Multiple myeloma (MM) frequently induces persisting osteolytic manifestations despite hematologic treatment response. This study aimed to establish a biometrically valid study endpoint for bone remineralization through quantitative and qualitative analyses in sequential CT scans. Twenty patients (seven women, 58 ± 8 years) with newly diagnosed MM received standardized induction therapy comprising the anti-SLAMF7 antibody elotuzumab, carfilzomib, lenalidomide, and dexamethasone (E-KRd). All patients underwent whole-body low-dose CT scans before and after six cycles of E-KRd. Two radiologists independently recorded osteolytic lesion sizes, as well as the presence of cortical destruction, pathologic fractures, rim and trabecular sclerosis. Bland–Altman analyses and Krippendorff’s α were employed to assess inter-reader reliability, which was high for lesion size measurement (standard error 1.2 mm) and all qualitative criteria assessed (α ≥ 0.74). After six cycles of E-KRd induction, osteolytic lesion size decreased by 22% (p< 0.001). While lesion size response did not correlate with the initial lesion size at baseline imaging (Pearson’s r = 0.144), logistic regression analysis revealed that the majority of responding osteolyses exhibited trabecular sclerosis (p< 0.001). The sum of osteolytic lesion sizes on sequential CT scans defines a reliable study endpoint to characterize bone remineralization. Patient level response is strongly associated with the presence of trabecular sclerosis.
多发性骨髓瘤（MM）即使在血液学治疗取得应答后，仍常引起持续的溶骨性表现。本研究旨在通过连续CT扫描的定量与定性分析，建立具有生物计量学效度的骨再矿化研究终点。20例新诊断MM患者（7名女性，58±8岁）接受了包含抗SLAMF7抗体埃罗妥珠单抗、卡非佐米、来那度胺及地塞米松（E-KRd）的标准化诱导治疗。所有患者在E-KRd方案六个疗程前后均接受全身低剂量CT扫描。两名放射科医师独立记录溶骨性病灶尺寸、皮质破坏情况、病理性骨折以及边缘与骨小梁硬化程度。通过Bland-Altman分析和Krippendorff's α评估阅片者间可靠性，结果显示病灶尺寸测量（标准误差1.2毫米）及所有定性指标均具有高度一致性（α≥0.74）。经六个疗程E-KRd诱导治疗后，溶骨性病灶尺寸减少22%（p<0.001）。虽然病灶尺寸应答与基线影像中的初始病灶大小无相关性（Pearson's r=0.144），但逻辑回归分析显示多数应答性溶骨病灶存在骨小梁硬化（p<0.001）。连续CT扫描中溶骨性病灶尺寸总和可作为表征骨再矿化的可靠研究终点，患者个体水平的应答与骨小梁硬化的存在密切相关。
肿瘤(癌症)患者之家