News | Computed Tomography (CT) | June 17, 2019

International Working Group Releases New Multiple Myeloma Imaging Guidelines

Recommendations guide optimal use of new imaging techniques

International Working Group Releases New Multiple Myeloma Imaging Guidelines

X-ray images such as the one on the left fail to indicate many cases of advanced bone destruction caused by multiple myeloma, says the author of new guidelines on imaging for patients with myeloma and related disorders. Image courtesy of Roswell Park Comprehensive Cancer Center.

June 17, 2019 — An International Myeloma Working Group (IMWG) has developed the first set of new recommendations in 10 years for imaging techniques to help diagnose multiple myeloma and other plasma-cell disorders.

Just as newer drugs have significantly improved outcomes for patients with multiple myeloma in the past decade, newer imaging techniques are upgrading detection of the disease, leading to earlier treatment. But standards to help guide clinicians on the optimal use of advanced imaging have lagged behind until now.

Jens Hillengass, M.D., chief of myeloma at Roswell Park Comprehensive Cancer Center in Buffalo, N.Y., led the IMWG effort to compile new recommendations for imaging techniques that offer more sensitive and accurate diagnosis and monitoring for patients with multiple myeloma and other plasma-cell disorders. Multiple myeloma — the second most common type of blood cancer — occurs when white blood cells known as plasma cells multiply out of control.

“Use of newer imaging techniques is changing the whole landscape, from diagnosis to treatment to supportive care to survivorship, and all those things are coming into this direction of research in multiple myeloma right now,” said Hillengass.

Hillengass and a team of two experts developed the guidelines, which were then reviewed by the entire working group. Their findings have been newly published in the journal The Lancet Oncology.1

The guidelines are based in part on an examination of results of computed tomography (CT) and X-ray imaging from several countries. The team found that using only conventional X-ray misses 25 percent of instances where patients have bone destruction already and need treatment.

“There has to be destruction of 30-50 percent of the bone, sometimes up to 70 percent, before you see anything on X-ray,” said Hillengass, who is first author on the new guidelines. “More sophisticated imaging is necessary not only in the beginning to assess the disease but also to assess the response and to see what is left after our standard treatment. Myeloma is a disease that can cause focal and diffuse destruction of the bone, and to see that, you need sharp imaging.”

The major change in the new imaging guidelines is that whole-body low-dose CT replaces conventional skeletal survey as the standard imaging technique recommended for assessing bone destruction. The IMWG team recommends that this more sophisticated technique and others, including positron emission tomography-CT (PET-CT) and magnetic resonance imaging (MRI) be introduced generally into clinical practices.

These practices are already employed in the clinical care of myeloma patients at Roswell Park, and a team at the cancer center is conducting a clinical trial to explore what CT-guided biopsies of focal lesions may reveal about the spatial and temporal heterogeneity of this disease.

Hillengass hopes that broader application of these newer techniques will lead to more refined imaging, more accurate diagnoses, earlier treatments and more patients living longer due to lasting remissions.

“There’s a lot of research underway now exploring whether incorporating more specific traces or dyes into various imaging techniques will be beneficial, and also to figure out how we can assess minimal residual disease, or very low tumor burdens after treatment,” he noted. “Therefore, we need much higher sensitivity and also functional information that cutting-edge imagery can provide. There are important questions still to be asked as these technologies evolve.”

The International Myeloma Foundation formed the IMWG in 2001 to encourage dialogue and collaboration among the world’s leading myeloma experts. The group includes 243 members from 39 countries who collaboratively conduct research to improve outcomes of the disease and provide scientifically valid consensus opinions regarding its diagnosis and treatment.

The paper, “International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders, is available online.

