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IMS 2026 | Prognostic value of FDG PET/CT in patients with R/R MM undergoing BCMA CAR-T therapy
Luis-Esteban Tamariz-Amador, MD, University Clinic of Navarra, Pamplona, Spain, discusses the findings of a multicenter analysis assessing the prognostic value of FDG PET/CT in patients with relapsed/refractory multiple myeloma (R/R MM) undergoing BCMA CAR-T therapy, highlighting the importance of baseline CT scans to identify extramedullary disease (EMD) and the optimal timing of reassessment at month 3 post-infusion. Dr Tamariz-Amador notes that a positive post-CAR-T PET/CT scan at month 3 would prompt consideration of the next treatment step, and recommends complementing PET-CT with MRI for further clarification. This interview took place at the 23rd International Myeloma Society (IMS) Annual Meeting in Glasgow, UK.
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Transcript
So throughout this study we were able to answer many questions. We find that it’s very useful to have a basal CT scan because you need to be aware whether the patient has extramedullary disease or not. We have found that having extramedullary disease clearly impacts in a negative way outcomes for the patients. Many of them have very short median times to progression...
So throughout this study we were able to answer many questions. We find that it’s very useful to have a basal CT scan because you need to be aware whether the patient has extramedullary disease or not. We have found that having extramedullary disease clearly impacts in a negative way outcomes for the patients. Many of them have very short median times to progression. So in these patients, when they have very high tumor volumes, perhaps another type of treatment should be warranted. Also, we have found that the best time for reassessment is at month 3 after the infusion. Because at month 1, we have seen that many of those inflammatory phenomena that can be caused by the CAR T-cell might confuse you at the time of interpreting the results, particularly regarding focal lesions. So the best time appears to be at month 3, and if at month 3, for example, you find the patient still has paramedullary disease or there are focal lesions, you would see that the treatment is failing and you have to start thinking about the next step. I think that having a positive PET-CT after CAR T-cell treatment particularly if it’s 3 months after having recieved the treatment, for sure has an impact, because if you find that the PET is positive at that time point, you should definitely start thinking of the next step because you know that the progression is very close by in case of if the positivity is not, for example, a lytic lesion which would not constitute itself as progression, but you would know that it would happen very soon and you would have to start planning. If the PET-CT is positive because of something that constitutes a progression, there would be no doubt. And the other thing that would be very useful is if you see any type of positivity, complement it with an MRI. Because there, with the diffusion sequences, you can clarify much better.
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