TY - JOUR T1 - The Role of <sup>18</sup>F-FDG-PET/CT Imaging in Predicting Outcome of Patients with Newly Diagnosed Multiple Myeloma JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 1678 LP - 1678 VL - 62 IS - supplement 1 AU - Esther Mena AU - Maria Liza Lindenberg AU - Ismail Turkbey AU - Stephen Adler AU - Philip Eclarinal AU - Yolanda McKinney AU - Juanita Weaver AU - Peter Choyke AU - Dickran Kazandjian Y1 - 2021/05/01 UR - http://jnm.snmjournals.org/content/62/supplement_1/1678.abstract N2 - 1678Objectives: 18F-FDG PET is a useful functional imaging modality for characterizing bone marrow disease in patients with multiple myeloma and may assist clinicians in deciding optimal treatment strategies. We investigate whether FDG-PET parameters, including number of focal bone marrow lesions, maximum standardized uptake value (SUVmax) and the presence of extramedullary disease (EMD) at baseline and at pre-maintenance therapy can predict prognosis of newly diagnosed multiple myeloma patients. Methods: We evaluated 25 patients with newly diagnosed multiple myeloma (10 women, 15 men, median age 69 yo; range 41 to 83 yo) treated with carfilzomib, lenalidomide, and dexamethasone (KRd). All patients underwent serial monitoring for minimal residual disease (MRD) using multi-parametric flow cytometry and 18F-FDG-PET/CT at baseline, achievement of complete response and/or after 8, 20 and 32 cycles and at termination of therapy. We evaluated the prognostic value of FDG-PET parameters (i.e. number of lesions, SUVmax, and the presence of EMD at baseline (n=25) and before starting maintenance therapy (n=21), using Kaplan-Meier and Cox regression analysis. Results: All 25 patients were followed: 11/25 patients had complete response, whereas 14/25 patients had progressive disease (median time to progression of 30.2 months, range: 8.1 to 86 months) and 6 of them expired. At baseline, 21/25 patients had a positive FDG-PET/CT scan, identifying at least 1 bone marrow lesion, numbered a total of 250 lesions, with 5 patients demonstrating EMD. At baseline FDG-PET/CT scan, number of lesions (p=0.02), SUVmax (p=0.05), and the presence of EMD (p=0.02) were independent predictor factors of progression free survival (PFS), but not at pre-maintenance therapy scan. At pre-maintenance therapy, MRD was negative by flow-cytometry in 21 patients while 3 patients showed progression and 1 patient showed partial response. FDG-PET/CT was positive at pre-maintenance therapy in 11/21 patients with negative MRD by flow cytometry, and negative in the remainder 10/21 patients. Conclusions: FDG-PET/CT appears to be a reliable predictor of outcome in patients with newly diagnosed multiple myeloma. Patients with higher number of focal lesions, higher SUVmax and the presence of EMD at baseline FDG-PET/CT may experience a higher risk for progression than those with fewer lesions, lower uptake values and without EMD. ER -