Cystic transformation of focal lesions after therapy is associated with remission but adverse outcome in myeloma

摘要

Response assessment in multiple myeloma (MM) isbased on measurements of monoclonal proteins andminimal residual disease (MRD) in bone marrow samplesfrom the iliac crest1. Since discrete areas of plasma cellaccumulation can be visualized as focal lesions (FL) bymagnetic resonance imaging (MRI) as well as positronemissioncomputed tomography (PET/CT), the InternationalMyeloma Working Group (IMWG) has includedMRI and PET/CT in their updated guidelines for primarydiagnosis and follow-up1,2. We analyzed conventionalMRI at primary diagnosis and after ASCT in newlydiagnosed patients enrolled in the prospective MM5 trial(EudraCT No. 2010-019173-16) of the German-SpeakingMyeloma Multicenter Group (GMMG). Treatment ofnewly diagnosed, symptomatic MM patients within theGMMG MM5 trial consisted of three cycles PAd (bortezomib,doxorubicin, dexamethasone) or VCD (bortezomib,cyclophosphamide, dexamethasone) inductiontherapy; high dose melphalan followed by ASCT as well asconsolidation and maintenance therapies with lenalidomidefor 2 years or until complete response (CR) (SupplementalFig. 1).