Predictive role of sustained imaging MRD negativity assessed by diffusion‐weighted whole‐body MRI in multiple myeloma
Abstract
To the Editor: Multiple Myeloma (MM) is still considered an incurable disease. However, the availability of novel and effective therapies is making the prospect of eradicating the malignant clone and converting MM into a curable disease realistic. In this context, the detection of minimal residual disease (MRD) has become of utmost importance. The high spatial genomic heterogeneity that characterizes MM patients explains the potential persistence of residual disease even in bone marrow (BM) MRD negative patients, highlighting the need of different techniques able to detect the disease within and outside of the BM. The prognostic usefulness of both MRD assessment and functional imaging response after treatment have been established. The combination of BM and imaging techniques has a direct impact on prognosis, with patients reaching double MRD negativity having the best outcome. Recently, sustained BM MRD-negativity and its association with an excellent outcome is emerging in clinical trials. Diffusion-weighted whole body MRI (DW-MRI) is increasingly used in the management of MM. It produces images in which the contrast between tissues is based on differences in the motion of water at a cellular level and permits to estimate cell density with the so-called apparent diffusion coefficient (ADC). The Myeloma Response Assessment and Diagnosis System (MY-RADS) recommendations have established criteria for Response Assessment Category (RAC) with a 5-point scale defining the range…
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