In an analysis reported in the Journal of Clinical Oncology, Zamagni et al found that fluorodeoxyglucose F-18 (FDG) uptake of less than 4 on the Deauville scale in bone marrow and focal lesions on pre–maintenance therapy FDG positron-emission tomography/computed tomography (PET/CT) scans was associated with improved survival outcomes in patients with newly diagnosed multiple myeloma.
Study Details
The analysis included data on 288 transplantation-eligible patients from two European phase III trials. One trial (IFM/DFCI2009) evaluated the combination of eight cycles of lenalidomide, bortezomib, and dexamethasone (RVD) vs RVD plus autologous stem-cell transplantation (ASCT) followed by lenalidomide maintenance. The other (EMN02/HO95) compared single vs double ASCT vs proteasome inhibitor–based intensification therapy after three to four cycles of bortezomib-based induction therapy and consolidation therapy vs no consolidation followed by lenalidomide maintenance. In both studies, FDG PET/CT scans were performed at baseline and before starting maintenance therapy (premaintenance scans).
“Focal lesion and bone marrow FDG uptake lower than the liver background [Deauville scale score < 4] after therapy was an independent predictor for improved progression-free survival and overall survival and can be proposed as the standardized criterion of PET complete metabolic response, confirming the value of the Deauville scale for patients with multiple myeloma.”— Zamagni et al
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The 5-point Deauville scale was used to quantify FDG uptake in bone marrow and focal lesions, with the association of premaintenance scan scores with clinical outcomes being evaluated (only scores > 1 considered positive for focal lesions or bone marrow uptake). Multivariate analysis included adjustment for age; sex; International Staging System (ISS) or ISS-Revised stage; presence of baseline cytogenetic abnormalities; and serum hemoglobin, albumin, calcium, platelet, lactate dehydrogenase, and β2-microglobulin levels.
Key Findings
The 228 patients were followed for a median of 62.9 months. At baseline, 78.1% of patients had focal lesions (11% extramedullary), with 82.0% having focal lesion scores ≥ 4. All patients had bone marrow diffuse uptake, with 35.5% having bone marrow scores ≥ 4.
At the premaintenance scan, 31.2% of patients had visually detectable focal lesions (2% extramedullary), with 32.3% of these having scores of 2 or 3 (24.2%) and 67.7% having scores ≥ 4. Residual bone marrow diffuse uptake was retained in 98.5%, with scores of 2 or 3 in 91.3% and ≥ 4 in 8.7%.
Median progression-free survival was 44.9 months vs 26.6 months (hazard ratio [HR] = 0.60, P = .030) among patients with premaintenance focal lesion scores < 4 vs ≥ 4 and 41.9 vs 26.6 months (HR = 0.48, P = .028) among those with premaintenance bone marrow scores < 4 vs ≥ 4.
Overall survival at 5 years was 77.7% vs 64.1% (HR = 0.48, P = .028) among patients with premaintenance focal lesion scores < 4 vs ≥ 4 and 76.7% vs 52.1% (HR = 0.29, P = .003) among those with premaintenance bone marrow scores < 4 vs ≥ 4.
On multivariate analysis, focal lesion scores < 4 and bone marrow scores < 4 remained significantly associated with improved progression-free survival (HR = 0.60, P = .030; HR = 0.50, P = .041) and overall survival (HR = 0.34, P = .004; HR = 0.25, P = .005).
The investigators concluded: “Focal lesion and bone marrow FDG uptake lower than the liver background [Deauville scale score < 4] after therapy was an independent predictor for improved progression-free survival and overall survival and can be proposed as the standardized criterion of PET complete metabolic response, confirming the value of the Deauville scale for patients with multiple myeloma.”
Elena Zamagni, PhD, of the “Seràgnoli” Institute of Hematology, Bologna University School of Medicine, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by grants from the French Ministry of Health, French National Agency for Research, and others. For full disclosures of the study authors, visit ascopubs.org.
