Diffuse pattern of bone marrow involvement on magnetic resonance imaging is associated with high risk cytogenetics and poor outcome in newly diagnosed, symptomatic patients with multiple myeloma: A single center experience on 228 patients

Abstract

Magnetic Resonance Imaging (MRI) and specific cytogenetic abnormalities offer important prognostic information for myeloma patients. However, limited data are available about the association between cytogenetic abnormalities and MRI patterns of marrow infiltration. To address this issue, we analyzed 228 consecutive newly diagnosed, symptomatic patients who were diagnosed and treated in a single center. On bone marrow MR images, 95 (41%) patients had diffuse, 94 (41%) had focal, 35 (15%) were normal, and 4 (1.7%) patients had variegated pattern of marrow infiltration. High risk cytogenetics were more commonly observed with diffuse MRI pattern (50% vs. 31% in focal and normal patterns). Patients with diffuse MRI pattern had poorer survival compared to others and responded better to novel agent-based therapies than to conventional chemotherapy (objective response: 88% vs. 46%, P < 0.001). There was a significant improvement of patients' survival with a diffuse MRI pattern when treated upfront with novel agents compared to conventional chemotherapy (47 vs. 24 months; P < 0.001). Diffuse MRI pattern along with ISS-3 and high risk cytogenetics could identify a very high risk group of patients with extremely poor median survival (21 months) and an only 35% probability of 3-year OS. Our study shows that symptomatic myeloma patients with a diffuse MRI pattern at diagnosis very often show high risk cytogenetic abnormalities and are benefiting from upfront novel agent-based therapies. Diffuse MRI pattern in combination with high risk cytogenetics and ISS-3 can identify a subset of myeloma patients with very poor prognosis who may need innovative treatment strategies and possibly more aggressive therapies. Am. J. Hematol. 87:861-864, 2012. V

Prognostic significance of bone marrow abnormalities in the appendicular skeleton of patients with multiple myeloma

“…A diffuse bone marrow pattern in the central bone is thought to be proceeded by the appearance of a focal pattern in the majority of patients. 21 Similarly, abnormal bone marrow lesions with a fatty and diffuse pattern in the AS correlated with the progression of MM and its tumor burden. 9 In the present study, medullary abnormalities were significantly associated with Durie-Salmon stage 3, R-ISS stage 3, creatinine level .2.0 mg/dL, and the proportion of bone marrow PCs.…”

Appearance of monoclonal plasma cell diseases in whole‐body magnetic resonance imaging and correlation with parameters of disease activity

“…16 Focal lesions and diffuse tumor cell infiltration detected by wb-MRI have been demonstrated to be of prognostic significance for predicting progression free and overall survival in monoclonal plasma cell diseases. [17][18][19] Therefore, the aim of our study was to assess in which way different infiltration patterns are associated with clinical stages, plasma cell content in bone marrow samples and established serum markers of disease activity.…”

The role of positron emission tomography-computed tomography and magnetic resonance imaging in diagnosis and follow up of multiple myeloma

“…51 This group also confronted MRI results of 228 newly diagnosed and symptomatic patients with other disease parameters, obtained treatment responses and survival. 13 A diffuse MRI pattern was seen more frequently seen in patients with high-risk cytogenetics and associated with a worse OS compared to other patterns. Combining the diffuse MRI pattern with the ISS score and cytogenetics identified a very high-risk group of patients with a 35% survival rate at three years.…”

“…Combining the diffuse MRI pattern with the ISS score and cytogenetics identified a very high-risk group of patients with a 35% survival rate at three years. 13 The earlier cited study of Walker et al also investigated the prognostic value of MRI and showed a shorter OS of patients with more than 7 lesions compared to those without lesions or with 7 lesions or less. 11 Bartel et al did not confirm a significant difference in OS according to the number of lesions detected by MRI, but event-free survival was closely correlated with the number of lesions detected (>7 or ≤ 7 lesions).…”

“…A focal as well as a diffuse infiltration pattern carries an adverse prognostic value in both symptomatic and asymptomatic MM. [11][12][13] Bone lesions often include cortical breakthrough and extension into the soft tissues. A finding of epidural extension arouses particular concern because of the potential for cord compression, an oncological emergency.…”