The Role of Interim F-18 FDG PET/CT in Patients of T Lymphoblastic Leukemia/Lymphoma Treated with ALL-Type Regimens

Abstract Background: T lymphoblastic leukemia/lymphoma (T-LBL) is highly aggressive. Although intensive chemotherapies such as acute lymphoblastic leukemia (ALL)-type regimens are commonly used, about half adult patients eventually relapse and die of T-LBL. Overwhelming evidences have confirmed the role of interim F-18 FDG PET/CT in Hodgkin lymphoma and many ongoing studies have implemented risk-adapted strategy determined by interim FDG-PET/CT. However, the role of interim FDG-PET/CT in T-LBL remains unclear. Materials and methods: 47 adult patients of T-LBL treated with ALL-like regimens were retrospectively reviewed. They were treated with modified Berlin-Frankfurt-Münster (BFM)-90 regimen (n=27), Medical Research Council (MRC) UKALLXII/Eastern Cooperative Oncology Group (ECOG) 2993 regimen (n=5), hyperCVAD/MA regimen (n=12), or other unspecified regimens (n=3). Interim (defined as the period between induction therapy and re-induction therapy) FDG-PET/CT was done in all 47 patients and evaluated according to the International Harmonization Project (IHP) criteria. Results: The male to female ratio was 3:1, and 29.8% of patients were older than 30 years old. About 90% of patients had mediastinal mass at presentation and 53.2% had bone marrow infiltration. 85.1% of patients had advanced disease. After induction therapy, interim FDG-PET/CT was positive in 19 patients (40.4%), most of whom had residual disease in the mediastinal lesion. Subsequent treatments were not changed according to this interim PET/CT results. After a median follow up time of 28 months, the 2-year and 3-year progression free survival (PFS) rate were 39% and 30%, respectively, and the 2-year and 3-year overall survival (OS) rate were 54% and 45%, respectively. Using Kaplan-Meier survival analysis and log-rank test, it was found that interim FDG-PET/CT positivity correlated with significantly inferior PFS and OS (p=0.002 and 0.010, respectively). Furthermore, patients with higher age (>30) had inferior PFS and OS than younger patients (p=0.037 and 0.036, respectively). However, there were no significant relationship between PFS, OS and bone marrow infiltration, LDH level, and stages (p>0.05). Conclusions: Interim FDG-PET/CT may predict PFS and OS in adult patients of T-LBL treated with ALL-type regimens, which needs to be validated in prospective clinical trials. The optimal criteria for interim FDG-PET/CT evaluation and risk-adapted treatment strategy determined by interim FDG-PET/CT should be investigated in future clinical practice. Disclosures No relevant conflicts of interest to declare.

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The role of bone marrow biopsy and FDG-PET/CT in identifying bone marrow infiltration in the initial diagnosis of high grade non-Hodgkin B-cell lymphoma and Hodgkin lymphoma. accuracy in a multicenter series of 372 patients

American Journal of Hematology ◽

10.1002/ajh.24044 ◽

2015 ◽

Vol 90 (8) ◽

pp. 686-690 ◽

Cited By ~ 25

Author(s):

Tzu-Hua Chen-Liang ◽

Taida Martin-Santos ◽

Andres Jerez ◽

Leonor Senent ◽

Maria Teresa Orero ◽

...

Keyword(s):

Bone Marrow ◽

B Cell ◽

Hodgkin Lymphoma ◽

Fdg Pet ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

High Grade ◽

Pet Ct ◽

Fdg Pet Ct

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Assessment of the role of 18F-FDG PET CT in detection of bone marrow infiltration in comparison to the Bone Marrow Aspirate in Lymphoma patients

QJM ◽

10.1093/qjmed/hcab106.031 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Madonna Adel Mikhail Ghaly ◽

Aida Mohamed El Shibiny ◽

Susan Adil Ali Abdul Rahim

Keyword(s):

Bone Marrow ◽

Ct Scan ◽

Fdg Pet ◽

Hodgkin’S Lymphoma ◽

Hodgkin's Lymphoma ◽

Bone Marrow Infiltration ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Pet Ct Scan

