Pre‐treatment metabolic tumour volume and total lesion glycolysis are superior to conventional positron‐emission tomography/computed tomography variables for outcome prediction in patients with newly diagnosed multiple myeloma in clinical practice
Toshiki Terao, Youichi Machida, Takafumi Tsushima, Daisuke Miura, Kentaro Narita, Akihiro Kitadate, Masami Takeuchi, Kosei Matsue
Abstract
Summary Metabolic tumour volume (MTV) and total lesion glycolysis (TLG) are positron‐emission tomography / computed tomography (PET/CT) variables for predicting multiple myeloma’s (MM) outcome. We retrospectively investigated and compared the predictive value of MTV, TLG and high‐risk PET/CT variables in clinical practice in 185 patients with newly diagnosed symptomatic MM. High‐risk PET/CT findings were defined as the presence of at least one of the following: more than three focal lesions, maximum standardised uptake value (SUV max ) >4·2 and extramedullary disease. MTV was defined as the volume of myeloma lesions visualised on PET/CT with SUV ≥ 2·5. TLG was calculated as the sum of the product of the average SUV and MTV of all lesions. The mortality prediction optimal cut‐off values for MTV and TLG were 56·4 cm 3 and 166·4 g, respectively. High‐burden MTV (≥56·4 cm 3 ), TLG (≥166·4 g) and high‐risk PET/CT findings differed significantly in progression‐free survival (PFS) and overall survival (OS). High‐burden MTV and TLG findings also predicted survival outcomes in young patients (age <75 years) and patients with high‐risk chromosomal abnormalities. High‐burden MTV and TLG independently predicted both worse PFS and OS. Pre‐treatment MTV and TLG independently predicted survival outcomes in clinical practice and may be more useful than high‐risk PET/CT variables.