Magnetic Resonance Appearance of Monoclonal Gammopathies of Unknown Significance and Multiple Myeloma

Bellaïche, Laurence; Laredo, Jean‐Denis; Lioté, Frédéric; Ac, Koeger; Hamzé, B.; Jm, Ziza; Pertuiset, Édouard; Bardin, Thomas; Jm, Tubiana

doi:10.1097/00007632-199711010-00017

Cited by 33 publications

(19 citation statements)

References 17 publications

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“…Thus, in the context of clinical suspicion of relapse after HSCT, imaging techniques, such as CT, MRI and positron-emission tomography (PET) studies, are useful in detecting EM MM relapse, in the evaluation of response and are currently being evaluated in larger studies. 38,39 New options for salvage treatment for MM, especially after treatment intensification, include agents, such as thalidomide and bortezomib, that target the marrow microenvironment, angiogenesis, NFkB targets and MM cells. 10,40,41 Both have proven to be effective in about 35% of relapsed or refractory MM patients, showing increased efficacy in combination with other MM-effective drugs, such as dexamethasone, melphalan, cyclophosphamide and others.…”

Section: Discussionmentioning

confidence: 99%

Extramedullary vs medullary relapse after autologous or allogeneic hematopoietic stem cell transplantation (HSCT) in multiple myeloma (MM) and its correlation to clinical outcome

Zeiser

Deschler

Bertz

et al. 2004

Bone Marrow Transplant

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Summary:Risk-adapted treatment of multiple myeloma (MM) includes autologous (auto-) and allogeneic (allo-) hematopoietic stem cell transplantation (HSCT). Case reports on extramedullary (EM) compared to bone marrow (BM) relapse after HSCT suggest a dismal prognosis. We compared the outcome of 78 MM patients relapsing after auto-(group A: n ¼ 53) or allo-(group B: n ¼ 25) HSCT, stratified into BM (64 patients) vs EM (14 patients) relapse. The relapse-specific groups were also compared with respect to risk factors, including age, b2-microglobulin, pretreatment, cytogenetics and stage. EM relapse sites were lungs (5), soft tissue (4), pericardium (2), bone (1), skin (1) and CNS (1). As of May 2004, the overall (OS) and progression-free (PFS) survival after HSCT in patients relapsing from EM sites was not significantly different from BM relapse patients, both after auto-and allo-HSCT. Although MM patients relapsing from EM sites after allo-HSCT used to be regarded as having few therapeutic options, we observed encouraging responses to donor lymphocyte infusions (DLI). Treatment responses to DLIs were observed in 5/9 (56%) BM relapse patients, and in 3/4 (75%) EM relapse patients. These observations suggest that EM relapse after HSCT is common and needs an individualized diagnostic and therapeutic approach in MM during clinical follow-up after HSCT.

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Section: Discussionmentioning

confidence: 99%

Extramedullary vs medullary relapse after autologous or allogeneic hematopoietic stem cell transplantation (HSCT) in multiple myeloma (MM) and its correlation to clinical outcome

Zeiser

Deschler

Bertz

et al. 2004

Bone Marrow Transplant

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“…Four out of 7 patients with abnormal initial MRI results, but none of 30 patients with normal findings showed progressive disease at follow-up. These data are supported by the results of a prospective multicenter study [19]. The French group performed MR examinations of the thoracolumbar spine in 24 patients with newly diagnosed monoclonal gammopathies and compared them with those of 44 untreated myeloma patients.…”

Section: Multiple Myelomamentioning

confidence: 69%

Magnetic Resonance Imaging of the Bone Marrow: Malignant Lymphoma – Multiple Myeloma – Bone Marrow

