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

OBJECTIVE. This study in myeloma patients treated with myeloablative therap y and bone marrow transplantation assessed the prognostic value of MR imagi ng before and after treatment of the bone marrow and the prognostic value o f an index reflecting changes on MR images obtained before and after treatm ent. SUBJECTS AND METHODS. MR images (T1-weighted images before and after inject ion of gadolinium and T2*-weighted images) of the spine and pelvis were obt ained 1 month before and 1 month after marrow transplantation in 25 consecu tive patients with stage III myeloma. Pre- and posttreatment MR imaging pat terns of marrow involvement (normal, focal, diffuse), number of focal lesio ns, and a "marrow evolution index" (0-8 on the basis of comparison of the l esions [number, size, contrast enhancement] and of the surrounding marrow b ackground 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 ove rall survival. RESULTS. Response quality did not differ among categories of patients deter mined on the basis of MR images. Individual MR imaging parameters did not c orrelate with response duration and survival. Patients with a low marrow ev olution index had significantly longer relapse-free (p < 10(-3)) and overal l 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 survi val.