Patterns of Bone Marrow Involvement in Patients with Multiple Myeloma: Associations with Disease Parameters, Cytogenetics and Prognosis

Abstract: Multiple myeloma is a complex haematological malignancy characterized by the clonal proliferation of plasma cells within the bone marrow. Whole Body Magnetic Resonance Imaging (WBMRI) is an important imaging modality in the staging of multiple myeloma due to its sensitivity for the detection of pathological changes in the bone marrow. Multiple myeloma patients can be classified on the basis of the pattern of bone marrow involvement manifested at WBMRI. Recent years have seen a significant evolution in our understanding of the complex biology of multiple myeloma. Of particular importance has been the diverse spectrum of cytogenetic abnormalities encountered in multiple myeloma, including chromosomal translocations, deletions, and hyperdiploidy. These aberrations are strongly linked to disease progression, treatment response, and overall survival. High-risk cytogenetic profiles, such as the presence of del(17p) or t(4;14) translocation, often indicate a more aggressive disease course and resistance to conventional therapies. This thesis explores the relationship between the pattern of myelomatous marrow involvement at WBMRI and certain high risk cytogenetic abnormalities. In addition, the associations between WBMRI disease patterns and a variety of other factors including patient demographics, haematological and biochemical parameters and clinical outcomes are examined. A significant relationship between WBMRI disease patterns and high risk cytogenetic abnormalities was not borne out by our findings. Diffuse marrow involvement at WBMRI was however significantly associated with multiple factors including more advanced disease stage at diagnosis and poorer survival outcomes. We conclude that while WBMRI patterns are not currently not employed in myeloma risk stratification, recognising diffuse marrow disease at diagnosis may allow the identification of patients who could possibly benefit from more aggressive or innovative treatment strategies.