autologous stem cell transplantation. Blood 2008;112(10):4017–23. DOI: 10.1182/blood-2008-05-159624. PMID: 18669875.

7. Rawstron A.C., Child J.A., Tute R.M. et al. Minimal residual disease assessed by multiparameter flow cytometry in multiple myeloma: impact on outcome in the Medical Research Council Myeloma IX Study. J Clin Oncol 2013;31(20):2540–7. DOI: 10.1200/JCO.2012.46.2119. PMID: 23733781.

8. Roussel M., Lauwers-Cances V., Robillard N. et al. Front-line transplantation program with lenalidomide, bortezomib, and dexamethasone combination as induction and consolidation followed by lenalidomide maintenance in patients with multiple myeloma: a phase II study by the Intergroupe Francophone du Myélo. J Clin Oncol 2014;32(25):2712–7. DOI: 10.1200/JCO.2013.54.8164. PMID: 25024076.

9. Dimopoulos M., Terpos E., Comenzo R.L. 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. Leukemia 2009;23(9):1545–56. DOI: 10.1038/leu.2009.89. PMID: 19421229.

10. Moulopoulos L.A., Gika D., Anagnostopoulos A. et al. Prognostic significance of magnetic resonance imaging of bone marrow in previously untreated patients with multiple myeloma. Ann Oncol 2005;16(11):1824–8. DOI: 10.1093/annonc/mdi362. PMID: 16087694.

11. Moulopoulos L.A., Dimopoulos М.А., Alexanian R. et al. Multiple myeloma: MR patterns of response to treatment. Radiology 1994;193(2):441–6. DOI: 10.1148/radiology.193.2.7972760. PMID: 7972760.

12. Bray T.J. P., Singh S., Latifoltojar A. et al. Diagnostic utility of whole body Dixon MRI in multiple myeloma: a multi-reader study. PLoS One 2017;12(7):e0180562. DOI: 10.1371/journal.pone.0180562. PMID: 28672007.

13. Lasocki A., Gaillard F., Harrison S.J. Multiple myeloma of the spine. Neuroradiol J 2017;30(3):259–68. DOI: 10.1177/1971400917699426. PMID: 28423980.

14. Dyrberg E., Hendel H.W., Al-Farra G. et al. A prospective study comparing whole-body skeletal X-ray survey with 18F-FDG-PET/CT, 18F-NaF-PET/CT and whole-body MRI in the detection of bone lesions in multiple myeloma patients. Acta Radiol Open 2017;6(10):2058460117738809. DOI: 10.1177/2058460117738809. PMID: 29123920.

15. Filonzi G., Mancuso K., Zamagni E. et al. A comparison of different staging systems for multiple myeloma: can the MRI pattern play a prognostic role? AJR Am J Roentgenol 2017;209(1):152–8. DOI: 10.2214/AJR.16.17219. PMID: 28418695.

16. Moreau P., Attal M., Caillot D. et al. Prospective evaluation of magnetic resonance imaging and [18F] fluorodeoxyglucose positron emission tomographycomputed tomography at diagnosis and before maintenance therapy in symptomatic patients with multiple myeloma included in the IFM/DFCI 2009 trial. J Clin Oncol 2017;35(25):2911–8. DOI: 10.1200/JCO.2017.72.2975. PMID: 28686535.

17. Hillengass J., Ayyaz S., Kilk K. et al. Changes in magnetic resonance imaging before and after autologous stem cell transplantation correlate with response and survival in multiple myeloma. Haematologica 2012;97(11):1757–60. DOI: 10.3324/haematol.2012.065359. PMID: 22689673.

18. Mendeleeva L.P., Votyakova O.M., Pokrovskaya O.S. et al. National clinical guidelines for the diagnosis and treatment of multiple myeloma. Gematologiya i transfuziologiya = Hematology and transfusiology 2016;61(1, Suppl. 2):1–24. (In Russ.). DOI: 10.18821/0234-5730-2016-61-1.

19. Sonneveld P., Avet-Loiseau H., Lonial S. et al. Treatment of multiple myeloma with high-risk cytogenetics: a consensus of the International Myeloma Working Group. Blood 2016;127(24):2955–62. DOI: 10.1182/blood-2016-01-631200. PMID: 27002115.