2-[18F]FDG-TEP/TDM dans le myélome multiple : valeur pronostique initiale et évaluation de la réponse au traitement

Over the past decade, 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography coupled with computed tomography (2-[18F]FDG-PET/CT) has become a pivotal imaging tool for the investigation of multiple myeloma, both in the initial workup and in the response to therapy assessment. Indeed, in addition to the detection at baseline of disease-related osteo-medullary and extra-osteo-medullary lesions which are criteria triggering the start of the treatment, several large prospective studies have showed the high added prognostic value of biomarkers derived from 2-[18F]FDG-PET/CT imaging. Consequently, international myeloma working group considers it as one of the recommended imaging technique in multiple myeloma initial workup. For response to therapy assessment, 2-[18F]FDG-PET/CT is the gold-standard imaging according to international recommendations, because of its ability to assess early changes of focal bone and/or extra-osseous lesions’ metabolism, and its strong predictive power for survival in all studies carried out at different points of first-line therapeutic management. Furthermore, the recent standardization of interpretation criteria of 2-[18F]FDG-PET/CT imaging performed after therapy during the follow-up has considerably strengthened its legitimacy in daily clinical routine making it one of the reference imaging technique in the management of multiple myeloma.