Multiple Myeloma Clinical Trial
Official title:
Novel Imaging Modalities to Characterize Angiogenesis in the Bone Marrow Microenvironment in Multiple Myeloma (MM) and Its Precursor Disease
Background:
- Multiple myeloma (MM) is a type of malignant blood cancer. It affects the plasma cells,
which help produce antibodies and fight infection. MM is nearly always preceded by a
pre-malignant state, monoclonal gammopathy of undetermined significance (MGUS) or smoldering
multiple myeloma (SMM). Currently, it is not possible to predict when someone with MGUS or
SMM will develop MM. Also, the disease changes in those early states are not well understood.
Researchers want to look at imaging studies of people with MGUS, SMM, and MM. They will study
whether the growth of blood vessels can be used to predict disease progression.
Objectives:
- To use imaging studies to evaluate disease progression in multiple myeloma.
Eligibility:
- Individuals at least 18 years of age who have MGUS, SMM, or newly diagnosed MM.
Design:
- Participants will be screened with a physical exam and medical history. They will also
have blood and urine tests, and provide bone marrow samples.
- Participants will have positron emission tomography (PET) scans with the new contrast
agent [18]F-Fluciclatide. The contrast agent is intended to show patterns of increased
vessel growth in the bone marrow.
- Participants will also have a magnetic resonance imaging (MRI) scan. This scan will be
done according to standard procedures.
- Researchers will compare these scans with blood tests and other clinical information to
study disease progression of MGUS, SMM, and MM.
Background:
- Multiple myeloma (MM) is a plasma cell neoplasm with a median survival of 3-4 years.
- Monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM)
are premalignant plasma cell proliferative disorders characterized by elevated
monoclonal protein and bone marrow plasma cells. MGUS affects 3.2% of Caucasians over
the age of 50 and has a 1% annual risk of progression to MM. Approximately 3,000 cases
of SMM are diagnosed annually with a 10% annual risk of progression to MM.
- Currently, it is not possible to predict which patients will progress to MM, and the
biological changes occurring in those precursor states remain poorly understood.
- Angiogenesis is a hallmark of multiple myeloma and its precursor disease.
Angiogenesis has been measured using microvessel density. In a prior study, we have
demonstrated increased microvessel density using CD34 immunohistochemistry in patients with
multiple myeloma, compared to SMM or MGUS, suggesting that there is increased vascular
density as the disease progresses. A correlation between MM disease stage and prognosis has
been reported for several serum angiogenic factors and myeloma cells and bone marrow
endothelial cells have been shown to secrete and respond to angiogenic modulators.
- Dynamic contrast-enhanced (DCE)-MRI is a noninvasive way to evaluate angiogenesis. In a
prior NIH study, we have demonstrated that the kep (a measure of contrast influx in
vessels in the bone marrow microenvironment) to be gradually higher in MM>SMM>MGUS,
however it was limited to imaging a single field of view (i.e. the lumbar spine). This
is also highly correlated with microvessel density.
- Fluciclatide is a small cyclic peptide containing the RGD tri-peptide, which
preferentially binds with high affinity to Alpha(v)Beta(3) integrins, which are
up-regulated in angiogenesis.
- Alpha(v)Beta(3) integrins are also expressed on certain types of tumor cells and on
activiated osteoclasts.
- (18)Fluciclatide (previously known (18)F-AH111585) is a new radiopharmaceutical
developed for PET imaging, which targets Alpha(v)Beta(3) receptors.
- Novel imaging modalities using tracers specific for angiogenesis, using
(18)F-Fluciclatide whole-body PET/CT imaging may improve our ability to predict patients
who are at high risk of progression.
Objectives:
- The primary objective of the study is to explore the distribution of (18)F-Fluciclatide
PET/CT in bone marrow microenvironment in patients with multiple myeloma and its
precursor disease.
- The secondary objectives are to preliminarily evaluate the distribution of
(18)Fluciclatide PET/CT with respect to DCE-MRI and bone marrow vascularity determined
by immunohistochemistry (CD34) on the bone marrow biopsy specimen.
- To preliminarily evaluate the distribution of (18)F-Fluciclatide PET/CT with respect to
established clinical markers of progression from MGUS/SMM to MM, including serum
M-protein, percentage of plasma cells in the bone marrow, serum free light-chain
abnormalities and immunoparesis, and ratio of normal/abnormal plasma cells in the bone
marrow by flow cytometry.
Eligibility:
- A confirmed diagnosis of MGUS, SMM or MM (based on IMWG diagnostic criteria)
- Age greater than or equal to 18 years
- ECOG performance status in the range of 0-2
Design:
- This is a cross-sectional pilot study of patients with MGUS, SMM or MM.
- Subjects with frank multiple myeloma will be enrolled first. If the (18)F-Fluciclatide
PET/CT is negative in the first 5 subjects, the study will be aborted and we will not
proceed with MGUS or SMM patients. However if the 18F-Fluciclatide PET/CT is positive in
MM patients, then we will proceed with MGUS and SMM patients.
- Subsequently (18)F-Fluciclatide PET/CT and DCE-MRI imaging will be done in all the
patients. When feasible, an optional non-contrast wholebody MR may also be performed.
- 10 MM, 10 SMM and 10 MGUS patients will be enrolled on this protocol.
- Patients may donate cellular products or tissues as appropriate for research purposes.
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