Stage I multiple myeloma: value of MR imaging of the bone marrow in the determination of prognosis.

Berg, B C Van de; Lecouvet, Frédéric; Michaux, Lucienne; Labaisse, M A; Malghem, Jacques; Jamart, Jacques; Maldague, Baudouin; Ferrant, Augustin; Michaux, Jean‐Louis

doi:10.1148/radiology.201.1.8816551

Cited by 92 publications

(28 citation statements)

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“…Although MGUS and SMM are defined as asymptomatic stages of monoclonal plasma cell diseases, where bone destruction has not taken place yet, these findings are not surprising: focal lesions in patients with asymptomatic MM have been demonstrated by other authors before. 16,29,30 Nevertheless, the number of focal lesions observed in our study was significantly higher in patients with MM compared to those with MGUS and SMM. Equivalent results were observed for the presence of diffuse bone marrow infiltration as well as their further categorization into S1P, moderate or severe patterns.…”

Section: Discussioncontrasting

confidence: 64%

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

Kloth

Hillengaß

Listl

et al. 2014

Intl Journal of Cancer

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The aim of our study was to assess in which way different infiltration patterns of monoclonal plasma cell diseases in wholebody (wb) magnetic resonance imaging (MRI) are associated with clinical stages, plasma cell content in bone marrow samples and established serum markers of disease activity. Institutional review board approval was obtained. We performed wb-MRI in 547 consecutive, unselected and untreated patients with monoclonal gammopathy of undetermined significance (MGUS, n 5 138), smoldering myeloma (SMM, n 5 157) and multiple myeloma (MM, n 5 252) on two 1.5 T MRI-scanners with body array coils. The studies were evaluated in consensus by two experienced radiologists blinded to the diagnosis. We observed focal lesions in 23.9% (MGUS), 34.4% (SMM) and 81.3% (MM), respectively. A diffuse infiltration pattern was detected in 38.4%, 45.9% and 71%, respectively. The differences between all infiltration patterns were significant (p < 0.0001). The presence of focal lesions and the presence of a diffuse bone marrow infiltration was associated with an increased plasma cell percentage in bone marrow samples (median 22% vs. 14%, 26% vs. 10%, both p < 0.0001) and monoclonal protein concentration (median 18 g/dl vs. 13 g/dl, p 5 0.003, 20 g/dl vs. 11 g/dl, p < 0.0001). Further categorization of the diffuse infiltration patterns in wb-MRI into "salt-and-pepper," moderate and severe identified significant associations with M-protein (median g/dl for S1P/moderate/severe 23/18/25, p 5 0.04), plasma cell percentage in the bone marrow (median 25%/24%/40%, p 5 0.02), and age (median years 67/60/57, p < 0.0001). Bone marrow infiltration in wb-MRI is significantly different between the various stages of plasma cell disease and correlates well with established markers of disease activity.Monoclonal plasma cell diseases like multiple myeloma (MM), monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM) are a group of hematologic premalignant or malignant disorders associated with monoclonal proliferation of plasma cells mainly in the bone marrow.1,2 Although MGUS, being the most common disorder of plasma cells and occurring in 2% of persons older than 50 years, has an overall annual risk of progression of only 1% per year, the rate of transformation of SMM to MM or systemic amyloidosis (AL) has been shown to be 10% per year in the first 5 years. [3][4][5][6] In the aforementioned monoclonal plasma cell disorders, the bone marrow involvement may be present in different patterns: diffuse bone marrow infiltration and focal lesions. Diffuse bone marrow infiltration is characterized by malignant plasma cells, mixed up with normal bone marrow cells, still preserving the cancellous bone structure. Focal lesions are circumscribed solid foci of plasma cells with the potential of destruction of the cancellous and cortical bone.To image these changes, plain radiographs (PRs), computed tomography (CT) and magnetic resonance imaging (MRI) are currently in routine use. 7 Although PR has been an integral part of...

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Section: Discussioncontrasting

confidence: 64%

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

Kloth

Hillengaß

Listl

et al. 2014

Intl Journal of Cancer

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“…Serial testing of the peripheral blood can show an increase in circulating plasma cells preceding the development of overt myeloma. Although some studies have shown that a magnetic resonance imaging study showing focal lesions may predict for progression in these patients [14,15], we and others have identified false positive and false negative readings in such patients. Other studies have also shown that screening bone mineral density is not a useful predictor of progression in asymptomatic stage 1 multiple myeloma patients, but we believe that bone mineral density should be measured in all patients with radiologic evidence of osteoporosis.…”

Section: Emerging Therapiescontrasting

confidence: 53%

Smoldering, asymptomatic stage 1, and indolent myeloma

Greipp

2000

Curr. Treat. Options in Oncol.

