Positron emission tomography combined with innovative laboratory techniques for improved risk and disease assessment in myeloma.

The standard treatment for fit newly diagnosed multiple myeloma (NDMM) patients (pts) comprises induction therapy, followed by autologous stem cell transplantation and maintenance therapy. Treatment response is observed in the majority of pts but a subpopulation of high-risk NDMM fail to achieve durable responses. The prognosis of these pts is particularly grim, with an overall survival of only 2 y compared to 7-10 y for the overall transplant-eligible group. Although conventional bone marrow (BM) analysis (including cytogenetic and FISH studies) can help to risk stratify MM patients, novel diagnostic tools are much needed for better risk assessment. Recently whole exome sequencing (WES), has come into the fore since it enables a more comprehensive and in-depth evaluation of MM genetics through the identification of additional gene abnormalities of prognostic and potentially therapeutic value. In addition, more sensitive techniques for disease assessment are required to identify minimal residual disease (MRD). Next-generation flow cytometry (NGF) is a highly sensitive technique for detection of MRD in BM samples. However, NGF is hampered by patchy infiltration of the BM and cannot detect extramedullary disease. To overcome this problem, the combination NGF with whole body imaging, like F18- fluorodeoxyglucose or Ga68 pentixafor positron emission tomography (PET) proved to be very promising to improve risk stratification and monitor MRD. We propose a single-arm, prospective, multicenter study to combine PET imaging with WES and NGF, for improved risk and disease assessment of NDMM pts. If validated, these biomarkers would allow a more risk-adapted treatment approach in the future with more intensified treatment schedules in pts with high-risk features for persistence of MRD. Conversely, the duration of lenalidomide maintenance could be reduced in low risk pts obtaining MRD on both PET and NGF. This will in turn have a positive impact on the healthcare budget. Applicant: Sigrid Stroobants | Application number: - 3

Keywords:MEDICAL GENOMICS, MYELOMA

Disciplines:Hematology, Image-guided interventions, Nuclear imaging

Project type:Collaboration project