Abstract
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Objectives: Multiple Myeloma (MM) is a rare but malignant hematological cancer, which is caused by proliferation of a single clone of plasma cells in the bone marrow. Chemotherapy is one of the most commonly used treatments for these patients usually a combination of corticosteroids or immunomodulating agents. We have studied the alterations of brain FDG uptake in MM patients before and after chemotherapy as a surrogate for brain glucose metabolism.
Methods: This study is part of the FULIMA study, a prospective study at Odense University Hospital in Denmark (NCT02187731). Patients with MM without history of any prior chemotherapy were included. Patients with other inflammatory conditions, recent biological therapies, recent radiotherapy or surgery were excluded. FDG PET/CT was performed baseline, before induction treatment and two months after high dose chemotherapy and stem cell transplantation. Supratentorial (including individual measurements for frontal, parietal, occipital and temporal lobes) and cerebellar FDG uptakes were measured by manual placement of ROIs (regions of interest) over these regions based on predefined criteria for each. The SUVmean across all slices was then calculated for each lobe and region, using OsiriX software; Pixmeo, Bemex, Switzerland).
Results: 21 patients with MM were included in this study with mean age of 64.85±7.15 years. The mean SUVmean of supratentorial brain was 7±1.3 on pretreatment scan compared to 6.72±1.7 on posttreatment scan (p-value<0.0001). The mean SUVmean for cerebellum was also lower on posttreatment FDG PET-CT (6.26±1.08 versus 5.97±0.85, p-value<0.002).
Conclusion: These findings confirm lower 18F-FDG uptake in supratentorial brain and cerebellum after combined induction treatment (IT), high dose chemotherapy and stem cell transplantation.