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Of patients presenting with multiple myeloma, 5% to 15% satisfy criteria for the diagnosis of multiple myeloma but have no or minimal symptoms and do not require chemotherapy (NRC). These patients are classified as having smoldering, asymptomatic stage 1, or indolent multiple myeloma in order of their increasing risk of progression. We avoid chemotherapy, especially with alkylating agents in such patients, and we either closely monitor them or use a nonchemotherapeutic intervention. If significant bone lesions, renal failure, or hypercalcemia occur, chemotherapy or transplant is recommended. Patients with mild anemia or with small or isolated bone lesions who are asymptomatic or minimally symptomatic because of anemia may be monitored and are classified as having indolent multiple myeloma. Unnecessary treatment with melphalan or cyclophosphamide probably has no benefit in multiple myeloma NRC and can cause significant risk. In long-term follow up, 25% of patients receiving alkylating agents develop myelodysplastic syndrome or acute leukemia. Patients who do not receive chemotherapy must be monitored closely to avoid complications of overt multiple myeloma, including anemia, bone lesions, renal failure, and hypercalcemia. We and others have begun to take a more active approach with the use of nonchemotherapeutic agents in selected patients. We use bisphosphonates in patients with bone lesions or osteoporosis or when there is a progressive rise in M-protein. We use dexamethasone alone in NRC multiple myeloma to reduce tumor burden in selected patients who do not yet have overt multiple myeloma or who are not candidates for chemotherapy. We use bisphosphonates to prevent osteoporosis in such patients. We use erythropoietin to correct anemia, and dexamethasone and erythropoietin together in patients with higher tumor burden (eg, indolent multiple myeloma). Future progress in treating multiple myeloma NRC depends on better identification of new therapeutic targets that control progression from the stable asymptomatic to the progressive symptomatic phase of multiple myeloma. We need to better understand the biologic target of new agents like thalidomide to design more effective treatment for this early phase of multiple myeloma. Although these approaches may delay chemotherapy, it is not known whether survival is prolonged. Nonchemotherapeutic approaches must be systematically studied in clinical trials in order to be put to better use.

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“…The incidence of a monoclonal gammopathy (M-protein) is present in 30-75% of cases (especially for bone presentation, usually minimally elevated [IgG <5 g/L, IgA <20 g/L], and urine monoclonal kappa or lambda <1.0 g/24 h) [8][9]. Tsang et al [4] observed the following myeloma protein levels in the blood of 46 patients with SP: normal 59%, minimally elevated 28% and elevated 13%.…”

Section: Diagnostic Work-upmentioning

confidence: 99%

“…A suppression of the normal immunoglobulin classes, also known as immunoparesis, correlates with a higher risk of progressing to MM [33,36]. M-protein levels are reported to be a predictive factor of occult disseminated disease, and patients showing persistent M-protein levels for more than one year after RT are prone to progress to MM [8,16,37]. Anaplastic plasmacytomas (those with a higher histologic grade) [26] and tumors with a high level of angiogenesis [9] are associated with poorer outcomes.…”

Section: Prognostic Factors Affecting the Outcomementioning

confidence: 99%

Radiation therapy for the solitary plasmacytoma

Kocak

Ballerini²,

Zouhair³

et al. 2010

Turk J Hematol

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Plasma-cell neoplasms are classically categorized into four groups as: multiple myeloma (MM), plasma-cell leukemias, solitary plasmacytomas (SP) of the bone (SPB), and extramedullary plasmacytomas (EMP). These tumors may be described as localized or diffuse in presentation. Localized plasma-cell neoplasms are rare, and include SP of the skeletal system, accounting for 2-5% of all plasma-cell neoplasms, and EMP of soft tissue, accounting for approximately 3% of all such neoplasms. SP is defined as a solitary mass of neoplastic plasma cells either in the bone marrow or in various soft tissue sites. There appears to be a continuum in which SP often progresses to MM. The main treatment modality for SP is radiation therapy (RT). However, there are no conclusive data in the literature on the optimal RT dose for SP. This review describes the interrelationship of plasma-cell neoplasms, and attempts to determine the minimal RT dose required to obtain local control. (Turk J Hematol 2010; 27: 57-61) Key words: Solitary plasmacytoma, radiotherapy, multiple myeloma, management Received: September 17, 2009 Accepted: March 3, 2010 ÖzetPlazma hücre malignitesi klasik olarak dört gruptur: multiple myelom (MM), plazma hücre lösemisi, kemik yerleşimli soliter plazmasitom (SPB) ve ekstrameduller yerleşimli plazmasitom (EMP). Lokalize plazma hücre malignitesini iskelet sistemi yerleşimli SP ve EMP oluşturur. Plazmasitoma birçok farklı şekilde tanımlanabilir. Çoğunlukla kemik iliğinde veya yumuşak dokuda plazma hücrelerinden oluşan bir kitle şeklinde görülür. Henüz, soliter plazmositomların MM'a dönüşümü arasindaki ilişki tam olarak tanımlanmamıştır. Soliter plazmositomlar, hem SPB hem de EMP için ana tedavi radyoterapidir. Ancak, SP için uygun tedavi dozu için ortak bir data yoktur. Lokal kontrol için optimal doz hastalığın yerine ve boyutuna bağlı olarak 30 ve 50 Gy arasında değişmektedir. Bu derlemede lokal kontrol için minimal RT dozu tanımlanmaya çalışılmıştır.(Turk J Hematol 2010; 27: 57-61) Anahtar kelimeler: Soliter plazmasitom, radyoterapi, multipl miyelom, tedavi yaklaşımı

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Stage I multiple myeloma: value of MR imaging of the bone marrow in the determination of prognosis.

Abstract: MR imaging of the bone marrow in patients with stage I multiple myeloma is an independent factor in the prediction of disease progression.

Cited by 92 publications

References 0 publications

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

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

Smoldering, asymptomatic stage 1, and indolent myeloma

Radiation therapy for the solitary plasmacytoma

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