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    Keywords: INVESTIGATE ; GAMMOPATHY ; WELL ; prognostic significance ; D ; A ; UNDETERMINED SIGNIFICANCE ; MARROW ; MONOCLONAL GAMMOPATHY ; methods ; PROFILES ; STANDARDS ; WHOLE-BODY ; PROGNOSTIC-FACTOR ; development ; BONE ; multivariate analysis ; PROTEIN ; RISK ; DISEASE ; COHORT ; PATIENT ; SURVIVAL ; imaging ; THERAPY ; CELL ; MULTIPLE-MYELOMA ; PROGNOSTIC-SIGNIFICANCE ; PROGNOSTIC FACTORS ; multiple myeloma ; THERAPIES ; INFILTRATION ; DISORDERS ; LESIONS ; PROGRESSION ; STAGE ; MAGNETIC-RESONANCE ; magnetic resonance imaging ; BONE-MARROW ; treatment ; SEQUENCES ; SEQUENCE ; DISORDER ; MRI ; PLASMA ; PROGNOSTIC-FACTORS
    Abstract: Introduction: The use of whole body magnetic resonance imaging (wb-MRI) enables the examination of almost the entire bone marrow compartment in patients with monoclonal plasma cell disease. Focal lesions detected by spinal MRI have been demonstrated to be of prognostic significance in symptomatic myeloma. The present study investigates the prognostic significance of focal lesions in wb-MRI in patients with asymptomatic monoclonal plasma cell disease. METHODS: Wb-MRI with T1 and T2 weighted sequences was performed in 250 patients with either monoclonal gammopathy of undetermined significance (MGUS, n = 84), solitary plasmacytoma (n = 17) or asymptomatic multiple myeloma (aMM, n = 149). The prognostic significance of the presence and absence, as well as the number of focal lesions for progression into a higher stage of disease or into symptomatic myeloma, respectively, were analyzed. Furthermore, multivariate analysis of additional prognostic factors for aMM was performed. RESULTS: Focal lesions were present in 9% of MGUS-patients and 28% of aMM-patients. In the plasmocytoma group, lesions additional to the initially diagnosed plasmocytoma were detected in 35% of patients. Among 185 patients without any focal lesions, 65 (35%) presented with a diffuse bone marrow infiltration in MRI. The presence of focal lesions per se and an increasing number of lesions were an adverse prognostic factor for both progression into a higher stage of disease and development of symptomatic myeloma (p 〈 0.001). Further adverse prognostic factors for progression free survival in patients with aMM were diffuse infiltration pattern in MRI, monoclonal protein of 40g/l or more and a degree of plasma cell infiltration in bone marrow of at least 20%. In accordance to previous reports, patients with progressive disease accounted for just about 1% per year (2 of 84) in the MGUS group in our cohort. In addition, the number of plasmocytoma patients was relatively low. Therefore, no multivariate analysis in these subgroups could be performed. CONCLUSIONS: Both presence and number of focal bone marrow lesions detected in wb-MRI are highly significant adverse prognostic factors for patients with monoclonal plasma cell disease who would not require systemic therapy according to current standards. We recommend performing wb-MRI in all patients with monoclonal plasma cell disease in order to assess individual risk profiles. However, the currently available evidence does not yet justify the initiation of treatment based on MRI findings alone.Gemeinsame Jahrestagung der Deutschen, Österreichischen und Schweizerischen Gesellschaften für Hämatologie und Onkologie, 2.-6. Oktober 2009, Heidelberg/Mannheim
    Type of Publication: Meeting abstract published
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