Abstract Background 18-F-2-Deoxy-D-Glucose Positron Emission Tomography [FDG-PET], combined with multidetector helical Computed Tomography [PET/CT] has emerged as a one of the most important prognostic tools for lymphoma management. Previous studies have indicated that PET/CT is a convenient method for bone marrow assessment in patients with lymphoma. A blind Bone Marrow Biopsy [BMB] has been traditionally used as the golden standard in marrow evaluation despite its invasiveness. Objective is to compare the results of PET/CT with BMB regarding bone marrow infiltration [BMI] in patients with Hodgkin's Lymphoma [HL] and Non-Hodgkin's Lymphoma [NHL] and to characterize the visual bone marrow FDG uptake pattern by PET-CT Methods A cross sectional study including 27 cases of Lymphoma, conducted at Ain Shams University hospitals, the patients were investigated using PET-CT scan and BMB ,the period was between December 2018 till the end of May 2019. Results Our study included 27 histologically proved Lymphoma patients, 14 (51.9%) were males and 13 (48.1%) were females, with age ranging from 17 to 69 years (mean 45 years). Among the total cases, 17 (63%) patients had NHL, while 10 (37%) patients had HL. All the patients were evaluated at first by BMB (taken from the dorsal portion of the iliac crest) for initial staging, then the patients underwent PET/CT scan. The study revealed 12 patients (44.4%) had BMI detected by PET/CT imaging; however, only 7 patients (25.9%) were detected by BMB. BMB and 18F-FDG PET/CT scans were concordant for BMI detection in 22 patients (81.5%): positive concordance in 7 patients and negative in 15. Of the 5 discordant cases, four had a focal marrow intense FDG uptake detected by PET/CT and were upstaged as their BMB results were false-negative, one patient had intense diffuse marrow uptake by PET/CT while its BMB was negative (revealed only hyper cellularity with mild dysplasia). The sensitivity, specificity, PPV, and NPV of PET for identifying BMI was 100%, 75%, 58.3%, 100% respectively with a diagnostic accuracy 81.5% with a (p value < 0.05). Conclusion 18F-FDG PET-CT imaging is more sensitive than bone marrow biopsy for bone marrow infiltration detection in Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma staging.

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Conventionally-Defined and PET/CT-Defined Complete Response (CR) to Novel Agent-Based Induction Therapy and Autologous Stem-Cell Transplantation (ASCT) In Multiple Myeloma (MM): A Prospective Study of Clinical and Prognostic Implications

Blood ◽

10.1182/blood.v118.21.826.826 ◽

2011 ◽

Vol 118 (21) ◽

pp. 826-826

Author(s):

Elena Zamagni ◽

Cristina Nanni ◽

Francesca Patriarca ◽

Annalisa Pezzi ◽

Beatrice Anna Zannetti ◽

...

Keyword(s):

