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@ARTICLE{Schinke:304239,
      author       = {C. Schinke and L. Rasche and C. Ashby and R. van Hemert and
                      S. Thanendrarajan and S. Al Hadidi and M. Zangari and C.
                      Bailey and D. V. Alapat and J. D. Shaughnessy and F. Zhan
                      and B. Barlogie and F. van Rhee and N. Weinhold$^*$},
      title        = {{P}rognostic impact of focal lesion location and
                      persistence in multiple myeloma: insights from serial
                      {PET}/{DWI} imaging.},
      journal      = {Blood advances},
      volume       = {9},
      number       = {17},
      issn         = {2473-9529},
      address      = {Washington, DC},
      publisher    = {American Society of Hematology},
      reportid     = {DKFZ-2025-01798},
      pages        = {4368 - 4377},
      year         = {2025},
      note         = {#LA:A360#},
      abstract     = {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.},
      keywords     = {Humans / Multiple Myeloma: therapy / Multiple Myeloma:
                      diagnostic imaging / Multiple Myeloma: mortality / Multiple
                      Myeloma: pathology / Multiple Myeloma: diagnosis / Prognosis
                      / Male / Female / Middle Aged / Positron-Emission
                      Tomography: methods / Diffusion Magnetic Resonance Imaging:
                      methods / Aged / Neoplasm, Residual / Adult},
      cin          = {A360},
      ddc          = {610},
      cid          = {I:(DE-He78)A360-20160331},
      pnm          = {311 - Zellbiologie und Tumorbiologie (POF4-311)},
      pid          = {G:(DE-HGF)POF4-311},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40590883},
      doi          = {10.1182/bloodadvances.2025016510},
      url          = {https://inrepo02.dkfz.de/record/304239},
}