TY  - JOUR
AU  - Schinke, Carolina
AU  - Rasche, Leo
AU  - Ashby, Cody
AU  - van Hemert, Rudy
AU  - Thanendrarajan, Sharmilan
AU  - Al Hadidi, Samer
AU  - Zangari, Maurizio
AU  - Bailey, Clyde
AU  - Alapat, Daisy V
AU  - Shaughnessy, John D
AU  - Zhan, Fenghuang
AU  - Barlogie, Bart
AU  - van Rhee, Frits
AU  - Weinhold, Niels
TI  - Prognostic impact of focal lesion location and persistence in multiple myeloma: insights from serial PET/DWI imaging.
JO  - Blood advances
VL  - 9
IS  - 17
SN  - 2473-9529
CY  - Washington, DC
PB  - American Society of Hematology
M1  - DKFZ-2025-01798
SP  - 4368 - 4377
PY  - 2025
N1  - #LA:A360#
AB  - Multiple 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.
KW  - Humans
KW  - Multiple Myeloma: therapy
KW  - Multiple Myeloma: diagnostic imaging
KW  - Multiple Myeloma: mortality
KW  - Multiple Myeloma: pathology
KW  - Multiple Myeloma: diagnosis
KW  - Prognosis
KW  - Male
KW  - Female
KW  - Middle Aged
KW  - Positron-Emission Tomography: methods
KW  - Diffusion Magnetic Resonance Imaging: methods
KW  - Aged
KW  - Neoplasm, Residual
KW  - Adult
LB  - PUB:(DE-HGF)16
C6  - pmid:40590883
DO  - DOI:10.1182/bloodadvances.2025016510
UR  - https://inrepo02.dkfz.de/record/304239
ER  -