Bone Marrow ◽

Induction Therapy ◽

Fdg Pet ◽

Bone Marrow Involvement ◽

Trend Test ◽

Agent Based ◽

Fdg Uptake ◽

Pet Ct ◽

Fdg Pet Ct ◽

Time To Relapse

Abstract Abstract 826 Incorporation of novel agents into ASCT allowed the achievement of unprecedented high rates of CR in young MM patients, a gain which translated into extended PFS and OS. As a consequence, interest in the evaluation of the depth of CR has progressively grown. More sensitive tools, such as multiparametric flow cytometry or molecular biology, led to the demonstration of a correlation between the depth of CR and prognosis, but failed to identify the persistence of residual disease outside of the bone marrow level. 18 F-FDG PET/CT is a careful technique to detect with high sensitivity and specificity the presence of active bone lesions and/or bone marrow involvement in newly diagnosed and previously treated MM. We prospectively analysed the prognostic significance of FDG-PET/CT at diagnosis, after induction therapy and ASCT in an homogeneous population of 192 patients with newly diagnosed MM, followed for a median of 43 months. By study design, all patients were studied with FDG-PET/CT at baseline, after induction treatment, after 3 months from ASCT (single or double), once a year during the maintenance/follow-up phase and at time of relapse. Bone marrow involvement was described as negative, diffuse or focal. The number of focal lesions (FLs), as well as size and associated standardized uptake values (SUV) were recorded. Extra-medullary disease (EMD), if present, was described by location, size, number and SUV. Twenty four percent of the patients had a negative PET/CT scan at diagnosis. Among PET/CT-positive patients, 44% showed ≥3 FLs, 46% had SUV values >4.2 and in 6% EMD could be detected. These 3 variables adversely affected 4-year estimates of PFS and OS. In particular, both EMD and severe FDG uptake were significantly associated with shorter PFS and OS. Thirty seven percent of the patients were PET/CT-negative after induction. A strong correlation between conventional response and SUV max reduction was evident, the mean SUV value of patients achieving CR being significantly lower in comparison with that of patients reaching very good partial response (VGPR) or partial response (mean: 1.4 vs 3, respectively) (Cuzick's trend test, P= 0.016). Persistence of severe FDG uptake (SUV max still >4.2) after induction predicted for shorter PFS at 4 years (P= 0.004). PET/CT negativity (PET-CR) was observed in 65% of patients after 3 months from ASCT(s). A close relationship between PET/CT negativity and response to ASCT was evident, since 95% of patients with a negative PET/CT had achieved at least a VGPR (P= 0.003). Moreover, a correlation between conventional response and SUV max reduction was evident after ASCT as well (mean: 0.8 vs 1.8, respectively) (Cuzick's trend test, P= 0.001). PET-CR after ASCT conferred superior PFS and OS in comparison with persistence of FDG uptake. In particular, the 4-year estimates of PFS and OS for PET-CR patients were 66% and 89%, respectively, as compared with 45% and 65% for positive patients (P=0.02 both for PFS and OS). Notably, 23% of patients achieving CR according to conventional criteria still had positive PET/CT scans and their 4-year estimate of PFS was 30%, as compared with 61% for negative patients (P=0.02). After ASCT, patients were followed with evaluation of M protein every 3 months and of PET/CT once a year. In 44% of those who had a conventionally-defined relapse or progression, the mean time to relapse/progression was 27.6 months for PET-negative patients as compared with 18 months for positive patients (P=0.05). In PET-positive patients, the SUV max was inversely correlated to the time to relapse (correlation coefficient −0.7, P= 0.003). In multivariate analysis, both severe PET/CT involvement at diagnosis (SUV >4.2 and/or EMD) and persistence of FDG uptake after ASCT were independent predictors of worst PFS (SUV >4.2= HR: 2.0, 95%CI: 1.13–3.72; EMD= HR: 15.0, 4.0–55.8; FDG uptake after ASCT= HR: 2.12, 1.19–3.77) and OS (EMD= HR: 6.99, 2.28–21.46; FDG uptake after ASCT= HR: 3.57, 1.03–12.39). In conclusion, PET-defined CR was linked to conventionally-defined CR and was an independent prognostic factor in MM patients receiving up-front novel agent-based induction therapy and ASCT. PET/CT contributed to a more careful definition of CR, in particular after ASCT, and could be usefully incorporated into the algorithm to evaluate the depth of response in young MM patients. Disclosures: No relevant conflicts of interest to declare.

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18F-FDG PET, combined FDG-PET/CT and MRI for evaluation of bone marrow infiltration in staging of lymphoma: A systematic review and meta-analysis

European Journal of Radiology ◽

10.1016/j.ejrad.2010.11.020 ◽

2012 ◽

Vol 81 (2) ◽

pp. 303-311 ◽

Cited By ~ 35

Author(s):

Lian-Ming Wu ◽

Fang-Yuan Chen ◽

Xiao-Xing Jiang ◽

Hai-Yan Gu ◽

Yan Yin ◽

...

Keyword(s):

Systematic Review ◽

Bone Marrow ◽

Fdg Pet ◽

Meta Analysis ◽

Bone Marrow Infiltration ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Ct And Mri

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2104 POSTER Role of FDG-PET/CT in the Evaluation of Bone Marrow Involvement of Solid Tumours

European Journal of Cancer ◽

10.1016/s0959-8049(11)71033-4 ◽

2011 ◽

Vol 47 ◽

pp. S210

Author(s):

O. Yildiz ◽

F. Selcukbiricik ◽

D. Tural ◽

H. Turna ◽

N.M. Mandel ◽

...