For more information: www.sciencedirect.com

Reference

1. Hillengass J., Usmani S., Rajkumar S.V., et al. International myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders. The Lancet Oncology, published online May 29, 2019. https://doi.org/10.1016/S1470-2045(19)30309-2

Related Content

Low Doses of Radiation Promote Cancer-capable Cells
News | Radiation Dose Management | July 18, 2019
Low doses of radiation equivalent to three computed tomography (CT) scans, which are considered safe, give cancer-...
Paragon Biosciences Launches Qlarity Imaging to Advance FDA-cleared AI Breast Cancer Diagnosis System

Qlarity Imaging’s software is used to assist radiologists in the assessment and characterization of breast lesions. Imaging features are synthesized by an artificial intelligence algorithm into a single value, the QI score, which is analyzed relative to a database of reference abnormalities with known ground truth. Image courtesy of Business Wire.

Technology | Artificial Intelligence | July 18, 2019
Paragon Biosciences LLC announced the launch of its seventh portfolio company, Qlarity Imaging LLC, which was founded...
Two brain metastases from primary lung cancer are contrast enhanced in the brain of a 61-year-old male. Speakers at AHRA 2019 will state that ProHance and other macrocyclic MR agents present a very low risk to patients. Images courtesy of Bracco

Two brain metastases from primary lung cancer are contrast enhanced in the brain of a 61-year-old male. Speakers at AHRA 2019 will state that ProHance and other macrocyclic MR agents present a very low risk to patients. Images courtesy of Bracco

Feature | Contrast Media | July 18, 2019 | By Greg Freiherr
Macrocyclic contrast agents have the best safety profile of all the magnetic resonance (MR) contrast media that are n
New Lung Ambition Alliance Aims to Double Five-year Lung Cancer Survival by 2025
News | Lung Cancer | July 17, 2019
The International Association for the Study of Lung Cancer (IASLC), Guardant Health, the Global Lung Cancer Coalition (...
AAPM 2019 Features More Than 40 Presentations on ViewRay's MRIdian MRI-guided Radiotherapy
News | Image Guided Radiation Therapy (IGRT) | July 16, 2019
ViewRay Inc. announced that the company's MRIdian System is the focus of more than 40 abstracts selected by the...
NorthStar Medical Radioisotopes Completes Construction on Beloit, Wis. Molybdenum-99 Processing Facility
News | Radiopharmaceuticals and Tracers | July 16, 2019
NorthStar Medical Radioisotopes LLC  announced completion of construction on its 20,000-square-foot molybdenum-99 (Mo-...
Example of an intentionally truncated CT image

Figure 1: Example of an intentionally truncated CT image. The truncation percentage was calculated as the ratio of the patient border touching the field of view to the total patient border (red/(read+blue)). Image courtesy of Qaelum.

Feature | Radiation Dose Management | July 15, 2019 | Niki Fitousi, Ph.D., and An Dedulle
One of the main benefits of a radiation dose management system is the possibility to automatically generate alerts when...
FDA Approves Bayer's Gadavist Contrast for Cardiac MRI in Adult Coronary Artery Disease Patients
Technology | Contrast Media | July 15, 2019
The U.S. Food and Drug Administration (FDA) has approved Gadavist injection for use in cardiac magnetic resonance...
Routine scan of abdomen pelvis taken with the UW-Madison’s Revolution 256 CT scanner using the FDA-cleared reconstruction algorithm, called TrueFidelity.

Routine scan of abdomen pelvis taken with the UW-Madison’s Revolution 256 CT scanner using the FDA-cleared reconstruction algorithm, called TrueFidelity. UW-Madison was the first site in the U.S. to get this technology. Its use is now being integrated into UW CT protocols. Image courtesy of Timothy P. Szczykutowicz

Feature | Computed Tomography (CT) | July 12, 2019 | By Greg Freiherr
When providers develop their own imaging protocols, they are wasting time and money, according to...
FDA Clears Koios DS Breast 2.0 AI-based Software
News | Ultrasound Women's Health | July 11, 2019
Koios Medical announced its second 510(k) clearance from the U.S. Food and Drug Administration (FDA).