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Lumbar Bone Marrow Microcirculation Measurements from Dynamic Contrast-Enhanced Magnetic Resonance Imaging Is a Predictor of Event-Free Survival in Progressive Multiple Myeloma

Authors' Affiliations: ¹ Department of Hematology, Oncology, and Rheumatology, University of Heidelberg; Departments of ² Radiology and ³ Physics in Radiology and ⁴ Central Unit of Biostatistics, German Cancer Research Center, ⁵ National Center of Tumor Diseases, Heidelberg, Germany; and ⁶ Department of Clinical Radiology, University Hospital of Mannheim, Mannheim, Germany

Requests for reprints: Jens Hillengass, Department of Hematology, Oncology, and Rheumatology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Phone: 1149-6221-56-8001; Fax: 11-01149-6221-56-5908; E-mail: Jens.Hillengass{at}med.uni-heidelberg.de.

Purpose: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with high temporal resolution enables the detection of microcirculation variables amplitude A and exchange rate constant k_ep. In this study, the prognostic value of the DCE-MRI variables for overall survival and event-free survival in patients with progressive multiple myeloma was investigated.

Experimental Design: Between 1999 and 2001, 65 patients with progressive or relapse of multiple myeloma requiring therapy were investigated with DCE-MRI of the lumbar spine before start of therapy. The contrast uptake was quantified using a two-compartment model with the output variables amplitude A and exchange rate constant k_ep reflecting bone marrow microcirculation. The estimated median follow-up was 56 months. Event-free survival and overall survival were investigated for DCE-MRI variables and for established prognosis variables (ß₂-microglobulin, lactate dehydrogenase, albumin, and age).

Results: Using a multivariate Cox regression model, ß₂-microglobulin and amplitude A of DCE-MRI were identified as statistically significant prognostic variable of event-free survival with Ps of 0.01 and 0.02, respectively. A statistical correlation of DCE-MRI variables with overall survival could not be found. The multivariate analysis of ß₂-microglobulin, age, lactate dehydrogenase, and albumin revealed ß₂-microglobulin as statistically significant prognostic factor for overall survival in this group of patients (P < 0.001).

Conclusions: This analysis identifies contrast-enhanced DCE-MRI variable amplitude A reflecting increased bone marrow microcirculation and angiogenesis as a novel and possibly useful prognostic factor in patients with multiple myeloma. Prospective studies are currently done to further investigate this functional variable for prognosis and stratification of myeloma patients.

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