Keyword(s):

Bone Marrow ◽

Fdg Pet ◽

Bone Marrow Involvement ◽

Solid Tumours ◽

Pet Ct ◽

Fdg Pet Ct

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Role of FDG-PET/CT in the Staging of Patients with Follicular Lymphoma

Blood ◽

10.1182/blood.v126.23.5010.5010 ◽

2015 ◽

Vol 126 (23) ◽

pp. 5010-5010 ◽

Cited By ~ 1

Author(s):

Sayako Yuda ◽

Dai Maruyama ◽

Hiroaki Kurihara ◽

Akiko Miyagi Maeshima ◽

Kosuke Toyoda ◽

...

Keyword(s):

Bone Marrow ◽

Follicular Lymphoma ◽

Fdg Pet ◽

International Prognostic Index ◽

Prognostic Index ◽

Response Assessment ◽

Bone Marrow Examination ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Introduction The Lugano Classification incorporating recommendations of 18-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography/computed tomography (PET/CT) in the staging and response assessment of FDG-avid lymphomas was published. This classification is based on plenty of reports that suggested that evaluation with FDG-PET/CT improved the accuracy of the staging and response assessment of FDG-avid lymphomas, especially of diffuse large B-cell lymphoma and Hodgkin lymphoma. However, we are not sure of the role of FDG-PET/CT in indolent B-cell lymphomas, such as follicular lymphoma (FL). Patients and Methods Patients who were initially diagnosed as having FL of grade 1 to 3a at our institution between 2010 and 2012 were included in this study. We analyzed the number of nodal areas and the location of extranodal diseases identified by FDG-PET/CT added to the conventional evaluation consisting of CT, bone marrow examination and upper gastrointestinal endoscopy. The clinical stage by the conventional evaluation was compared to that by the Lugano Classification using FDG-PET/CT. It was also investigated whether adding PET/CT to the conventional evaluation might have had any influence on the decision regarding the initial treatment for patients with FL. Results A total of 67 patients with a median age of 62 years (range: 39-85) were included in this analysis. In comparison with CT, FDG-PET/CT identified a higher number of nodal areas in 11 patients (16%). Most of the extranodal sites except bone marrow and gastrointestinal tract were more frequently detected by PET-CT. Bone marrow examination detected 22 patients (33%) with bone marrow involvement, while PET-CT detected only 4 patients (6%). Gastrointestinal lesions were identified in 15 patients (22%) with conventional evaluation and in 4 patients (6%) by PET-CT (Table 1). In one of these 4 patients, endoscopic biopsy revealed that the PET-CT positive lesion was adenoma. In seven patients (10%), upstaging occurred through conventional evaluation plus PET-CT: 3 patients were upstaged from stage I to II, 2 from stage II to IV, 1 from stage II to III, and 1 from stage III to IV (Table 2). International Prognostic Index (IPI) and Follicular Lymphoma International Prognostic Index (FLIPI) were revised upward in 9 patients (13%) and 12 patients (18%), respectively. However, the change of stage, IPI, or FLIPI did not affect the decision regarding the initial treatment. Conclusion Our data suggest that FDG-PET/CT cannot take the place of the conventional evaluation, especially in patients with FL, because of the low sensitivity of involvements in bone marrow and gastrointestinal tract, although it may be helpful to use FDG-PET/CT in the staging of FL. Moreover, FDG-PET/CT might not have had any impact on the decision regarding the treatment strategy in FL. That may be partly because the lesions detected only by FDG-PET/CT did not affect the judgment of tumor burden. Prospective evaluation of the influence of FDG-PET/CT on the clinical outcomes is needed to establish an appropriate evaluation in the staging of patients with FL. Disclosures Maruyama: Takeda Pharmaceutical Company Limited: Honoraria; Eisai Co., Ltd.: Honoraria. Kobayashi:Nippon Shinyaku: Honoraria; Pfizer: Research Funding. Tobinai:Gilead Sciences: Research Funding.

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