Rofo 2019; 191(11): 998-1009
DOI: 10.1055/a-0897-3966
Review
© Georg Thieme Verlag KG Stuttgart · New York

Leitlinien zum multiplen Myelom und ihre aktuellen Anpassungen: Konsequenzen für die Bildgebung

Artikel in mehreren Sprachen: English | deutsch
Jennifer Mosebach
Division of Radiology, German Cancer Research Center
,
Heidi Thierjung
Division of Radiology, German Cancer Research Center
,
Heinz-Peter Schlemmer
Division of Radiology, German Cancer Research Center
,
Stefan Delorme
Division of Radiology, German Cancer Research Center
› Institutsangaben
Weitere Informationen

Publikationsverlauf

30. August 2018

01. März 2019

Publikationsdatum:
28. Mai 2019 (online)

Zusammenfassung

Hintergrund Seit 2014 haben sich die diagnostischen Kriterien für das multiple Myelom und seine nicht therapiepflichtigen Vorstufen geändert. Zudem wurden neue Empfehlungen zur Modalität der Bildgebung und zum Therapieansprechen vorgeschlagen. Dieser Übersichtsartikel soll einen Überblick über aktuelle Definitionen, diagnostische Optionen und neue, für den Radiologen relevante Empfehlungen zum Vorgehen bei Plasmazellerkrankungen bieten.

Methode Eine Pubmed-Suche bezüglich Leitlinien zum multiplen Myelom wurde durchgeführt und hinsichtlich der aktuellsten Veröffentlichungen internationaler Fachgesellschaften und Expertenreviews gefiltert. Die Empfehlungen der „International Myeloma Working Group“ (IMWG), des „National Comprehensive Cancer Networks“ (NCCN, USA), der Europäischen Gesellschaft für Medizinische Onkologie (ESMO) sowie des Europäischen Myelom-Netzwerks (EMN) wurden zusammengefasst.

Ergebnisse und Schlussfolgerung Der konventionelle Skelettstatus nach dem „Pariser Schema“ sollte zunehmend durch die Schnittbildgebung ersetzt werden. Zur Differenzierung eines durch Osteolysen oder Knochenmarkbeteiligung therapiepflichtigen multiplen Myeloms von seinen Vorstufen wird eine initiale Diagnostik mittels Ganzkörper-Niedrigdosis-CT und ggf. Ganzkörper-MRT empfohlen. 2 oder mehr fokale Myelom-verdächtige Herdbefunde zeigen nun auch bei intaktem mineralisiertem Knochen ein symptomatisches Myelom an. Zur Verlaufsbeurteilung gibt es bisher keine klare Empfehlung. Die Beurteilung eines fokalen Befalls vor und nach Therapie mittels 18F-FDG-PET/CT ist Bestandteil der neuen Guidelines zur Detektion einer minimalen Resterkrankung, die somit die Rolle der PET/CT neu definieren könnten.

Kernaussagen:

  • Die Ganzkörper-Niedrigdosis-CT wird als neuer Standard zur Detektion von Osteolysen durch internationale Fachgesellschaften befürwortet.

  • Fokale Läsionen in der MRT zeigen auch bei intaktem mineralisiertem Knochen ein therapiepflichtiges Myelom an.

  • Die IMWG empfiehlt mindestens eine Schnittbildgebung in der initialen Diagnostik: Ganzkörper-Niedrigdosis-CT, MRT oder PET/CT je nach Verfügbarkeit und Finanzierungsmöglichkeiten.

  • Das diagnostische Potenzial der 18F-FDG-PET/CT beim Follow-Up wird i. R. der Definition einer minimalen Resterkrankung nach Therapie unterstrichen; die Umsetzung in Deutschland ist wegen ihres eingeschränkten Einsatzes in der Routine unsicher.

