F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma
F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma
复制标题
DOI：
10.1182/blood-2009-03-213280
复制
发表时间：
2009-09-03
期刊：
影响因子：
20.3
通讯作者：
Barlogie, Bart
中科院分区：
文献类型：
--
作者：
Bartel, Twyla B.;Haessler, Jeff;Barlogie, Bart
F18-氟脱氧葡萄糖正电子发射断层扫描 (FDG-PET) 是研究肿瘤代谢活动的作用及其通过治疗对癌症生存的抑制的强大工具。作为新诊断多发性骨髓瘤整体治疗 3 的一部分，对 239 名未经治疗的患者进行了转移性骨调查、磁共振成像和 FDG-PET 扫描的评估。所有 3 种成像技术均显示与预后相关基线参数的相关性：局灶性病变 (FL) 的数量，特别是当 PET 计算机断层扫描显示 FDG 丰富时，与高水平的 β-2-微球蛋白、C 反应蛋白和乳酸脱氢酶呈正相关；基因表达谱参数中，高风险和增殖相关参数与FL呈正相关，低骨病分子亚型与FL呈负相关。超过 3 个 FDG 亲和 FL 的存在与骨髓瘤生物学和基因组学的基本特征相关，是与较差的总体生存率和无事件生存率相关的主要独立参数。首次移植前 FL 中完全 FDG 抑制可带来显着更好的结果，并且仅与基因表达谱定义的高风险状态相反，这些状态合计约占生存变异性的 50%（R-2 检验）。我们的结果为检验以下假设提供了理论依据：对于诱导治疗后无法实现 FDG 抑制的患者，通过改变治疗方法可以提高骨髓瘤生存率。 （血。2009；114：2068-2076）
F18-fluorodeoxyglucose positron emission tomography (FDG-PET) is a powerful tool to investigate the role of tumor metabolic activity and its suppression by therapy for cancer survival. As part of Total Therapy 3 for newly diagnosed multiple myeloma, metastatic bone survey, magnetic resonance imaging, and FDG-PET scanning were evaluated in 239 untreated patients. All 3 imaging techniques showed correlations with prognostically relevant baseline parameters: the number of focal lesions (FLs), especially when FDG-avid by PET-computed tomography, was positively linked to high levels of beta-2-microglobulin, C-reactive protein, and lactate dehydrogenase; among gene expression profiling parameters, high-risk and proliferation-related parameters were positively and low-bone-disease molecular subtype inversely correlated with FL. The presence of more than 3 FDG-avid FLs, related to fundamental features of myeloma biology and genomics, was the leading independent parameter associated with inferior overall and event-free survival. Complete FDG suppression in FL before first transplantation conferred significantly better outcomes and was only opposed by gene expression profiling-defined high-risk status, which together accounted for approximately 50% of survival variability (R-2 test). Our results provide a rationale for testing the hypothesis that myeloma survival can be improved by altering treatment in patients in whom FDG suppression cannot be achieved after induction therapy. (Blood. 2009; 114: 2068-2076)