Prediction of Progression-Free Survival in Patients With Multiple Myeloma Following Anthracycline-Based Chemotherapy Based on Dynamic FDG-PET
Prediction of Progression-Free Survival in Patients With Multiple Myeloma Following Anthracycline-Based Chemotherapy Based on Dynamic FDG-PET
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DOI：
10.1097/rlu.0b013e3181b06bc5
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发表时间：
2009-09-01
影响因子：
10.6
通讯作者：
Strauss, Ludwig G.
中科院分区：
文献类型：
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作者：
Dimitrakopoulou-Strauss, Antonia;Hoffmann, Martin;Strauss, Ludwig G.
方法：对接受蒽环类药物化疗的多发性骨髓瘤患者进行f -18脱氧葡萄糖动态正电子发射断层扫描（PET）研究，以评估全动力学分析的影响，并评估其在无进展生存期（PFS）方面的价值。评估包括19例多发性骨髓瘤患者（56例转移灶）。所有患者均接受蒽环类药物联合化疗。PFS作为PET数据的参考。所有患者在化疗开始前和第一个周期开始后第23至28天（在第二个周期之前）进行检查。从动态PET研究中检索以下参数：计算标准化摄取值（SUV），分维（FD），计算2室模型K1， k2, k3, k4（单位：1/min），分数血容量（vB）和fdg -内流（根据Patlak）。结果：观察到的PFS从18个月不等，普遍高于1组（超过94%）。基线SUV的使用导致第二组的CCR为82%，生存期较长。根据参数和预测研究的不同，I组短生存期的CCR在55% - 70%之间变化。此外，与FDG基线研究（75%-82%）相比，仅基于第二项研究数据的两组CCR略低（740%-75%）。最后，联合使用每项研究的预测变量，即SUV、k3和FD（通过Wilcoxon秩和检验选择），两组的CCR最高均为85%。这一组合对于预测2组更长的生存（CCR为94%）特别有用。区分短PFS和长PFS的最佳临界值为基线研究的SUV 4.0和k3 0.07。结论：研究结果表明，对多发性骨髓瘤患者1个化疗周期前后的FDG研究进行完整的动力学分析有助于预测PFS，并可用于识别从该化疗方案中受益的患者。基线研究的高SUV （>4.0 SUV）和高k3（>0.07）是不良预后参数，与较短的PFS相关。
Methods: Dynamic positron emission tomography (PET) studies with F-18-deoxyglucose were performed in patients with multiple myeloma who received anthracycline-based chemotherapy to evaluate the impact of full kinetic analysis and assess its value with regard to progression-free survival (PFS).The evaluation included 19 patients (56 metastatic lesions) with multiple myelomas. All patients received combined anthracycline-based chemotherapy. PFS served as a reference for the PET data. All patients were examined prior to the onset of chemotherapy and on days 23 to 28 after the onset of the first cycle (prior to the second cycle). The following parameters were retrieved from the dynamic PET studies: Standardized Uptake Value (SUV), firactal dimension (FD), 2 compartment model with computation of K1, k2, k3, k4 (unit: 1/min), the fractional blood volume (vB), and the FDG-influx according to Patlak were calculated.Results: The observed PFS varied from 18 months) was generally higher (exceeding 94%) than for group 1. The use of the baseline SUV led to a CCR of 82% for the group 2 with the longer survival. The CCR of group I with the short survival varied between 55% and 70% depending on the parameter and the study used for prediction. Furthermore, the CCR for both groups based only on the data of the second study was somewhat lower (740%-75%) as compared with the baseline FDG study (75%-82%). Finally, the combined use of the predictor variables, namely SUV, k3, and FD (selected by the Wilcoxon rank sum test) of each study led to the highest CCR of 85% for both groups. This combination was in particular useful for the prediction of group 2 with the longer survival with a CCR of 94%. Best cutoff-values for the differentiation between short and long PFS were SUV of 4.0 and a k3 of 0.07 of the baseline study.Conclusions: The results demonstrate, that a full kinetic analysis of the FDG studies prior and after 1 chemotherapeutic cycle in patients with multiple myeloma is helpful for the prediction of PFS and may be used to identify those patients who benefit from this chemotherapeutic protocol. A high SUV (>4.0 SUV) as well as a high k3 (>0.07) of the baseline study were bad prognostic parameters and related to a short PFS.