The [18F]FDG PET/CT for prognostic stratification in multiple myeloma: A systematic review and meta-analysis.

PURPOSE: This study aims to perform a systematic review and meta-analysis of prognostic significance of pretreatment [18F]FDG PET/CT parameters in patients with multiple myeloma (MM).

METHODS

A systematic literature search was performed in PubMed, Web of Science, Embase, and Cochrane Library databases from database inception until March 15, 2025. The risk of bias was assessed using Quality In Prognosis Studies (QUIPS). The hazard ratios (HRs) of [18F]FDG PET/CT parameters were meta-analytically pooled using random-effects model, with progression free survival (PFS) and overall survival (OS) serving as end points.

RESULTS

A total of 54 studies were included, among which over 10 [18F]FDG PET/CT parameters were reported. For PFS, the pooled HRs of presence of extramedullary disease (EMD), presence of paramedullary disease (PMD), higher SUV, higher total metabolic tumor volume (TMTV), higher total lesion glycolysis (TLG), and larger number of focal lesions (FLs) were 2.80 (95% CI: 2.05–3.83), 2.57 (95% CI: 1.39–4.76), 2.06 (95% CI: 1.71–2.48), 3.25 (95% CI: 1.10–9.57), 4.30 (95% CI: 1.07–17.31), and 1.66 (95% CI: 1.32–2.09). For OS, the corresponding HRs were 3.52 (95% CI: 2.49–4.99), 1.43 (95% CI: 0.82–2.49), 2.35 (95% CI: 1.72–3.22), 3.11 (95% CI: 0.83–11.66), 3.82 (95% CI: 1.23–11.86), and 1.66 (95% CI: 1.24–2.21), respectively.

CONCLUSIONS

The presence of EMD, higher SUV, and larger number of FLs were significantly associated with shorter PFS and OS, and could serve as prognostic predictors in MM. The presence of PMD, higher TMTV and TLG exhibited the potential prognostic value for risk stratification in MM.