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Background  Multiple myeloma (MM) is a disease of cancerous plasma cells in the bone marrow. Imaging-based timely determination of therapeutic response is critical for improving outcomes in MM patients. Very late antigen-4 (VLA4, CD49d/CD29) is overexpressed in MM cells. Here, we evaluated [ 18 F]FDG and VLA4 targeted [ 64 Cu]Cu-LLP2A for quantitative PET imaging in disseminated MM models of variable VLA4 expression, following bortezomib therapy.    Methods  In vitro and ex vivo VLA4 expression was evaluated by flow cytometry. Human MM cells, MM.1S-CG and U266-CG (C: luciferase and G: green fluorescent protein), were injected intravenously in NOD-SCID gamma mice. Tumor progression was monitored by bioluminescence imaging (BLI). Treatment group received bortezomib (1 mg/kg, twice/week) intraperitoneally. All cohorts (treated, untreated and no tumor) were longitudinally imaged with [ 18 F]FDG (7.4–8.0 MBq) and [ 64 Cu]Cu-LLP2A (2–3 MBq; Molar Activity: 44.14 ± 1.40 MBq/nmol) PET, respectively.    Results  Flow cytometry confirmed high expression of CD49d in U266 cells (> 99%) and moderate expression in MM.1S cells (~ 52%). BLI showed decrease in total body flux in treated mice. In MM.1S-CG untreated versus treated mice, [ 64 Cu]Cu-LLP2A localized with a significantly higher SUV mean  in spine (0.58 versus 0.31,  p  < 0.01) and femur (0.72 versus 0.39,  p  < 0.05) at week 4 post-tumor inoculation. There was a four-fold higher uptake of [ 64 Cu]Cu-LLP2A (SUV mean ) in untreated U266-CG mice compared to treated mice at 3 weeks post-treatment. Compared to [ 64 Cu]Cu-LLP2A, [ 18 F]FDG PET detected treatment-related changes at later time points.    Conclusion  [ 64 Cu]Cu-LLP2A is a promising tracer for timely in vivo assessment of therapeutic response in disseminated models of MM.    Supplementary Information  The online version contains supplementary material available at 10.1186/s13550-021-00840-4.

ejnmmi research

In vivo quantitative assessment of therapeutic response to bortezomib therapy in disseminated animal models of multiple myeloma with [18F]FDG and [64Cu]Cu-LLP2A PET