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      Prognostic implications of serial 18-fluoro-deoxyglucose emission tomography in multiple myeloma treated with total therapy 3.

      Blood
      Aged, Antineoplastic Combined Chemotherapy Protocols, therapeutic use, Bone Neoplasms, drug therapy, mortality, secondary, Clinical Trials as Topic, Fluorodeoxyglucose F18, diagnostic use, Follow-Up Studies, Gene Expression Profiling, Humans, Magnetic Resonance Imaging, Multiple Myeloma, pathology, Multivariate Analysis, Neoplasm Recurrence, Local, Positron-Emission Tomography, Prognosis, Radiopharmaceuticals, Survival Rate, Tumor Markers, Biological, analysis

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          Abstract

          Prognostic implications of 3 imaging tools, metastatic bone survey, magnetic resonance imaging, and positron emission tomography (PET), were evaluated in 2 consecutive Total Therapy 3 trials for newly diagnosed myeloma. Data including PET at baseline and on day 7 of induction as well as standard prognostic factors were available in 302 patients of whom 277 also had gene expression profiling (GEP)-derived risk information. According to multivariate analysis, more than 3 focal lesions on day 7 imparted inferior overall survival and progression-free survival, overall and in the subset with GEP-risk data. GEP high-risk designation retained independent significance for all 3 end points examined. Thus, the presence of > 3 focal lesions on day 7 PET follow-up may be exploited toward early therapy change, especially for the 15% of patients with GEP-defined high-risk disease with a median overall survival expectation of 2 years. This trial was registered at www.clinicaltrials.gov as #NCT00081939 and # NCT00572169.

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