PMC8488511_01
MRD study of BM by NGS of patient 1. Upper panel showed clonality detection of BM at diagnosis by NGS. Bases in red showed the CDR3 sequence of the myeloma clonal sequence with the utilization of VH2, DH1, and JH4 gene segments. Lower panel showed MRD detection by NGS in triplicates of BM DNA at clinical CR that showed detection of sensitivity control at the concentration of 1x10-5, and the absence of MRD as evidenced by the absence of MRD reads in all three BM triplicates.
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CR (Figure 1) and dual-tracer PET-CT five months after MRD-negative CR showed metabolic CR with complete resolution of the previous diffusely increased ACT uptake in bone marrow (ACT SUVmax 2.9, FDG SUVmax 1.9). Currently, he remained in CR 17 months since diagnosis.
PMC8488511_02
Pre- and post-treatment dual-tracer PET-CT of patient 2. Pre-treatment FDG-PET (Left upper) showed absence of hypermetabolic BM lesions while pre-treatment ACT-PET (Right upper) showed diffusely hypermetabolic BM uptakes in the axial skeleton (red arrows), including sternum (red arrowhead) with focally hypermetabolic lesions in calvarium and femora (blue arrows). Repeat post-treatment ACT-PET (Right lower) at clinical CR showed complete resolution of ACT-avid BM lesions, hence ACT PET-CR. Post-treatment FDG-PET (Left lower) remained unremarkable except for non-specific inflammatory thoracic lymph nodes and tiny right lower rib fractures, which are FDG-avid.
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Reassessment dual-tracer PET-CT one month after MRD-negative CR showed complete ACT-PET metabolic response. (Figure 2) She is currently in CR 12 months since diagnosis.
PMC8488511_03