Claudio Cerchione, MD, PhD, on Staging Multiple Myeloma: New Findings on FDG PET/CT Scans and Whole-Body MRI

In [the] last year, we have seen a great therapeutic revolution in multiple myeloma, according to many new drugs and new combination that have been approved and registered. However, I think that we should also concentrate and optimize the use of therapeutic solution and of novelties that we have seen in last years, thanks to the concentration on diagnostic tools. In this institution that we have realized, in my cancer center, we have seen the combination between whole body MRI, together with the PET FDG, which is the standard of care worldwide, both in patient newly diagnosed in relapsed refractory. And we have checked these diagnostic tools, is smoldering myeloma, as you can see in another poster presentation. Also, a task for 2024. We have seen that the combination of the double technique can totally change the journey of our patient, particularly thanks to the accuracy of whole body MRI, that is of about 97 as we have seen. And we have studied 73 patients, both newly diagnosed in the relapsed refractory. In which we have seen that in 26% of them, the combination of techniques can change their journey, particularly changing the potential treatment that we can anticipate before that signs and symptoms arise. And I think that this is particularly important because we can start to treat the patient before that he is going to suffer for myeloma pains. In particular, the combination of whole body MRI together with FDG-PET, can better characterize the bone lesion that are the main characteristic for which we treat the patient in multiple diagnosis and relapse and refractory setting. And this was the first part of the study, the radiomic part that we have presented here. But we are going to, in some way, potentiate to the study, adding a biologic characterization of our patient, in which we want to develop new biomarkers' evaluation, in the idea of having a biomarkers driven approach in next future studying metabolomic pathways. In order to start maybe to think to a dream, the personalized medicine in multiple myeloma. Which thanks to this multiomic study, we can better characterize, thanks to new generation tools our patient, and really optimize the exact drug for every patient. I think that the time is mature to concentrate on also a new prognostic score in multiple myeloma because we have seen a changing over the treatment, both in newly [inaudible 00:02:40] and the relapsed refractory setting. But we should now concentrate in changing the prognostic index that is of many years ago. This is the way to optimize all what we offer to our patient. Not only in terms of treatment, but also in terms of lifetime expectancy. And thanks to biological characterization that we are performing inside this study, we dream also to think about an MRD evaluation that could take to maybe a treatment-free remission or to optimize the dosing, dose dense and dose intensity of the drug, imagining to in some way have the patient not in ongoing treatment. And this is what they want. However, I think that the optimization of diagnostic tools can be in some way something that will help us to run toward the cure in multiple myeloma. That is not so far, and this is the best wish that we give to our patients, to their caregivers, and to all myeloma researchers around the world.