Predictive role of diffusion-weighted whole-body MRI (DW-MRI) imaging response according to MY-RADS criteria after autologous stem cell transplantation in patients with multiple myeloma and combined evaluation with MRD assessment by flow cytometry.
Predictive role of diffusion-weighted whole-body MRI (DW-MRI) imaging response according to MY-RADS criteria after autologous stem cell transplantation in patients with multiple myeloma and combined evaluation with MRD assessment by flow cytometry.
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DOI：
10.1002/cam4.4136
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发表时间：
2021-09
期刊：
影响因子：
4
通讯作者：
Tucci A
中科院分区：
文献类型：
--
作者：
Belotti A;Ribolla R;Cancelli V;Villanacci A;Angelini V;Chiarini M;Giustini V;Facchetti GV;Roccaro AM;Ferrari S;Peli A;Bottelli C;Cattaneo C;Crippa C;Micilotta M;Frittoli B;Grazioli L;Rossi G;Tucci A
弥散加权全身 MRI (DW-MRI) 越来越多地用于多发性骨髓瘤 (MM) 患者的治疗，但缺乏有关治疗后 DW-MRI 成像反应的预后作用的数据。骨髓瘤疗效评估和诊断系统（MY-RADS）影像学建议最近提出了疗效评估类别（RAC）的5分制标准，以标准化治疗后的疗效评估，但该评分仍需验证。我们研究了 RAC 标准在 64 例自体干细胞移植 (ASCT) 后新诊断的 MM 患者中的预后作用，并将 MY-RADS 的结果与多参数流式细胞术 (MFC) 的微小残留病 (MRD) 评估结果结合起来。与影像学残留病灶 (RAC≥2) 的患者相比，在具有完全影像学缓解 (RAC1) 的患者中观察到了更好的 ASCT 后 PFS 和 OS：未达到中位 PFS (NR) 与 26.5 个月，p = 0.0047，HR 0.28 (95% CI: 0.12–0.68)； ASCT 后 3 年 OS 分别为 RAC1 和 RAC ≥2 的 92% 和 69%，p = 0.047，HR 0.24（95% CI：0.06-0.99）。结合 MRD 和影像学改进了结果预测，双阴性和双阳性特征分别定义了具有优异和较差 PFS 的组（PFS NR 与 10.6 个月）； p = 0.001，HR 0.07（95% CI：0.01–0.36）。本研究支持 MY-RADS 建议在 ASCT 后的适用性； RAC 标准能够对患者进行独立分层并更好地预测其预后，并且 DW-MRI 与 MFC 的结合使用可以更精确地评估 MRD。本研究支持拟议的骨髓瘤反应评估和诊断系统 (MY-RADS) 建议的适用性和临床实用性，该建议应用于 MM 一线治疗（包括 ASCT）后获得的 DW-MRI 成像。 MY-RADS RAC 标准能够对患者进行独立分层，并更好地预测他们的结果和预后。事实证明，DW-MRI 是通过功能成像评估残留骨病的有力工具：它补充了骨髓流式细胞术，因此可能代表着越来越多通过新治疗方法实现 CR 的 MM 患者的临床管理向前迈出了一步。
Diffusion‐weighted whole‐body MRI (DW‐MRI) is increasingly used in the management of multiple myeloma (MM) patients, but data regarding the prognostic role of DW‐MRI imaging response after treatment are lacking. The Myeloma Response Assessment and Diagnosis System (MY‐RADS) imaging recommendations recently proposed the criteria for response assessment category (RAC) with a 5‐point scale in order to standardize response assessment after therapy, but this score still needs to be validated. We investigated the prognostic role of RAC criteria in 64 newly diagnosed MM patients after autologous stem cell transplantation (ASCT), and we combined the results of MY‐RADS with those of minimal residual disease (MRD) assessment by multiparametric flow cytometry (MFC). Superior post‐ASCT PFS and OS were observed in patients with complete imaging response (RAC1), with respect to patients with imaging residual disease (RAC≥2): median PFS not reached (NR) versus 26.5 months, p = 0.0047, HR 0.28 (95% CI: 0.12–0.68); 3‐year post‐ASCT OS 92% versus 69% for RAC1 versus RAC ≥2, respectively, p = 0.047, HR 0.24 (95% CI: 0.06–0.99). Combining MRD and imaging improved prediction of outcome, with double‐negative and double‐positive features defining groups with excellent and dismal PFS, respectively (PFS NR vs. 10.6 months); p = 0.001, HR 0.07 (95%CI: 0.01–0.36). The present study supports the applicability of MY‐RADS recommendations after ASCT; RAC criteria were able to independently stratify patients and to better predict their prognosis and the combined use of DW‐MRI with MFC allowed a more precise evaluation of MRD. The present study supports both the applicability and the clinical usefulness of the proposed Myeloma Response Assessment and Diagnosis System (MY‐RADS) recommendations applied to DW‐MRI imaging obtained after first‐line treatment of MM including ASCT. MY‐RADS RAC criteria were able to independently stratify patients and to better predict their outcome and their prognosis. DW‐MRI proved to be a powerful tool for the assessment of residual bone disease by functional imaging: it complemented bone marrow flow cytometry and may, therefore, represent a step forward in the clinical management of the increasing number of MM patients achieving CR with the novel treatment approaches.
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影响因子：
8.4
作者：
Eisenhauer, E. A.;Therasse, P.;Verweij, J.
通讯作者：
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45.3
作者：
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Engelhardt M
影响因子：
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作者：
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通讯作者：
Weinhold, N.
影响因子：
168.9
作者：
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通讯作者：
Sonneveld, Pieter