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The prognostic importance of the presence of more than one focal lesion in spine MRI of patients with asymptomatic (smoldering) multiple myeloma

Leukemia volume 28, pages 2402–2403 (2014)Cite this article

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Patients with asymptomatic multiple myeloma (AMM) are at risk for development of symptomatic disease requiring therapy, at the rate of about 10% per year, in the first 5 years after diagnosis.1 However, while some patients with AMM have a relatively low risk approaching that of monoclonal gammopathy of undetermined significance, there is a subset of patients with AMM at very high risk for imminent development of disease complications (that is, within 1–2 years after diagnosis). Such complications may include bone fractures (commonly vertebral compression fractures) or acute renal injury and renal insufficiency, which increase the morbidity and mortality of MM patients. Currently, it is recommended that patients with AMM should be followed closely without therapy;2 however, a recent clinical trial indicated that for patients at high risk for progression, early intervention may be beneficial.3 Thus, for these ‘high-risk’ patients early intervention is now indicated by many experts,4 in order to avoid catastrophic complications of the disease. Nevertheless, the identification of high-risk patients is challenging and requires the consideration of several different disease characteristics. The Mayo Clinic group recently identified that patients with extensive BM infiltration (⩾60%) or with extremely abnormal free light chains (FLC) ratio (>100) are at very high risk for imminent progression within <2 years from the diagnosis of AMM.5,6 Our group has also confirmed that the above risk features identify a subset of patients with AMM at very high risk for progression, within 12–18 months from diagnosis.7 The Spanish group has proposed more sophisticated criteria, which require high-quality, flow cytometric analysis.8 In view of the need for widely available methods to identify high-risk patients, imaging studies may offer significant information. Moulopoulos et al. has published since the 90s the prognostic importance of spine magnetic resonance imaging (MRI) for patients with symptomatic9 and asymptomatic MM.10 Hillengass et al.11 published data indicating that patients with more than one focal lesion in whole-body MRI are at high risk for progression to symptomatic disease; however, whole-body MRI is not widely available. Our group also identified abnormal spine MRI (with either a focal or a diffuse pattern) as a factor associated with a high risk of progression to symptomatic MM.7 Recently the SWOG S0120 study also identified focal lesions in spine MRI as a predictor of disease progression.12 Thus, it is now increasingly recommended that spine MRI should be considered in the initial workup of patients with AMM with high-risk features and that patients with more than one focal lesion should be considered for early intervention.4

Herein, we present data from our database of patients with AMM with available spine MRI at diagnosis and with mature follow-up, in order to evaluate the prognostic importance of the presence of focal lesions in spine MRI for the identification of patients with AMM at high risk of progression.

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  1. Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    E Kastritis, E Terpos & M A Dimopoulos

  2. 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    L A Moulopoulos & V Koutoulidis

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  1. E Kastritis
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Correspondence to M A Dimopoulos.

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Kastritis, E., Moulopoulos, L., Terpos, E. et al. The prognostic importance of the presence of more than one focal lesion in spine MRI of patients with asymptomatic (smoldering) multiple myeloma. Leukemia 28, 2402–2403 (2014). https://doi.org/10.1038/leu.2014.230

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