Purpose This study aimed to assess and compare the Durie-Salmon PLUS staging performance and high-risk prediction capabilities between [68Ga]Ga-Pentixafor and [18F]FDG PET/CT in newly diagnosed multiple myeloma (NDMM). Methods Eligible participants with NDMM who underwent [68Ga]Ga-Pentixafor and [18F]FDG PET/CT between October 2021 and March 2025 were prospectively enrolled in this study (NCT05255926). The diagnostic and staging performance of [68Ga]Ga-Pentixafor and [18F]FDG were assessed and compared. The parameters including standardized uptake value (SUV), tumor-to-liver ratio (TLR), total bone marrow uptake (TBMU), total bone marrow uptake volume (TBMV), and total burden score (TBS) were calculated. Independent predictors for high-risk NDMM were identified using single-factor and multivariate logistic regression. Results Sixty-nine participants (40 men) with a median age of 64 years (interquartile range [IQR], 57–71.5 years) were finally analysed. [68Ga]Ga-Pentixafor PET/CT exhibited a higher positive detection rate (82.6% [57/69] vs. 53.6% [37/69], P < 0.001), maximum SUV (SUVmax; 13.5 vs. 5.3 P < 0.001), mean SUV (SUVmean; 3.5 vs. 2.9, P = 0.029), TLR (8.1 vs. 2.0, P < 0.001), and TBS (45 vs. 4, P < 0.001) than [18F]FDG. [68Ga]Ga-Pentixafor-derived TBSCXCR4, TBMVCXCR4, and TBMUCXCR4 positively correlated with bone marrow plasma cell percentage, β2-microglobulin, and total additive score, respectively. For Durie-Salmon PLUS staging, [68Ga]Ga-Pentixafor better identified advanced participants than did [18F]FDG PET/CT (53 vs. 35; P < 0.001). According to the Mayo mSMART 4.0 stratification system, multivariate logistic regression analysis demonstrated that SUVmeanCXCR4 (odds ratio [OR] = 1.752, 95% confidence interval [CI] = 1.085– 2.828, P = 0.022) and TBSCXCR4 (OR = 1.041, 95% CI = 1.011–1.072, P = 0.008) were independent indicators for predicting high-risk NDMM. Conclusion In NDMM, [68Ga]Ga-Pentixafor demonstrated better diagnostic accuracy, Durie-Salmon PLUS staging, and high-risk prediction capabilities than did [18F]FDG PET/CT. [68Ga]Ga-Pentixafor-derived SUVmeanCXCR4 and TBSCXCR4 could accurately identify high-risk NDMM. Trial registration number: NCT05255926.

[⁶⁸Ga]Ga-Pentixafor PET/CT for Durie-Salmon PLUS staging and risk stratification in newly diagnosed multiple myeloma

期刊论文
发表日期：

2026年2月28日

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Jie Chen,
Shuaihu Tang,
Li Liu,
Yueli Tian,
Yichun Wang,
Zhiwei Xiao,
Diankui Xing,
Fuling Zhou,
Chongjiao Li,
Yong He

摘要

Purpose

This study aimed to assess and compare the Durie-Salmon PLUS staging performance and high-risk prediction capabilities between [⁶⁸Ga]Ga-Pentixafor and [¹⁸F]FDG PET/CT in newly diagnosed multiple myeloma (NDMM).

Methods

Eligible participants with NDMM who underwent [⁶⁸Ga]Ga-Pentixafor and [¹⁸F]FDG PET/CT between October 2021 and March 2025 were prospectively enrolled in this study (NCT05255926). The diagnostic and staging performance of [⁶⁸Ga]Ga-Pentixafor and [¹⁸F]FDG were assessed and compared. The parameters including standardized uptake value (SUV), tumor-to-liver ratio (TLR), total bone marrow uptake (TBMU), total bone marrow uptake volume (TBMV), and total burden score (TBS) were calculated. Independent predictors for high-risk NDMM were identified using single-factor and multivariate logistic regression.

Results

Sixty-nine participants (40 men) with a median age of 64 years (interquartile range [IQR], 57–71.5 years) were finally analysed. [⁶⁸Ga]Ga-Pentixafor PET/CT exhibited a higher positive detection rate (82.6% [57/69] vs. 53.6% [37/69], P < 0.001), maximum SUV (SUVmax; 13.5 vs. 5.3 P < 0.001), mean SUV (SUVmean; 3.5 vs. 2.9, P = 0.029), TLR (8.1 vs. 2.0, P < 0.001), and TBS (45 vs. 4, P < 0.001) than [¹⁸F]FDG. [⁶⁸Ga]Ga-Pentixafor-derived TBS_CXCR4, TBMV_CXCR4, and TBMU_CXCR4 positively correlated with bone marrow plasma cell percentage, β2-microglobulin, and total additive score, respectively. For Durie-Salmon PLUS staging, [⁶⁸Ga]Ga-Pentixafor better identified advanced participants than did [¹⁸F]FDG PET/CT (53 vs. 35; P < 0.001). According to the Mayo mSMART 4.0 stratification system, multivariate logistic regression analysis demonstrated that SUVmean_CXCR4 (odds ratio [OR] = 1.752, 95% confidence interval [CI] = 1.085– 2.828, P = 0.022) and TBS_CXCR4 (OR = 1.041, 95% CI = 1.011–1.072, P = 0.008) were independent indicators for predicting high-risk NDMM.

Conclusion

In NDMM, [⁶⁸Ga]Ga-Pentixafor demonstrated better diagnostic accuracy, Durie-Salmon PLUS staging, and high-risk prediction capabilities than did [¹⁸F]FDG PET/CT. [⁶⁸Ga]Ga-Pentixafor-derived SUVmean_CXCR4 and TBS_CXCR4 could accurately identify high-risk NDMM.

Trial registration number: NCT05255926.

[68Ga]Ga-Pentixafor PET/CT for Durie-Salmon PLUS staging and risk stratification in newly diagnosed multiple myeloma

摘要

[⁶⁸Ga]Ga-Pentixafor PET/CT for Durie-Salmon PLUS staging and risk stratification in newly diagnosed multiple myeloma