Early identification of functional high-risk multiple myeloma patients after transplant: the predictive power of fat fraction and Response Assessment Category score in diffusion-weighted whole-body magnetic resonance imaging
Functional high-risk (FHR) multiple myeloma (MM) patients, defined as those with early relapse despite optimal initial therapy, represent an unmet clinical need. Diffusionweighted whole-body MRI (DW-MRI) is increasingly used in MM management due to its high sensitivity in assessing treatment respon...
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Ferrata Storti Foundation
2025-04-01
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| Series: | Haematologica |
| Online Access: | https://haematologica.org/article/view/12011 |
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| author | Angelo Belotti Barbara Frittoli Sofia Terlizzi Rossella Ribolla Claudia Crippa Chiara Saeli Samantha Ferrari Nicola Bianchetti Chiara Bottelli Chiara Cattaneo Carmela Carbone Alessandro Gullino Marco Chiarini Viviana Giustini Aldo Roccaro Luigi Grazioli Alessandra Tucci |
| author_facet | Angelo Belotti Barbara Frittoli Sofia Terlizzi Rossella Ribolla Claudia Crippa Chiara Saeli Samantha Ferrari Nicola Bianchetti Chiara Bottelli Chiara Cattaneo Carmela Carbone Alessandro Gullino Marco Chiarini Viviana Giustini Aldo Roccaro Luigi Grazioli Alessandra Tucci |
| author_sort | Angelo Belotti |
| collection | DOAJ |
| description |
Functional high-risk (FHR) multiple myeloma (MM) patients, defined as those with early relapse despite optimal initial therapy, represent an unmet clinical need. Diffusionweighted whole-body MRI (DW-MRI) is increasingly used in MM management due to its high sensitivity in assessing treatment response. The Myeloma Response Assessment and Diagnosis System (MY-RADS) established the Response Assessment Category (RAC), a 5-point scale ranging from complete response (RAC 1) to progressive disease (RAC 5), which independently stratifies patients with different outcomes after autologous stem cell transplantation (ASCT). The relative Fat Fraction (rFF), derived from DW-MRI, provides additional prognostic insights into bone marrow composition. This study aimed to evaluate whether the combined assessment of RAC and rFF could identify FHR MM patients at risk of early relapse, defined as progression within 18 months post-ASCT. Ninety-seven MM patients were retrospectively analyzed after ASCT, before maintenance, with a median follow-up of 47 months. An rFF threshold of 17.2% predicted early relapse with 83% sensitivity and 85% specificity. Patients with rFF >17.2% had significantly improved post-ASCT progression-free survival (PFS, median not reached vs. 13.7 months, HR 0.18; 95% CI 0.08–0.43) and overall survival (OS, 3-year rate: 96% vs. 62%, HR 0.12; 95% CI 0.03–0.45) compared to rFF ≤17.2%. Patients with RAC 1/rFF High had the best outcomes, while RAC ≥2/rFF Low had the worst prognosis (median PFS: NR vs. 12.3 months, HR 0.21; 95% CI 0.07–0.62). rFF complements RAC for response assessment after ASCT, enabling early identification of FHR patients with poor prognosis.