Zitierweise

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

 
  • References

  • 1 International Myeloma Working G. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. British journal of haematology 2003; 121: 749-757
  • 2 Seckinger A, Hose D. Interaction between myeloma cells and bone tissue. Der Radiologe 2014; 54: 545-550
  • 3 Rajkumar SV, Dimopoulos MA, Palumbo A. et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. The Lancet Oncology 2014; 15: e538-e548
  • 4 Moreau P, San Miguel J, Sonneveld P. et al. Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology: official journal of the European Society for Medical Oncology 2017; 28 (Suppl. 04) iv52-iv61
  • 5 Kyle RA, Therneau TM, Rajkumar SV. et al. Prevalence of monoclonal gammopathy of undetermined significance. The New England journal of medicine 2006; 354: 1362-1369
  • 6 Bhutani M, Landgren O. Imaging in smoldering (asymptomatic) multiple myeloma/. Past, present and future. Der Radiologe 2014; 54: 572, 4–81
  • 7 Mai EK, Goldschmidt H. Clincal features and treatment of multiple myeloma. Der Radiologe 2014; 54: 538-544
  • 8 Rahmouni A, Divine M, Mathieu D. et al. Detection of multiple myeloma involving the spine: efficacy of fat-suppression and contrast-enhanced MR imaging. American journal of roentgenology 1993; 160: 1049-1052
  • 9 Baur-Melnyk A, Buhmann S, Durr HR. et al. Role of MRI for the diagnosis and prognosis of multiple myeloma. European journal of radiology 2005; 55: 56-63
  • 10 Moulopoulos LA, Dimopoulos MA, Smith TL. et al. Prognostic significance of magnetic resonance imaging in patients with asymptomatic multiple myeloma. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 1995; 13: 251-256
  • 11 Mariette X, Zagdanski AM, Guermazi A. et al. Prognostic value of vertebral lesions detected by magnetic resonance imaging in patients with stage I multiple myeloma. British journal of haematology 1999; 104: 723-729
  • 12 Hillengass J, Fechtner K, Weber MA. et al. Prognostic significance of focal lesions in whole-body magnetic resonance imaging in patients with asymptomatic multiple myeloma. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2010; 28: 1606-1610
  • 13 Kastritis E, Moulopoulos LA, Terpos E. et al. The prognostic importance of the presence of more than one focal lesion in spine MRI of patients with asymptomatic (smoldering) multiple myeloma. Leukemia 2014; 28: 2402-2403
  • 14 Durie BG, Salmon SE. A clinical staging system for multiple myeloma. Correlation of measured myeloma cell mass with presenting clinical features, response to treatment, and survival. Cancer 1975; 36: 842-854
  • 15 Durie BG, Kyle RA, Belch A. et al. Myeloma management guidelines: a consensus report from the Scientific Advisors of the International Myeloma Foundation. The hematology journal: the official journal of the European Haematology Association/EHA 2003; 4: 379-398
  • 16 Greipp PR, San Miguel J, Durie BG. et al. International staging system for multiple myeloma. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2005; 23: 3412-3420
  • 17 Bannas P, Kroger N, Adam G. et al. Modern imaging techniques in patients with multiple myeloma. RoFo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 2013; 185: 26-33
  • 18 Horger M, Claussen CD, Bross-Bach U. et al. Whole-body low-dose multidetector row-CT in the diagnosis of multiple myeloma: an alternative to conventional radiography. European journal of radiology 2005; 54: 289-297
  • 19 Kropil P, Fenk R, Fritz LB. et al. Comparison of whole-body 64-slice multidetector computed tomography and conventional radiography in staging of multiple myeloma. European radiology 2008; 18: 51-58
  • 20 Regelink JC, Minnema MC, Terpos E. et al. Comparison of modern and conventional imaging techniques in establishing multiple myeloma-related bone disease: a systematic review. British journal of haematology 2013; 162: 50-61
  • 21 Wolf MB, Murray F, Kilk K. et al. Sensitivity of whole-body CT and MRI versus projection radiography in the detection of osteolyses in patients with monoclonal plasma cell disease. European journal of radiology 2014; 83: 1222-1230
  • 22 Hillengass J, Moulopoulos LA, Delorme S. et al. Whole-body computed tomography versus conventional skeletal survey in patients with multiple myeloma: a study of the International Myeloma Working Group. Blood cancer journal 2017; 7: e599
  • 23 Terpos E, Kleber M, Engelhardt M. et al. European Myeloma Network guidelines for the management of multiple myeloma-related complications. Haematologica 2015; 100: 1254-1266
  • 24 Kumar SK, Callander NS, Alsina M. et al. Multiple Myeloma, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network: JNCCN 2017; 15: 230-269
  • 25 Nanni C, Zamagni E, Celli M. et al. The value of 18F-FDG PET/CT after autologous stem cell transplantation (ASCT) in patients affected by multiple myeloma (MM): experience with 77 patients. Clinical nuclear medicine 2013; 38: e74-e79
  • 26 Baur A, Stabler A, Bartl R. et al. Infiltration patterns of plasmacytomas in magnetic resonance tomography. RoFo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 1996; 164: 457-463
  • 27 Mai EK, Hielscher T, Kloth JK. et al. Association between magnetic resonance imaging patterns and baseline disease features in multiple myeloma: analyzing surrogates of tumour mass and biology. European radiology 2016; 26: 3939-3948
