文章：

基于MY-RADS的多发性骨髓瘤全身MRI影像学疗效评估

Whole body MRI by MY-RADS for imaging response assessment in multiple myeloma

原文发布日期：2025-07-17

DOI: 10.1038/s41408-025-01327-4

类型: Article

开放获取: 是

英文摘要：

Minimal residual disease (MRD) testing has underpinned the evaluation and expansion of therapeutic options for patients with multiple myeloma (MM). Imaging is essential for evaluating residual disease status, overcoming sampling errors inherent with other MRD modalities. The accuracy of whole-body MRI (WB-MRI) has led to its incorporation into MM diagnostic imaging guidelines. We report here on the prospective iTIMM trial (image-guided theranostics in MM; NCT02403102), designed to evaluate imaging residual disease using contemporary, functional WB-MRI as per MY-RADS protocol. In iTIMM, 70 MM patients planned to undergo autologous stem cell transplantation ASCT in newly diagnosed MM or at first relapse, underwent WB-MRI before start of induction and at day 100 post-ASCT. Patients with residual disease post-ASCT (RAC2 or higher) had shorter progression-free survival (median 24 months, 95% confidence interval (CI): 19–41 vs. 42 months, 95% CI: 37–not evaluable (NE), log-rank p = 0.013; hazard ratio (HR) 2.09 (95% CI: 1.15–3.78) and overall survival (median 47 months, 95% CI: 30.9–NE vs. NE (95% CI: NE–NE), p = 0.002, HR = 5.45 (95% CI: 1.67–17.87) than those without (RAC1). Imaging response also refined the prognostic association of bone marrow MRD and serological response. Our results support WB-MRI implementation for evaluation of residual disease alongside conventional laboratory-based assessments.
 

摘要翻译： 

微小残留病（MRD）检测已成为评估和拓展多发性骨髓瘤（MM）患者治疗方案的重要基础。影像学检查对于评估残留病灶状态至关重要，能够克服其他MRD检测方法固有的取样误差。全身磁共振成像（WB-MRI）因其高准确性已被纳入MM诊断影像指南。本文前瞻性报告了iTIMM试验（MM影像引导治疗诊断；NCT02403102），该试验旨在依据MY-RADS方案，采用现代功能性WB-MRI评估影像学残留病灶。在iTIMM试验中，70例计划接受自体干细胞移植（ASCT）的新诊断或首次复发MM患者，在诱导治疗开始前及ASCT后第100天接受了WB-MRI检查。ASCT后存在残留病灶（RAC2或更高等级）的患者，其无进展生存期（中位24个月，95%置信区间[CI]：19-41个月；对比42个月，95% CI：37-无法评估[NE]；时序检验p=0.013；风险比[HR] 2.09，95% CI：1.15-3.78）和总生存期（中位47个月，95% CI：30.9-NE；对比NE，95% CI：NE-NE；p=0.002；HR=5.45，95% CI：1.67-17.87）均短于无残留病灶（RAC1）患者。影像学反应还能细化骨髓MRD与血清学反应的预后关联。我们的研究结果支持将WB-MRI应用于残留病灶评估，以补充传统实验室检测手段。

原文链接：

Whole body MRI by MY-RADS for imaging response assessment in multiple myeloma