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MULTIPLE MYELOMA, GAMMOPATHIES

Simultaneous whole-body multi-parametric 2-[18F]FDG-PET/MRI in smoldering multiple myeloma assessment: diagnostic and prognostic impact

Leukemia volume 39, pages 2516–2522 (2025)Cite this article

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Abstract

The co-primary aims of this study were to assess the diagnostic and prognostic performance of Whole-body-2-[18F]-fluorodeoxyglucose-positron emission tomography coupled with MRI (WB-2-[18F]FDG-PET/MRI) imaging in the smoldering multiple myeloma (SMM) workup for detection of MM-related medullary or extra-medullary disease and for the prediction of progression-free survival (PFS) defined as time to progression to symptomatic MM requiring therapy. A total of 116 patients with SMM (without CRAB or SLiM criteria before imaging) were prospectively included in the study and underwent full multi-parametric WB-2-[18F]FDG-PET/MRI imaging. PET detected at least one FL > 5 mm in 9% of patients compared to 20% on MRI (p = 0.02). PET detected diffuse bone marrow involvement (BMI) in 20% of patients and MRI in 53% (p < 10−3). A total of 98 patients with true SMM not requiring treatment were then followed up. The presence of diffuse BMI on MRI was the strongest adverse prognostic parameter for PFS (univariate: hazard ratio (HR), 6.12; p < 10−2. Multivariate : HR, 4.16; p = 0.03) and could be proposed as a new high-risk biomarker for progression to symptomatic MM. Dynamic contrast-enhanced (DCE)-MRI based increased peak enhancement intensity (PEI) and maximum intensity time ratio (MITR) values were other strong adverse prognostic factors.

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Fig. 1: Flow diagram.
Fig. 2
Fig. 3: Progression-free survival of smoldering multiple myeloma patients.
Fig. 4: 75 year-old IgGk SMM woman patient.

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Data availability

The anonymized datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This work has been supported in part by the French National Research Agency (ANR) “France 2030 investment plan” under the references I-SITE NExT (ANR-16-IDEX-0007) and Labex DHOLMEN, by financial support from the Pays de la Loire Region, by a grant from INCa-DGOS-INSERM/ITMO Cancer_18011 (SIRIC ILIAD) and by Siemens Healthineers, the industrial partner of the NExT research industrial chair IMRAM.

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Authors and Affiliations

  1. Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Médecine Nucléaire, Nantes, France

    Bastien Jamet, Hatem Necib, Huajun Sun, Chloe Francois, Thomas Carlier, Aurélien Monnet, Caroline Bodet-Milin & Françoise Kraeber-Bodere

  2. Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Hématologie, Nantes, France

    Cyrille Touzeau, Nicolas Blin, Nicoletta Lilli & Philippe Moreau

  3. Nantes Université, Univ Angers, CHU Nantes, INSERM, CNRS, CRCI2NA, Radiologie, Nantes, France

    Hatem Necib, Éric Frampas & Aurélien Monnet

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  1. Bastien Jamet
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Contributions

Conception and design of the study: BJ, FKB. Provision of study patients: CT, NB, PM. BJ, CT, HN, EF, HS, CF, NB, TC, AM, NL, CBM, PM and FKB contributed to the study execution, the collection and assembly of data, the data analysis and interpretation and the manuscript writing. BJ, CT, HN, EF, HS, CF, NB, TC, AM, NL, CBM, PM and FKB provided a full review of the manuscript and are fully responsible for all content and editorial decisions, were involved in all stages of manuscript development, and have approved the final version.

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Correspondence to Bastien Jamet.

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Jamet, B., Touzeau, C., Necib, H. et al. Simultaneous whole-body multi-parametric 2-[18F]FDG-PET/MRI in smoldering multiple myeloma assessment: diagnostic and prognostic impact. Leukemia 39, 2516–2522 (2025). https://doi.org/10.1038/s41375-025-02717-0

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