Bone marrow transplantation in patients with multiple myeloma: Prognostic significance of MR imaging

OBJECTIVE. This study in myeloma patients treated with myeloablative therapy and bone marrow transplantation assessed the prognostic value of MR imaging before and after treatment of the bone marrow and the prognostic value of an index reflecting changes on MR images obtained before and after treatment. SUBJECTS AND METHODS. MR images (T1-weighted images before and after injection of gadolinium and T2*-weighted images) of the spine and pelvis were obtained 1 month before and 1 month after marrow transplantation in 25 consecutive patients with stage III myeloma. Pre- and posttreatment MR imaging patterns of marrow involvement (normal, focal, diffuse), number of focal lesions, and a marrow evolution index (0-8 on the basis of comparison of the lesions [number, size, contrast enhancement] and of the surrounding marrow background on pre- and posttreatment MR images) were determined. Hematologic and MR imaging parameters were correlated with the quality of response to treatment (complete versus partial remission) and with relapse-free and overall survival. RESULTS. Response quality did not differ among categories of patients determined on the basis of MR images. Individual MR imaging parameters did not correlate with response duration and survival. Patients with a low marrow evolution index had significantly longer relapse-free (p < 10(-3)) and overall survival (p = 0.005) than patients with a high index. CONCLUSION. Individual MR imaging parameters before and after treatment had no prognostic significance in our series of myeloma patients treated with marrow transplantation. Comparison of MR images before and after treatment using a marrow evolution index may help predict response duration and survival.