Systematic review and meta-analysis of the symptoms and treatment options of multiple myeloma in sub-Saharan African patients

S66Body MRI (WB-MRI) is a cross-sectional imaging technique for the entire skeletal study, with high sensitivity in detecting bone lesions, not still widely available because of costs and technical reasons.Moreover, since MRI has a higher sensitivity for detecting higher bone marrow cellularity, which is a clue of plasmacellular infiltration without overt bone lytic lesions, WB-MRI can detect a diffuse pattern of marrow involvement.Nevertheless, the IMWG has not yet defined the MRI diffuse pattern as a criterion for symptomatic disease, then the routine detection of this pattern could be relevant in patients with SMM to possibly suggest a group of patients with higher risk of developing lytic lesions and so progression in MM.Methods: In our Institution, from January 2021 to January 2023, we performed a prospective trial enrolling 26 consecutive newly diagnosed HR-SMM, according to IMWG, in which WB-MRI was performed according to MY-RADS criteria in combination with FDG PET-CT(median age 56; range 36-85).Results: Interim analysis of the comparison between WB-MRI and FDG PET-CT, showed a discordance in 4/26 (15%).In particular, in 3/26 (12%) WB-MRI showed bone lesions that have lead to symptomatic MM diagnosis according to IMWG, while PET-CT was negative.In one case, PET-CT showed a diffuse uptake, not diagnostic for MM, while WB-MRI was negative.WB-MRI showed a 100% of accuracy in detecting SMM and MM.Therefore, WB-MRI has lead to a modification of the prognosis and treatment (observation in SMM vs treatment in MM) in 3/26 patients (11%) (i.e.Fig. 1).In 5/23 (22%) SMM WB-MRI showed a slight diffuse alteration pattern of bone marrow without any overt lytic bone lesion, which could be a potential prognostic evidence.Conclusions: Our preliminary results support a fundamental role of WB-MRI plus FDG PET/CT in newly diagnosed high risk SMM, which could modify prognosis and treatment.In particular, WB-MRI plus FDG PET/CT could be more accurate in the detection of bone lesions than FDG PET/ CT alone, being able to anticipate MM diagnosis and its treatment.Moreover, a diffuse pattern of marrow involvement could be detected in some HR-SMM patients without any overt lytic lesions: it is questionable if this group is associated with a rapid progression in lytic lesions and so in symptomatic MM.