Magnetic resonance imaging pattern of bone marrow involvement as a new predictive parameter of disease progression in newly diagnosed patients with multiple myeloma eligible for autologous stem cell transplantation

Summary We investigated the prognostic value of the magnetic resonance imaging ( MRI ) pattern of bone marrow involvement in patients with multiple myeloma ( MM ) eligible for autologous stem cell transplantation ( ASCT ). 126 patients with untreated MM indicated for ASCT underwent spine MRI and cytogenetic analysis at diagnosis. All patients received ASCT after induction therapy of VAD (vincristine, doxorubicin, dexamethasone; n  =   55) or a thalidomide‐based regimen ( TCD ; n  =   71). Thalidomide maintenance therapy was performed in 68 patients. The MRI pattern was normal in 27, focal in 47, and diffuse/variegated in 52 patients. Patients with the diffuse/variegated pattern showed significantly higher stage ( P  =   0·038), higher β‐2 microglobulin level ( P  =   0·001) and severe anaemia ( P  =   0·015). However, the cytogenetics were not different among the MRI patterns ( P  =   0·890). Progression‐free survival ( PFS ) was lower in the diffuse/variegated pattern ( P  =   0·002) than other patterns, but not overall survival ( OS ) ( P  =   0·058). Thalidomide maintenance therapy was correlated only with PFS ( P  = 0·001). High‐risk cytogenetics were associated with both poorer PFS ( P  <   0·001) and OS ( P  =   0·003). In a multivariate analysis, the diffuse/variegated MRI pattern was an independent predictor of disease progression (Hazard Ratio, 1·922; 95% confidence interval, 1·185–3·118; P  =   0·008). The diffuse/variegated MRI pattern is a novel prognostic factor for disease progression in MM patients eligible for ASCT .