Intensifying treatment in PET-positive multiple myeloma patients after upfront autologous stem cell transplantation

Jakob Nordberg Nørgaard, Niels Abildgaard, Anna Lysén, Galina Tsykunova, Annette Juul Vangsted, Cristina João, Nora Remen, Lene Kongsgaard Nielsen, Liv Osnes, Caroline Stokke, James P. Connelly, Mona Elisabeth R. Revheim, Fredrik Schjesvold

Research output: Contribution to journalArticlepeer-review


18F-Fluorodeoxyglucose positron emission tomography/computed tomography (PET) positivity after first-line treatment with autologous stem cell transplantation (ASCT) in multiple myeloma is strongly correlated with reduced progression-free and overall survival. However, PET-positive patients who achieve PET negativity after treatment seem to have comparable outcomes to patients who were PET negative at diagnosis. Hence, giving PET-positive patients additional treatment may improve their outcome. In this phase II study, we screened first-line patients with very good partial response (VGPR) or better after ASCT with PET. PET-positive patients received four 28-day cycles of carfilzomib-lenalidomide-dexamethasone (KRd). Flow cytometry-based minimal residual disease (MRD) analysis was performed before and after treatment for correlation with PET. Overall, 159 patients were screened with PET. A total of 53 patients (33%) were PET positive and 57% of PET-positive patients were MRD negative, demonstrating that these response assessments are complementary. KRd consolidation converted 33% of PET-positive patients into PET negativity. MRD-negative patients were more likely to convert than MRD-positive patients. In summary, PET after ASCT detected residual disease in a substantial proportion of patients in VGPR or better, even in patients who were MRD negative, and KRd consolidation treatment changed PET status in 33% of patients.

Original languageEnglish
Pages (from-to)2107 - 2114
Issue number10
Early online date11 Aug 2023
Publication statusPublished - Oct 2023


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