scholarly journals Baseline FDG-PET/CT detects bone marrow involvement in follicular lymphoma and provides relevant prognostic information

2020 ◽  
Vol 4 (8) ◽  
pp. 1812-1823
Author(s):  
Reiko Nakajima ◽  
Alison J. Moskowitz ◽  
Laure Michaud ◽  
Audrey Mauguen ◽  
Connie Lee Batlevi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Follicular Lymphoma ◽  
Univariate Analysis ◽  
Bone Marrow Involvement ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Prognostic Information ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract In follicular lymphoma (FL), detection of bone marrow (BM) involvement (BMI) by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) improves the accuracy of staging vs BM biopsy (BMB) alone. Our objective was to determine the diagnostic utility of PET for BMI FL and the prognostic value of BMI by PET (positive PET result [PET+]). Records of patients (2002-2016) with PET and BMB at the time of initial treatment were reviewed. BMI was identified by positive BMB result (BMB+) and/or unifocal or multifocal BM FDG uptake on blindly reviewed PET scans with no corresponding CT abnormality (PET+). Among 261 patients, BMI was diagnosed in 78 patients (29.9%) by PET+, in 81 patients (31.0%) by BMB+, and in 113 patients (43.3%) by either PET+ or BMB+. PET+ upstaged 24 patients to stage IV, including 10 from stages I or II to stage IV. Median duration of follow-up was 6.0 years (range, 0-16.6 years). In univariate analysis, a high Follicular Lymphoma International Prognosis Index (FLIPI) score, PET+, and BMB+ correlated with shorter progression-free survival (PFS; all P ≤ .03), and high FLIPI, PET+, and combined PET+ and BMB+ with shorter overall survival (OS; all P ≤ .01). In multivariate analysis, PET+ was the only independent predictor of PFS, whereas high FLIPI score and PET+ predicted OS (P ≤ .03). Combined PET and BMB identify BMI more accurately than either BMB or PET alone, but BMB rarely adds critical information. For patients initiating treatment of FL, identification of BMI by PET is predictive of PFS and OS.

Association of FDG PET-CT (PET) avid skeletal lesions (SL) with progression-free survival (PFS) in patients (pts) with previously untreated follicular lymphoma (FL).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e19026-e19026
Author(s):  
Joseph J. Maly ◽  
Lai Wei ◽  
Jessica Hemminger ◽  
Beth Christian ◽  
Kami J. Maddocks ◽  
...  
Keyword(s):  
Bone Marrow Involvement ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Single Center ◽  
Bulky Disease ◽  
Therapeutic Trials ◽  
Increased Risk ◽  
Pet Ct ◽  
Stage Iv Disease ◽  
Fdg Pet Ct

e19026 Background: PET scan is frequently utilized in FL. Reduced EFS has been observed in DLBCL pts with SL treated with RCHOP (Held, JCO 31:4115, 2013). Methods: We performed a retrospective single center study to assess outcomes of FL pts with PET avid SL between January 2005 and November 2015. 131 pts with newly diagnosed FL and PET performed within 1 month of diagnosis were included. Results: 32 of these pts had SL (median 4, range 1-11) on initial PET. Median age was 57 (range 43-79), 15 (47%) were female, 30 (94%) had stage IV disease, LDH was elevated in 6 (19%), 6 (19%) had bulky disease > 6 cm, and FLIPI-1 score was low in 5, intermediate in 11, and high 16 pts. 27 pts had grade (gr) 1-2 FL, 2 had gr 3a, and 3 had gr 3 (not classified). All but 1 patient received rituximab (R)-containing therapy (9 received BR, 7 received RCHOP, 5 RCVP, 9 other). 8 pts received maintenance R, and none received radiation. There were no statistically significant differences in median age, tumor gr, LDH, or use of anthracycline containing therapy (28% in SL group vs 16% in non-SL group, p = 0.13) in pts with SL compared to those without SL (n = 99). Pts with SL had higher incidence of bone marrow involvement (27% vs 9%, p = 0.013). With a median follow-up of 35 months, SL pts had 44% rate of transformation to DLBCL compared 12% in non-SL pts (p = 0.004). Median PFS was 45.8 months in SL pts not-reached in non-SL pts (p = 0.003). Median OS was 105.9 months in SL pts and not reached in non-SL pts (p = 0.08). In the multi-variate analysis, SL (p = 0.037), male gender (p = 0.048), higher FLIPI-1 score (p = 0.009), and absence of anthracycline containing therapy (p = 0.005) were significantly associated with decreased PFS using backward selection. Conclusions: The presence of PET identified SL in previously untreated FL is associated with an increased risk of transformation and reduced PFS in this single center retrospective analysis. Larger studies of uniformly treated pts are needed to validate these data. The identification of high-risk PET avid SL in FL pts in future prospective therapeutic trials could be used to select pts for specific induction regimens, maintenance rituximab, or consolidative radiation.