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| format | Article |
| id | doaj-art-c35abaa5d48746fcad3daf7ef45681da |
| institution | DOAJ |
| issn | 0390-6078 1592-8721 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Ferrata Storti Foundation |
| record_format | Article |
| series | Haematologica |
| spelling | doaj-art-c35abaa5d48746fcad3daf7ef45681da2025-08-20T03:06:44ZengFerrata Storti FoundationHaematologica0390-60781592-87212025-04-01999110.3324/haematol.2025.287409Early identification of functional high-risk multiple myeloma patients after transplant: the predictive power of fat fraction and Response Assessment Category score in diffusion-weighted whole-body magnetic resonance imagingAngelo Belotti0Barbara Frittoli1Sofia Terlizzi2Rossella Ribolla3Claudia Crippa4Chiara Saeli5Samantha Ferrari6Nicola Bianchetti7Chiara Bottelli8Chiara Cattaneo9Carmela Carbone10Alessandro Gullino11Marco Chiarini12Viviana Giustini13Aldo Roccaro14Luigi Grazioli15Alessandra Tucci16Department of Hematology, ASST Spedali Civili di Brescia, BresciaDepartment of Radiology, ASST Spedali Civili di Brescia, BresciaUniversity of Brescia, BresciaDepartment of Hematology, ASST Spedali Civili di Brescia, BresciaDepartment of Hematology, ASST Spedali Civili di Brescia, BresciaDepartment of Radiology, ASST Spedali Civili di Brescia, BresciaDepartment of Hematology, ASST Spedali Civili di Brescia, BresciaDepartment of Hematology, ASST Spedali Civili di Brescia, BresciaDepartment of Hematology, ASST Spedali Civili di Brescia, BresciaDepartment of Hematology, ASST Spedali Civili di Brescia, BresciaUniversity of Brescia, BresciaUniversity of Brescia, BresciaClinical Chemistry Laboratory/Diagnostic Department, ASST Spedali Civili di BresciaClinical Chemistry Laboratory/Diagnostic Department, ASST Spedali Civili di BresciaClinical Research Development and Phase I Unit - Spedali Civili di BresciaDepartment of Radiology, ASST Spedali Civili di Brescia, BresciaDepartment of Hematology, ASST Spedali Civili di Brescia, Brescia Functional high-risk (FHR) multiple myeloma (MM) patients, defined as those with early relapse despite optimal initial therapy, represent an unmet clinical need. Diffusionweighted whole-body MRI (DW-MRI) is increasingly used in MM management due to its high sensitivity in assessing treatment response. The Myeloma Response Assessment and Diagnosis System (MY-RADS) established the Response Assessment Category (RAC), a 5-point scale ranging from complete response (RAC 1) to progressive disease (RAC 5), which independently stratifies patients with different outcomes after autologous stem cell transplantation (ASCT). The relative Fat Fraction (rFF), derived from DW-MRI, provides additional prognostic insights into bone marrow composition. This study aimed to evaluate whether the combined assessment of RAC and rFF could identify FHR MM patients at risk of early relapse, defined as progression within 18 months post-ASCT. Ninety-seven MM patients were retrospectively analyzed after ASCT, before maintenance, with a median follow-up of 47 months. An rFF threshold of 17.2% predicted early relapse with 83% sensitivity and 85% specificity. Patients with rFF >17.2% had significantly improved post-ASCT progression-free survival (PFS, median not reached vs. 13.7 months, HR 0.18; 95% CI 0.08–0.43) and overall survival (OS, 3-year rate: 96% vs. 62%, HR 0.12; 95% CI 0.03–0.45) compared to rFF ≤17.2%. Patients with RAC 1/rFF High had the best outcomes, while RAC ≥2/rFF Low had the worst prognosis (median PFS: NR vs. 12.3 months, HR 0.21; 95% CI 0.07–0.62). rFF complements RAC for response assessment after ASCT, enabling early identification of FHR patients with poor prognosis. https://haematologica.org/article/view/12011 |
| spellingShingle | Angelo Belotti Barbara Frittoli Sofia Terlizzi Rossella Ribolla Claudia Crippa Chiara Saeli Samantha Ferrari Nicola Bianchetti Chiara Bottelli Chiara Cattaneo Carmela Carbone Alessandro Gullino Marco Chiarini Viviana Giustini Aldo Roccaro Luigi Grazioli Alessandra Tucci Early identification of functional high-risk multiple myeloma patients after transplant: the predictive power of fat fraction and Response Assessment Category score in diffusion-weighted whole-body magnetic resonance imaging Haematologica |
| title | Early identification of functional high-risk multiple myeloma patients after transplant: the predictive power of fat fraction and Response Assessment Category score in diffusion-weighted whole-body magnetic resonance imaging |
| title_full | Early identification of functional high-risk multiple myeloma patients after transplant: the predictive power of fat fraction and Response Assessment Category score in diffusion-weighted whole-body magnetic resonance imaging |
| title_fullStr | Early identification of functional high-risk multiple myeloma patients after transplant: the predictive power of fat fraction and Response Assessment Category score in diffusion-weighted whole-body magnetic resonance imaging |
| title_full_unstemmed | Early identification of functional high-risk multiple myeloma patients after transplant: the predictive power of fat fraction and Response Assessment Category score in diffusion-weighted whole-body magnetic resonance imaging |
| title_short | Early identification of functional high-risk multiple myeloma patients after transplant: the predictive power of fat fraction and Response Assessment Category score in diffusion-weighted whole-body magnetic resonance imaging |
| title_sort | early identification of functional high risk multiple myeloma patients after transplant the predictive power of fat fraction and response assessment category score in diffusion weighted whole body magnetic resonance imaging |
| url | https://haematologica.org/article/view/12011 |
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