IMS 2025 | Performance of the Deauville score and TLG as response markers for multiple myeloma with EMD

Extramedullary disease is a major concern. It’s an aggressive disease entity that requires urgent treatment and treatment options aren’t very effective. One of the challenges in assessing responses is what’s the best response parameter to utilize. The IMWG guidelines utilize the five-point deauville scale which is very well established in lymphoma and myeloma. It’s a visual scale and it’s subjective. In our study, we looked at total lesion glycolysis which is a measure derived from the standardized uptake value and total metabolic volume. It’s a much more objective parameter and we developed a risk stratification tool using total lesion glycolysis where we classified complete metabolic response where there was a hundred percent reduction in the TLG or total lesion glycolysis, a major metabolic response being more than 50% reduction and non-significant metabolic response being less than 50% reduction. What we identified is a distinct prognostication with these three strata, both in PFS and OS, but more importantly, they outperform the deauville score. In about every strata of the deauville score, one third of patients are reclassified using total lesion glycolysis and these patients that have a discordant response and the deauville score and TLG, the TLG outperforms them with a better PFS compared to the deauville score. We think that this represents a very unique study and maybe paradigm-shifting in the recent future for response assessment.

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