Interim PET Analysis in First-Line Therapy of Multiple Myeloma: Prognostic Value of ΔSUVmax in the FDG-Avid Patients of the IMAJEM Study

Abstract : Purpose: To assess the prognostic value of interim 18 F-fluorodeoxyglucose (FDG)-PET analysis using decrease in maximum standardized uptake value (SUVmax) versus visual analysis in patients with multiple myeloma. Patients and Methods: We evaluated the prognostic value of FDG-PET after three cycles of lenalidomide, bortezomib, and dexamethasone (RVD) in patients with FDG-avid multiple myeloma included in the French prospective multicenter IMAJEM study. All images were centrally reviewed and interpreted using visual criteria and maximal standardized uptake value reduction (DSUVmax). Known prognostic factors, such as the revised International Staging System and biochemical response after three cycles of chemotherapy, were also evaluated. Results: In the multivariate analysis, only DSUVmax [P < 0.001, HR ¼ 5.56; 95% confidence interval (CI), 1.96-15.81] and biochemical response after three cycles of RVD (P ¼ 0.025, HR ¼ 0.29; 95% CI, 0.1-0.85) appeared as independent prognostic factors, with a more discriminative HR for DSUVmax. DSUVmax analysis (>-25% vs.-25%) identified patients with improved median progression-free survival (22.6 months and not reached, respectively). Conclusions: DSUVmax appears to be a powerful tool for the prediction of long-term outcome in patients with FDG-avid multiple myeloma. Other prospective studies are needed to further validate this prognostic biomarker.