Golder¹

1999

Oncol Res Treat

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Magnetic resonance imaging (MRI) has become the most applied imaging technique in evaluating lymphomatous diseases, multiple myeloma, myelodysplastic syndromes, and gross therapeutic effects in bone marrow. The tomograms help explain the etiology of pain, palsy, and other clinical symptoms in patients with hematologic malignancies by elucidating osseous and extra-osseous components in their relationships to nerves and vessels. Moreover, MRI permits the detection of bone marrow abnormalities before skeletal lesions become evident on plain radiographs, but it cannot reliably predict the histological nature of a marrow lesion, just like bone marrow scintigraphy. Almost every third of the patients who have had negative bone marrow biopsies for malignant lymphoma, will be recognized as suffering from marrow involvement on a subsequent MR imaging procedure. Consequently, the clinical stage IV will be assigned to a remarkable percentage of patients on the basis of MRI results. In multiple myeloma, MRI has proved to be very reliable for depicting all types of marrow involvement. To assess the local extent of the tumor and to search for other thus far hidden foci of the disease, the technique has become an integral part of the staging procedure in patients with solitary plasmacytoma. All three fundamental MR patterns of abnormal bone marrow have been observed in patients with multiple myeloma, the focal one being most frequent. The prognostic significance of the different MR patterns is controversial. MRI identifies patients at high risk for the development of vertebral collapses, but cannot predict the time and precise level of the fracture. The criteria defined for differentiating benign and malignant vertebral collapses at MRI are quite reliable. Quantitative MRI seems to enable monitoring of treatment response. The typical fatty appearance of the irradiated spine is irreversible for doses exceeding 30 Gy and serves as a dependable indicator for the extent of the irradiation field. MRI can direct harvest procedures for autologous bone marrow transplantation to sites of relatively unaffected marrow. In the evaluation of the status of bone marrow after transplantation, quantitative contrast-enhanced MRI seems to be a promising new tool, because the degree and rate of gadolinium chelate uptake depends on the cellularity of the marrow.

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“…Therefore, according to the authors, abnormal MRI patterns in patients with smoldering multiple myeloma may justify the initiation of systemic treatment. In another study on 24 patients with MGUS who underwent an MRI of the thoracolumbar spine, all patients had normal scans, compared with only 86% of patients with smoldering multiple myeloma [58]. …”

Section: Bone Imaging In Monoclonal Gammopathy Of Undetermined Signifmentioning

confidence: 99%

Bone disease in multiple myeloma and precursor disease: novel diagnostic approaches and implications on clinical management

Kristinsson¹,

Minter²,

Korde³

et al. 2011

Expert Review of Molecular Diagnostics

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The manifestations of bone involvement in patients with multiple myeloma (MM) can have devastating clinical effects and increase mortality. Recent studies demonstrate that patients with the precursor conditions smoldering MM (SMM) and monoclonal gammopathy of undetermined significance (MGUS) show evidence of bone disease and increased risk of fractures. The understanding of the pathogenesis of bone disease in MM has expanded in recent years. The traditional skeletal survey will probably be replaced by newer and more sensitive imaging techniques, which may have a prognostic impact and change our definition of MGUS and SMM. Bisphosphonates are recommended to prevent skeletal events in patients with MM, and have also been studied in SMM and MGUS. This article summarizes the current knowledge of bone disease in plasma cell disorders, and discusses the current standard and future role of novel imaging techniques, as well as the evidence and current guidelines for bisphosphonates in MM, SMM and MGUS.

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Magnetic Resonance Appearance of Monoclonal Gammopathies of Unknown Significance and Multiple Myeloma

Cited by 33 publications

References 17 publications

Extramedullary vs medullary relapse after autologous or allogeneic hematopoietic stem cell transplantation (HSCT) in multiple myeloma (MM) and its correlation to clinical outcome

Extramedullary vs medullary relapse after autologous or allogeneic hematopoietic stem cell transplantation (HSCT) in multiple myeloma (MM) and its correlation to clinical outcome

Magnetic Resonance Imaging of the Bone Marrow: Malignant Lymphoma – Multiple Myeloma – Bone Marrow

Bone disease in multiple myeloma and precursor disease: novel diagnostic approaches and implications on clinical management

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