Hi Multibilly,
It is whole body, all of it. Althoug the X-ray is done incremental. The other machines are enormous.
The main problem is to lay absolutely still for 20-30 minutes while going in and out. Some of the tubes are pretty narrow ... slightly claustrophobic.
And no: It is a trial, so they give the full package.
Best regards,
Lev
Forums
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Lev - Name: Lev
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: June 2014
- Age at diagnosis: 57
Re: To PET or not to PET
Is a negative PET a new criteria for CR? Is it used in MRD testing?
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blair77 - Who do you know with myeloma?: My husband
- When were you/they diagnosed?: April 2013
- Age at diagnosis: 43
Re: To PET or not to PET
Not a clue 
Somebody?
Somebody?
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Lev - Name: Lev
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: June 2014
- Age at diagnosis: 57
Re: To PET or not to PET
Hi Blair,
There are no new criteria for whether or not a patient has achieved a complete response (CR). They are still:
1. M-spike = 0 (negative immunofixation of serum and urine)
2. Absence of any soft-tissue (extramedullary) plasmacytomas
3. Less than 5 percent plasma cells in the bone marrow
See table 1 in this paper,
SV Rajkumar et al, "Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1," Blood, 5 MAY 2011, 177:18
The only potential role for PET scanning would be in helping to determine if any soft-tissue plasmacytomas present at diagnosis were now gone. But that's a role that is not new.
As for MRD, there isn't yet a standard for MRD testing, although the IMWG is working on one. PET is one approach that could be used for helping to determine MRD status, but the typical approach involves testing of cells from bone marrow samples.
See Dr. Shain's recent posting here for some more additional thoughts on CR, MRD, etc.
"Re: Complete response after ASCT ... or not?", posting by Beacon Medical Advisor Dr. Ken Shain on Sep 28, 2014
Hope this helps a bit.
There are no new criteria for whether or not a patient has achieved a complete response (CR). They are still:
1. M-spike = 0 (negative immunofixation of serum and urine)
2. Absence of any soft-tissue (extramedullary) plasmacytomas
3. Less than 5 percent plasma cells in the bone marrow
See table 1 in this paper,
SV Rajkumar et al, "Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1," Blood, 5 MAY 2011, 177:18
The only potential role for PET scanning would be in helping to determine if any soft-tissue plasmacytomas present at diagnosis were now gone. But that's a role that is not new.
As for MRD, there isn't yet a standard for MRD testing, although the IMWG is working on one. PET is one approach that could be used for helping to determine MRD status, but the typical approach involves testing of cells from bone marrow samples.
See Dr. Shain's recent posting here for some more additional thoughts on CR, MRD, etc.
"Re: Complete response after ASCT ... or not?", posting by Beacon Medical Advisor Dr. Ken Shain on Sep 28, 2014
Hope this helps a bit.
-
JimNY
Re: To PET or not to PET
Just came across this article...lots of good information for those folks debating which imaging modality to use.
T Derlin and P Bannas, "Imaging of multiple myeloma: Current concepts," World Journal of Orthopedics, July 2014 (full text of article)
Abstract:
Medical imaging is of crucial importance for diagnosis and initial staging as well as for differentiation of multiple myeloma from other monoclonal plasma cell diseases. Conventional radiography represents the reference standard for diagnosis of multiple myeloma due to its wide availability and low costs despite its known limitations such as low sensitivity, limited specificity and its inability to detect extraosseous lesions. Besides conventional radiography, newer cross-sectional imaging modalities such as whole-body low-dose computed tomography (CT), whole-body magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT are available for the diagnosis of osseous and extraosseous manifestations of multiple myeloma. Whole-body low-dose CT is used increasingly, replacing conventional radiography at selected centers, due to its higher sensitivity for the detection of osseous lesions and its ability to diagnose extraosseous lesions. The highest sensitivity for both detection of bone marrow disease and extraosseous lesions can be achieved with whole-body MRI and 18F-FDG PET/CT. According to current evidence, MRI is the most sensitive method for initial staging while 18F-FDG PET/CT allows monitoring of treatment of multiple myeloma. There is an evolving role for assessment of treatment response using newer MR imaging techniques. Future studies are needed to further define the exact role of the different imaging modalities for individual risk stratification and therapy monitoring.
T Derlin and P Bannas, "Imaging of multiple myeloma: Current concepts," World Journal of Orthopedics, July 2014 (full text of article)
Abstract:
Medical imaging is of crucial importance for diagnosis and initial staging as well as for differentiation of multiple myeloma from other monoclonal plasma cell diseases. Conventional radiography represents the reference standard for diagnosis of multiple myeloma due to its wide availability and low costs despite its known limitations such as low sensitivity, limited specificity and its inability to detect extraosseous lesions. Besides conventional radiography, newer cross-sectional imaging modalities such as whole-body low-dose computed tomography (CT), whole-body magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT are available for the diagnosis of osseous and extraosseous manifestations of multiple myeloma. Whole-body low-dose CT is used increasingly, replacing conventional radiography at selected centers, due to its higher sensitivity for the detection of osseous lesions and its ability to diagnose extraosseous lesions. The highest sensitivity for both detection of bone marrow disease and extraosseous lesions can be achieved with whole-body MRI and 18F-FDG PET/CT. According to current evidence, MRI is the most sensitive method for initial staging while 18F-FDG PET/CT allows monitoring of treatment of multiple myeloma. There is an evolving role for assessment of treatment response using newer MR imaging techniques. Future studies are needed to further define the exact role of the different imaging modalities for individual risk stratification and therapy monitoring.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: To PET or not to PET
Another nice article on the tradeoffs of various imaging methods for multiple myeloma patients. Also contains a lot of gems like radiation exposure comparisons, a table comparing the usefulness of each imaging modality for different situations, etc.
