Researchers at the University of Miami’s Sylvester Comprehensive Cancer Center report that a targeted immunoPET scan detected active multiple myeloma in 17 of 60 patients — 28% — whose standard PET/CT scans and blood tests missed disease, as reported in the study published in Radiology.
This gap matters because multiple myeloma, a blood cancer, can spread throughout the body while remaining invisible to the imaging tools doctors rely on most. More than 36,000 Americans are diagnosed with the disease each year, and tracking whether it remains after treatment helps doctors more accurately map disease, guide treatment decisions and confirm whether cancer remains after therapy.
Antibody Scan Detects Hidden Myeloma Missed by Standard Tests
- A new antibody-based PET scan found active cancer in 17 patients whose standard scans and blood tests missed it.
- Standard PET/CT scans miss myeloma in up to 40% of cases because myeloma cells often consume glucose at the same rate as healthy cells, so they never “light up.”
- The scan is not yet routine care — it takes about a week for the antibody to reach tumors — but it adds a layer of detection that biopsies, blood tests, and standard imaging each miss on their own.
Why Standard PET/CT Scans Miss Myeloma in Up to 40% of Cases
Standard PET/CT imaging works by injecting labeled glucose and looking for cells that gobble it up faster than their neighbors. That logic holds for many cancers, but myeloma breaks the rule. As C. Ola Landgren, M.D., Ph.D., chief of the Myeloma Division and director of Sylvester Myeloma Institute at Sylvester, explained, “Myeloma cells frequently consume the same amount of glucose as the surrounding normal cells,” meaning lesions in the bone may never appear on the scan. Because of the absence of abnormal glucose uptake, conventional scans can fail to detect residual disease in up to 40% of cases.
In this targeted editorial, Dr. Choyke explores the future of multiple myeloma imaging, highlighting the potential of CD38-targeted immuno-PET as an innovative molecular imaging approach. https://t.co/HnbhijSh5y pic.twitter.com/a2k3yASd5q
How the CD38-Targeting Antibody Closes the Detection Gap
Rather than hunting for metabolic activity, the new approach hunts the cancer cells directly. The researchers labeled antibodies engineered to recognize CD38, a surface protein expressed on myeloma cells, creating what they call immunoPET. After laboratory testing and early human studies at Hoag Cancer Center, the team advanced the method into a multicenter Phase II trial published in Radiology. In the trial, each of the 60 enrolled patients underwent both a standard glucose-based PET/CT and the antibody-based immunoPET scan, allowing a head-to-head comparison in the same bodies.
28% Versus 22%: Neither Scan Wins Every Time
The results cut both ways. ImmunoPET uncovered disease that standard PET/CT missed in 17 patients (28%), and follow-up biopsies confirmed those signals were active myeloma. In one case, a patient with persistent back pain, normal blood markers, and normal imaging was found by immunoPET to have myeloma lesions in the spine; after switching treatments, the pain resolved. In another, a patient with negative scans and blood tests was found to have nearly 100 sites of disease throughout the body. Yet the reverse also happened: in 13 patients (22%), standard PET/CT spotted disease that immunoPET missed, and in the remaining patients both scans showed a similar extent of disease. No single test caught everything, which is why Landgren frames the technology as an additional layer rather than a replacement.
In a phase II trial, CD38-targeted zirconium 89 deferoxamine-daratumumab immuno-PET/CT was much more efficient than FDG PET/CT, even depicting multiple myeloma in some participants with no signs of disease at FDG PET/CT. @hoaghealth https://t.co/AFuiiSnPgf pic.twitter.com/pKYtaFy4WJ
| Imaging result | Patients | Share of 60-patient trial |
|---|---|---|
| ImmunoPET found disease standard PET/CT missed (biopsy-confirmed) | 17 | 28% |
| Standard PET/CT found disease immunoPET missed | 13 | 22% |
| Both scans showed a similar amount of disease | Remaining patients | N/A |
| Cases where standard PET/CT can miss residual disease (no abnormal glucose uptake) | Up to 40% of cases generally | Population-level estimate |
From Week-Long Scan to Same-Day Test
The current version of immunoPET is not yet practical for routine use: it takes about a week for the antibody to travel through the body and attach to cancer cells. Landgren and colleagues are developing next-generation versions using smaller antibody fragments that could reach tumors faster, potentially enabling a same-day test. As Landgren put it, “If we are going to cure multiple myeloma, we need two things. One, we need really effective medicines. Second, we need to be able to make sure there is no disease left behind after these treatments.”
What This Means for Patient Access
Because the study is a Phase II trial, immunoPET remains investigational. Access is limited to clinical trial settings.
Talk to Oncologists About Sensitive Detection Despite Clean Scans
ImmunoPET is not yet available outside research settings, so no patient can request it as routine care today. Anyone with multiple myeloma who has persistent bone pain, unexplained fractures, or worsening symptoms despite “clean” standard scans and blood tests should raise the question of more sensitive detection with their oncologist, since the trial showed exactly such patients can harbor active disease.
The open question is whether adding immunoPET to standard workups actually changes survival, not just detection. Until larger trials answer that, the scan’s role is to make visible what has been hiding in plain sight.
A novel CD38-targeted immuno-PET tracer could help detect multiple myeloma in some patients with no signs of disease, according to results from a phase II trial. @DrOlaLandgrenhttps://t.co/gqK2OQyVA2
References
- Ulaner, G. A., et al. (2026). Phase 2 Trial of 89Zr-Deferoxamine-Daratumumab for CD38-targeted Immuno-PET/CT Detection of Multiple Myeloma. Radiology. https://pubs.rsna.org/doi/10.1148/radiol.260517
