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. 2017 Apr 15;23(8):1981-1987.
doi: 10.1158/1078-0432.CCR-16-0235. Epub 2016 Oct 3.

Assessment of Total Lesion Glycolysis by 18F FDG PET/CT Significantly Improves Prognostic Value of GEP and ISS in Myeloma

James E McDonald  1 , Marcus M Kessler  1 , Michael W Gardner  2 , Amy F Buros  3 , James A Ntambi  1 , Sarah Waheed  3 , Frits van Rhee  3 , Maurizio Zangari  3 , Christoph J Heuck  3 , Nathan Petty  3 , Carolina Schinke  3 , Sharmilan Thanendrarajan  3 , Alan Mitchell  4 , Antje Hoering  4 , Bart Barlogie  3 , Gareth J Morgan  3 , Faith E Davies  5
Affiliations

Assessment of Total Lesion Glycolysis by 18F FDG PET/CT Significantly Improves Prognostic Value of GEP and ISS in Myeloma

James E McDonald et al. Clin Cancer Res. .

Abstract

Purpose: Fluorine-18 fluorodeoxyglucose positron emission tomography with CT attenuation correction (18F-FDG PET/CT) is useful in the detection and enumeration of focal lesions and in semiquantitative characterization of metabolic activity (glycolytic phenotype) by calculation of glucose uptake. Total lesion glycolysis (TLG) and metabolic tumor volume (MTV) have the potential to improve the value of this approach and enhance the prognostic value of disease burden measures. This study aims to determine whether TLG and MTV are associated with progression-free survival (PFS) and overall survival (OS), and whether they improve risk assessments such as International Staging System (ISS) stage and GEP70 risk.Experimental Design: 192 patients underwent whole body PET/CT in the Total Therapy 3A (TT3A) trial and were evaluated using three-dimensional region-of-interest analysis with TLG, MTV, and standard measurement parameters derived for all focal lesions with peak SUV above the background red marrow signal.Results: In multivariate analysis, baseline TLG > 620 g and MTV > 210 cm3 remained a significant factor of poor PFS and OS after adjusting for baseline myeloma variables. Combined with the GEP70 risk score, TLG > 205 g identifies a high-risk-behaving subgroup with poor expected survival. In addition, TLG > 205 g accurately divides ISS stage II patients into two subgroups with similar outcomes to ISS stage I and ISS stage III, respectively.Conclusions: TLG and MTV have significant survival implications at baseline and offer a more precise quantitation of the glycolytic phenotype of active disease. These measures can be assessed more readily than before using FDA-approved software and should be standardized and incorporated into clinical trials moving forward. Clin Cancer Res; 23(8); 1981-7. ©2016 AACR.

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Conflict of interest statement

Conflict of interest and disclosure: BB is a co-inventor on patents and patent applications related to use of gene expression profiling in cancer medicine that have been licensed to Myeloma Health, LLC, but has no financial interests in this company. The remaining authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Maximum intensity projection (MIP) images from a patient with multiple focal lesions. The image on the right is following lesion segmentation for quantitation.
Figure 2
Figure 2
PFS (left) and OS (right) for Baseline TLG.
Figure 3
Figure 3
A and B. PFS (left) and OS (right) for GEP70-Risk and TLG and ISS Stage and TLG combined.
Figure 3
Figure 3
A and B. PFS (left) and OS (right) for GEP70-Risk and TLG and ISS Stage and TLG combined.
See this image and copyright information in PMC

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