Multiple Myeloma Guidelines and Their Recent Updates: Implications for Imaging

Jennifer Mosebach, Heidi Thierjung, Heinz-Peter Schlemmer, Stefan Delorme
RöFo: Fortschritte Auf Dem Gebiete der Röntgenstrahlen und der Nuklearmedizin 2019, 191 (11): 998-1009

BACKGROUND:  In 2014, the diagnostic criteria for multiple myeloma were updated, leading to revised recommendations for imaging modalities and definition of therapy response. This review provides an overview of the current definitions of monoclonal plasma cell disease, diagnostic options, and changes relevant to radiologists.

METHOD:  A pubmed search regarding the multiple myeloma guidelines was conducted, and results were filtered considering publications of international associations and expert reviews. Recommendations by the International Myeloma Working Group (IMWG), the National Comprehensive Cancer Network (NCCN, USA), the European Society for Medical Oncology (ESMO), and the European Myeloma Network are acknowledged.

RESULTS AND CONCLUSION:  Conventional skeletal survey is to be replaced by cross-sectional imaging techniques. For initial diagnostics of bone lesions or bone marrow involvement defining multiple myeloma, whole-body low-dose CT and whole-body MRI are recommended. Two or more focal bone marrow lesions suspicious for myeloma on MRI will now define symptomatic disease even in the case of intact mineralized bone. Follow-up imaging is not clearly specified so far. New guidelines concerning the definitions of minimal residual disease include the assessment of focal lesions before and after treatment using 18 F-FDG-PET/CT, with the potential to redefine the role of PET/CT in the diagnostics of multiple myeloma.

KEY POINTS:   · Whole-body low-dose CT is recommended by international reference organizations for detecting lytic bone lesions.. · Focal myeloma lesions detected on whole-body MRI will indicate symptomatic multiple myeloma requiring therapy, even in the absence of damage to mineralized bone.. · The IMWG recommends using cross-sectional imaging in the initial work-up: whole-body low-dose CT, MRI, or PET/CT, depending on availability and resources.. · The diagnostic potential of 18F-FDG-PET/CT is highlighted by its inclusion in the definition of minimal residual disease after therapy; implementation in Germany is uncertain due to limited access in the daily routine..

CITATION FORMAT: · Mosebach J, Thierjung H, Schlemmer H et al. Multiple Myeloma Guidelines and Their Recent Updates: Implications for Imaging. Fortschr Röntgenstr 2019; 191: 998 - 1009.

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