  • 28 Dimopoulos M, Terpos E, Comenzo RL. et al. International myeloma working group consensus statement and guidelines regarding the current role of imaging techniques in the diagnosis and monitoring of multiple Myeloma. Leukemia 2009; 23: 1545-1556
  • 29 Bauerle T, Hillengass J, Fechtner K. et al. Multiple myeloma and monoclonal gammopathy of undetermined significance: importance of whole-body versus spinal MR imaging. Radiology 2009; 252: 477-485
  • 30 Weber DM, Dimopoulos MA, Moulopoulos LA. et al. Prognostic features of asymptomatic multiple myeloma. British journal of haematology 1997; 97: 810-814
  • 31 Dimopoulos MA, Moulopoulos A, Smith T. et al. Risk of disease progression in asymptomatic multiple myeloma. The American journal of medicine 1993; 94: 57-61
  • 32 Dimopoulos MA, Hillengass J, Usmani S. et al. Role of magnetic resonance imaging in the management of patients with multiple myeloma: a consensus statement. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2015; 33: 657-664
  • 33 Zamagni E, Nanni C, Patriarca F. et al. A prospective comparison of 18F-fluorodeoxyglucose positron emission tomography-computed tomography, magnetic resonance imaging and whole-body planar radiographs in the assessment of bone disease in newly diagnosed multiple myeloma. Haematologica 2007; 92: 50-55
  • 34 Gariani J, Westerland O, Natas S. et al. Comparison of whole body magnetic resonance imaging (WBMRI) to whole body computed tomography (WBCT) or (18)F-fluorodeoxyglucose positron emission tomography/CT ((18)F-FDG PET/CT) in patients with myeloma: Systematic review of diagnostic performance. Critical reviews in oncology/hematology 2018; 124: 66-72
  • 35 Sachpekidis C, Mosebach J, Freitag MT. et al. Application of (18)F-FDG PET and diffusion weighted imaging (DWI) in multiple myeloma: comparison of functional imaging modalities. American journal of nuclear medicine and molecular imaging 2015; 5 (05) 479-492
  • 36 Derlin T, Peldschus K, Munster S. et al. Comparative diagnostic performance of (1)(8)F-FDG PET/CT versus whole-body MRI for determination of remission status in multiple myeloma after stem cell transplantation. European radiology 2013; 23: 570-578
  • 37 Usmani SZ, Mitchell A, Waheed S. et al. Prognostic implications of serial 18-fluoro-deoxyglucose emission tomography in multiple myeloma treated with total therapy 3. Blood 2013; 121: 1819-1823
  • 38 Bartel TB, Haessler J, Brown TL. et al. F18-fluorodeoxyglucose positron emission tomography in the context of other imaging techniques and prognostic factors in multiple myeloma. Blood 2009; 114: 2068-2076
  • 39 Chantry A, Kazmi M, Barrington S. et al. Guidelines for the use of imaging in the management of patients with myeloma. British journal of haematology 2017; 178: 380-393
  • 40 Zamagni E, Tacchetti P, Terragna C. et al. Multiple myeloma: disease response assessment. Expert review of hematology 2016; 9 (09) 831-837
  • 41 Cavo M, Terpos E, Nanni C. et al. Role of (18)F-FDG PET/CT in the diagnosis and management of multiple myeloma and other plasma cell disorders: a consensus statement by the International Myeloma Working Group. The Lancet Oncology 2017; 18: e206-e217
  • 42 Laubach J, Garderet L, Mahindra A. et al. Management of relapsed multiple myeloma: recommendations of the International Myeloma Working Group. Leukemia 2016; 30: 1005-1017
  • 43 Horger M, Kanz L, Denecke B. et al. The benefit of using whole-body, low-dose, nonenhanced, multidetector computed tomography for follow-up and therapy response monitoring in patients with multiple myeloma. Cancer 2007; 109: 1617-1626
  • 44 Dutoit JC, Verstraete KL. Whole-body MRI, dynamic contrast-enhanced MRI, and diffusion-weighted imaging for the staging of multiple myeloma. Skeletal radiology 2017; 46: 733-750
  • 45 Messiou C, Collins DJ, Morgan VA. et al. Optimising diffusion weighted MRI for imaging metastatic and myeloma bone disease and assessing reproducibility. European radiology 2011; 21: 1713-1718
  • 46 Messiou C, Giles S, Collins DJ. et al. Assessing response of myeloma bone disease with diffusion-weighted MRI. The British journal of radiology 2012; 85: e1198-e1203
  • 47 Koutoulidis V, Fontara S, Terpos E. et al. Quantitative Diffusion-weighted Imaging of the Bone Marrow: An Adjunct Tool for the Diagnosis of a Diffuse MR Imaging Pattern in Patients with Multiple Myeloma. Radiology 2017; 282: 484-493
  • 48 Rajkumar SV, Harousseau JL, Durie B. et al. Consensus recommendations for the uniform reporting of clinical trials: report of the International Myeloma Workshop Consensus Panel 1. Blood 2011; 117: 4691-4695
  • 49 Kumar S, Paiva B, Anderson KC. et al. International Myeloma Working Group consensus criteria for response and minimal residual disease assessment in multiple myeloma. The Lancet Oncology 2016; 17: e328-e346
  • 50 Moreau P, Attal M, Caillot D. et al. Prospective Evaluation of Magnetic Resonance Imaging and [18F]Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography at Diagnosis and Before Maintenance Therapy in Symptomatic Patients With Multiple Myeloma Included in the IFM/DFCI 2009 Trial: Results of the IMAJEM Study. Journal of clinical oncology: official journal of the American Society of Clinical Oncology 2017; 35: 2911-2918