G Rubini et al, "Myeloma bone and extramedullary disease: Role of PET/CT and other whole-body imaging techniques," Critical Reviews in Oncology / Hematology, published online March 2016 (full text of article)
The above article might contain more information than you would care to read, so I'm also including the text of the abstract below.
Abstract:
Multiple myeloma is the second most common hematological malignancy. Although it can affect different organs, the bone compartment stands out both in terms of prevalence and clinical impact. Despite the striking advances in multiple myeloma therapy, bone disease can remarkably affect the patient’s quality of life. The occurrence and extension of bone marrow and extramedullary involvement should be carefully assessed to confirm the diagnosis, to locate and whenever possible prevent dreadful complications such as pathological fractures and spinal cord compression, and to establish suitable therapeutic measures. Many imaging techniques have been proposed for the detection of multiple myeloma skeletal involvement. With the development of more sophisticated imaging tools, it is time to use the right technique at the right time. Based on the review of the literature and our own experience, this article discusses advantages and disadvantages of the different imaging methods in the work-up of multiple myeloma patients, with particular emphasis on the role that PET/CT can play. It is emphasized that whole body low-dose computed tomography should be the preferred imaging technique at baseline. However, bone marrow infiltration and extramedullary manifestations are better detected by whole body magnetic resonance imaging. Positron emission tomography/computed tomography, on the other hand, combines the benefits of the two mentioned imaging procedures and is particularly useful not only for the detection of osteolytic lesions unrevealed by conventional X-ray, but also in the assessment of prognosis and therapeutic response.
G Rubini et al, "Myeloma bone and extramedullary disease: Role of PET/CT and other whole-body imaging techniques," Critical Reviews in Oncology / Hematology, published online March 2016 (full text of article)
The above article might contain more information than you would care to read, so I'm also including the text of the abstract below.
Abstract:
Multiple myeloma is the second most common hematological malignancy. Although it can affect different organs, the bone compartment stands out both in terms of prevalence and clinical impact. Despite the striking advances in multiple myeloma therapy, bone disease can remarkably affect the patient’s quality of life. The occurrence and extension of bone marrow and extramedullary involvement should be carefully assessed to confirm the diagnosis, to locate and whenever possible prevent dreadful complications such as pathological fractures and spinal cord compression, and to establish suitable therapeutic measures. Many imaging techniques have been proposed for the detection of multiple myeloma skeletal involvement. With the development of more sophisticated imaging tools, it is time to use the right technique at the right time. Based on the review of the literature and our own experience, this article discusses advantages and disadvantages of the different imaging methods in the work-up of multiple myeloma patients, with particular emphasis on the role that PET/CT can play. It is emphasized that whole body low-dose computed tomography should be the preferred imaging technique at baseline. However, bone marrow infiltration and extramedullary manifestations are better detected by whole body magnetic resonance imaging. Positron emission tomography/computed tomography, on the other hand, combines the benefits of the two mentioned imaging procedures and is particularly useful not only for the detection of osteolytic lesions unrevealed by conventional X-ray, but also in the assessment of prognosis and therapeutic response.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: To PET or not to PET
Hello,
I recognize this post is old, but it references exactly what I was looking to assess. I had several MRI's (whole body not available) at diagnosis of smoldering myeloma and follow-up MRI's again due to potential symptoms about 6 months ago.
The MRI's show different things and are quite cryptic when it comes to determining if there are myeloma lesions in the bone. The head MRI found one focal lesion. This was a head and neck soft tissue and there were no other findings, but I have a lump in my face that was not even mentioned. The second MRI was of my pelvis, and it came back with diffuse lucencies. The third MRI was of my thoracic spine and lumbar spine, and it came back with only degenerative disc disease and several atypical hemangiomas. I read that hemangiomas are often early myeloma lesions that have been misinterpreted?
My oncologist offered a PET scan, but I declined. I'd be curious to know if anyone thinks the above MRI findings would warrant a PET scan.
J
I recognize this post is old, but it references exactly what I was looking to assess. I had several MRI's (whole body not available) at diagnosis of smoldering myeloma and follow-up MRI's again due to potential symptoms about 6 months ago.
The MRI's show different things and are quite cryptic when it comes to determining if there are myeloma lesions in the bone. The head MRI found one focal lesion. This was a head and neck soft tissue and there were no other findings, but I have a lump in my face that was not even mentioned. The second MRI was of my pelvis, and it came back with diffuse lucencies. The third MRI was of my thoracic spine and lumbar spine, and it came back with only degenerative disc disease and several atypical hemangiomas. I read that hemangiomas are often early myeloma lesions that have been misinterpreted?
