What Imaging Technology Is Used to Monitor Myeloma Progression?

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Topics include: Treatments and Understanding

What tools are used to monitor disease progression in multiple myeloma patients? Noted myeloma expert, Dr. Noopur Raje from Massachusetts General Hospital Cancer Center, discusses the latest technology used to identify biomarkers and match myeloma treatment plans to patients. Dr. Raje also explains what specific tests are appropriate for each stage of the disease, and when it’s necessary to use them. 

Produced by Patient Power in partnership with The University of Texas MD Anderson Cancer Center. We thank AbbVie Inc. and Takeda Oncology for their support.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Jack Aiello:

Whether it's PET scans, whether it's MRIs, whether it's X-rays—are all tools used for myeloma. Some are better than others. Some are used in different ways. Dr. Raje, can you talk a little bit about imaging and what is your preferred imaging technique to determine if a patient is doing well or needs to have new treatment? 

Dr. Noopur Raje:               

This is one of the newer pieces which we've incorporated into the new International Myeloma Working Group guidelines as well. And hopefully helps us discriminate between smoldering myeloma and multiple myeloma. So skeletal surveys or X-rays of our long bones and other bones to pick up bone disease has been the traditional way of picking up bone disease and myeloma. It's been around for 40, 50 years now. And we've come a ways away from that now. At least at our center, we're using whole-body low-dose CAT scans. These are much easier tests. And the sensitivity of these tests is to the tune of about 90 percent. 

With X-rays, typically you're going to find bone disease in about 60 percent of patients. And you need about 50 percent of your bone to be lost before you can pull it up on an X-ray. Whereas a CAT scan, you have a sensitivity of 90 percent. 

So we are replacing skeletal surveys now with these whole-body low-dose CAT scans. There are other situations wherein you've talked about PET scans, Jack. You've talked about MRIs. Now, PET CT scans are useful certainly in situations where myeloma behaves a little bit differently. There are some patients where patients will present with kind of focal myeloma. So, lots of macrofocal disease, different lesions, not a lot of disease in the bone marrow. And in that space, I find PET CT scans to be incredibly useful in picking up and following disease. 

The one thing I will say is PET scan is different for different people. Myeloma tends to be a slow-growing disease. And the myeloma cells don't proliferate as much. So, PET scans are not always that informative. And that's something worth understanding.

We are using PET scans also as a response marker in addition to the MRD testing that we've talked about. With response, if your PET becomes negative, then patients tend to do better. So, these are obviously expensive tests. And should be done only in the context of clinical trials, because I don't think insurance companies are going to be paying for PET scans to just look at PET negativity. And the last piece is the MRI. Now, MRI is absolutely useful when you're concerned about issues around the spinal cord. When you have back pain and you're concerned about any neurological deficit, I would absolutely do an MRI.

The other place where an MRI is useful is where you think you have smoldering myeloma and you want to make sure that there are no focal lesions or no extra lesions which will be better picked up on an MRI. That's another place where you'd do an MRI of the spine. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on February 14, 2018