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000304239 1001_ $$00000-0002-2699-1741$$aSchinke, Carolina$$b0
000304239 245__ $$aPrognostic impact of focal lesion location and persistence in multiple myeloma: insights from serial PET/DWI imaging.
000304239 260__ $$aWashington, DC$$bAmerican Society of Hematology$$c2025
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000304239 520__ $$aMultiple myeloma (MM) is a heterogeneous disease exemplified by focal lesions (FLs), densely populated nodules whose number and persistence during treatment predict poor outcome. However, the prognostic role of FL location and the relationship between FLs at different time points remain underexplored, although they may provide critical clues to disease evolution and resistance mechanisms. We analyzed positron emission tomography (PET) and diffusion-weighted magnetic resonance imaging (DWI) scans from 243 patients with MM enrolled in total therapies at baseline, after autologous stem cell transplant (ASCT), and every 6 to 12 months thereafter until relapse or last follow-up. Baseline FLs in the humerus or femur were associated with poor prognosis. Although rare, residual PET-positive FLs after ASCT identified patients with worse outcomes. One-third of patients had residual FLs on DWI after ASCT, which also correlated with poor prognosis. Even FLs that resolved after the second ASCT in patients who underwent tandem ASCTs retained adverse prognostic significance, highlighting the limitations of late imaging in high-risk patients. Patients who achieved both minimal residual disease (MRD) and imaging negativity after ASCT had the best outcomes. Conversely, MRD-negative patients with FLs had as poor outcomes as double-positive patients. Residual FLs persisting to relapse were predominantly observed in early relapse cases, and resolved FLs frequently recurred at the same or nearby sites, suggesting limited imaging sensitivity for detection of focal resistant cells. Taken together, this study identifies long bone FLs as a risk factor, and underscores the value of serial imaging and the urgent need for alternative treatment strategies for patients with persistent FLs.
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000304239 650_2 $$2MeSH$$aHumans
000304239 650_2 $$2MeSH$$aMultiple Myeloma: therapy
000304239 650_2 $$2MeSH$$aMultiple Myeloma: diagnostic imaging
000304239 650_2 $$2MeSH$$aMultiple Myeloma: mortality
000304239 650_2 $$2MeSH$$aMultiple Myeloma: pathology
000304239 650_2 $$2MeSH$$aMultiple Myeloma: diagnosis
000304239 650_2 $$2MeSH$$aPrognosis
000304239 650_2 $$2MeSH$$aMale
000304239 650_2 $$2MeSH$$aFemale
000304239 650_2 $$2MeSH$$aMiddle Aged
000304239 650_2 $$2MeSH$$aPositron-Emission Tomography: methods
000304239 650_2 $$2MeSH$$aDiffusion Magnetic Resonance Imaging: methods
000304239 650_2 $$2MeSH$$aAged
000304239 650_2 $$2MeSH$$aNeoplasm, Residual
000304239 650_2 $$2MeSH$$aAdult
000304239 7001_ $$00000-0002-9536-9649$$aRasche, Leo$$b1
000304239 7001_ $$aAshby, Cody$$b2
000304239 7001_ $$avan Hemert, Rudy$$b3
000304239 7001_ $$aThanendrarajan, Sharmilan$$b4
000304239 7001_ $$aAl Hadidi, Samer$$b5
000304239 7001_ $$aZangari, Maurizio$$b6
000304239 7001_ $$aBailey, Clyde$$b7
000304239 7001_ $$aAlapat, Daisy V$$b8
000304239 7001_ $$aShaughnessy, John D$$b9
000304239 7001_ $$00000-0001-5417-2973$$aZhan, Fenghuang$$b10
000304239 7001_ $$aBarlogie, Bart$$b11
000304239 7001_ $$avan Rhee, Frits$$b12
000304239 7001_ $$0P:(DE-He78)66b39a79f3f922997656d7b902d324fb$$aWeinhold, Niels$$b13$$eLast author$$udkfz
000304239 773__ $$0PERI:(DE-600)2876449-3$$a10.1182/bloodadvances.2025016510$$gVol. 9, no. 17, p. 4368 - 4377$$n17$$p4368 - 4377$$tBlood advances$$v9$$x2473-9529$$y2025
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