My oncologist offered a PET scan, but I declined. I'd be curious to know if anyone thinks the above MRI findings would warrant a PET scan.
J
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jhorner - Name: Magpie
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 2013
- Age at diagnosis: 49
Re: To PET or not to PET
I don't think I can give you a medical answer to this JHorner. But if there were some inconsistencies found on an MRI and my doc then offered me a PET/CT, I know I would jump at doing the PET/CT ... if only to put my mind at rest and to have a baseline PET/CT on file.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: To PET or not to PET
Here's a new article that compares MRI to PET/CT in a study of myeloma patients. Especially interesting to me since I am getting my first whole-body MRI in a couple of weeks and I've already had a couple of PET/CTs in the past.
Moreau, P, et al, "Prospective Evaluation of Magnetic Resonance Imaging and [18F]Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography at Diagnosis and Before Maintenance Therapy in Symptomatic Patients With Multiple Myeloma Included in the IFM/DFCI 2009 Trial: Results of the IMAJEM Study," Journal of Clinical Oncology, September 2017 (full text of article)
Abstract:
Purpose - Magnetic resonance imaging (MRI) and positron emission tomography–computed tomography (PET-CT) are important imaging techniques in multiple myeloma (multiple myeloma). We conducted a prospective trial in patients with multiple myeloma aimed at comparing MRI and PET-CT with respect to the detection of bone lesions at diagnosis and the prognostic value of the techniques.
Patients and Methods - One hundred thirty-four patients received a combination of lenalidomide, bortezomib, and dexamethasone (RVD) with or without autologous stem-cell transplantation, followed by lenalidomide maintenance. PET-CT and MRI were performed at diagnosis, after three cycles of RVD, and before maintenance therapy. The primary end point was the detection of bone lesions at diagnosis by MRI versus PET-CT. Secondary end points included the prognostic impact of MRI and PET-CT regarding progression-free (PFS) and overall survival (OS).
Results - At diagnosis, MRI results were positive in 127 of 134 patients (95%), and PET-CT results were positive in 122 of 134 patients (91%; P = .33). Normalization of MRI after three cycles of RVD and before maintenance was not predictive of PFS or OS. PET-CT became normal after three cycles of RVD in 32% of the patients with a positive evaluation at baseline, and PFS was improved in this group (30-month PFS, 78.7% v 56.8%, respectively). PET-CT normalization before maintenance was described in 62% of the patients who were positive at baseline. This was associated with better PFS and OS. Extramedullary disease at diagnosis was an independent prognostic factor for PFS and OS, whereas PET-CT normalization before maintenance was an independent prognostic factor for PFS.
Conclusion - There is no difference in the detection of bone lesions at diagnosis when comparing PET-CT and MRI. PET-CT is a powerful tool to evaluate the prognosis of de novo myeloma.
Moreau, P, et al, "Prospective Evaluation of Magnetic Resonance Imaging and [18F]Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography at Diagnosis and Before Maintenance Therapy in Symptomatic Patients With Multiple Myeloma Included in the IFM/DFCI 2009 Trial: Results of the IMAJEM Study," Journal of Clinical Oncology, September 2017 (full text of article)
Abstract:
Purpose - Magnetic resonance imaging (MRI) and positron emission tomography–computed tomography (PET-CT) are important imaging techniques in multiple myeloma (multiple myeloma). We conducted a prospective trial in patients with multiple myeloma aimed at comparing MRI and PET-CT with respect to the detection of bone lesions at diagnosis and the prognostic value of the techniques.
Patients and Methods - One hundred thirty-four patients received a combination of lenalidomide, bortezomib, and dexamethasone (RVD) with or without autologous stem-cell transplantation, followed by lenalidomide maintenance. PET-CT and MRI were performed at diagnosis, after three cycles of RVD, and before maintenance therapy. The primary end point was the detection of bone lesions at diagnosis by MRI versus PET-CT. Secondary end points included the prognostic impact of MRI and PET-CT regarding progression-free (PFS) and overall survival (OS).
Results - At diagnosis, MRI results were positive in 127 of 134 patients (95%), and PET-CT results were positive in 122 of 134 patients (91%; P = .33). Normalization of MRI after three cycles of RVD and before maintenance was not predictive of PFS or OS. PET-CT became normal after three cycles of RVD in 32% of the patients with a positive evaluation at baseline, and PFS was improved in this group (30-month PFS, 78.7% v 56.8%, respectively). PET-CT normalization before maintenance was described in 62% of the patients who were positive at baseline. This was associated with better PFS and OS. Extramedullary disease at diagnosis was an independent prognostic factor for PFS and OS, whereas PET-CT normalization before maintenance was an independent prognostic factor for PFS.
Conclusion - There is no difference in the detection of bone lesions at diagnosis when comparing PET-CT and MRI. PET-CT is a powerful tool to evaluate the prognosis of de novo myeloma.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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