scholarly journals Correlation of FDG-PET-CT with Bone Marrow Aspiration and Biopsy at the Initial Staging in Follicular Lymphoma: Can We Omit Bone Marrow Biopsy in Some?

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4436-4436
Author(s):  
Manju Sengar ◽  
Hasmukh Jain ◽  
Venkatesh Rangarajan ◽  
Archi Agrawal ◽  
Hari Menon ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Follicular Lymphoma ◽  
Bone Marrow Biopsy ◽  
Predictive Value ◽  
Fdg Pet ◽  
Early Stage ◽  
Bone Marrow Involvement ◽  
Bone Marrow Uptake ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Introduction: The role of FDG PET-CT in follicular lymphoma is limited to accurate assessment of disease extent in early stage patients and selection of biopsy site in cases of suspected high- grade transformation. Despite the known FDG avidity of follicular lymphoma, FDG PET-CT has not yet been included as part of standard staging procedures in these patients. FDG PET-CT has shown significant correlation with bone marrow biopsy in Hodgkin and diffuse large B-cell lymphomas. In this retrospective analysis we have assessed the correlation of PET-CT with that of bone marrow biopsy, the reference standard for assessment of bone marrow infiltration in follicular lymphoma. Methods: We retrospectively analyzed electronic medical records and database of patients with newly diagnosed follicular lymphoma registered at Tata Memorial Centre from July 2009 to Jun 2014, who underwent complete staging workup as per the current recommendations along with whole body 18FDG-PET/CT. The demographic features, performance status, stage, LDH, nodal sites, haemoglobin, follicular lymphoma international prognostic index (FLIPI), FDG PET-CT findings (bone marrow involvement, pattern of involvement- focal or diffuse, sites of marrow involvement, liver and spleen uptake, SUVmax of most FDG avid lesion) and bone marrow aspiration/biopsy (morphology, immunohistochemistry and immunophenotyping on aspirate, where available) findings were recorded. Focal uptake in marrow on baseline PET-CT was considered as marrow involvement if post therapy PET-CT showed resolution of these lesions. The sensitivity, specificity, negative and positive predictive value of PET-CT in detecting bone marrow infiltration was assessed taking bone marrow biopsy as gold standard. The factors responsible for discordant results were analyzed. Results: A total of 54 patients (males-38, females-16) were included in analysis with median age of 50 years, (range 22-73 years). At diagnosis 83% (45 patients) had stage III or IV disease and 57% patients had high-risk FLIPI score. Approximately 88% patients had good performance status (ECOG-<2). Bone marrow showed infiltration in approximately 60% (32 patients) on biopsy and immunophenotyping. PET-CT showed bone marrow involvement in 18 patients (focal-12, diffuse -6). In 4 patients with focal PET-CT positivity, bone marrow was uninvolved. However, post therapy these lesions showed resolution, thus confirming the presence of disease pretherapy. The sensitivity, specificity, positive and negative predictive value of PET/CT with respect to biopsy was 43.7%, 81.2%, 77.8% and 50% respectively. However, if we include the above mentioned 4 cases as true positives, then specificity and positive predictive value improves to 100% each. In addition, PET-CT could accurately predict absence of bone marrow involvement in stage I and stage II disease (100% concordance). The median SUVmax of most FDG avid lesion was 13.1 (5.25-34.93). However the SUVmax did not correlate with grade of lymphoma as the node biopsy was not done based on PET-CT results. Conclusion: This study shows that in patients with advanced stage follicular lymphoma bone marrow biopsy can be omitted if PET-CT shows focal or diffuse bone marrow uptake. Similarly, patients with early stage disease with no bone marrow uptake on PET-CT can be spared from bone marrow biopsy. Disclosures No relevant conflicts of interest to declare.

scholarly journals Radiotherapy in Follicular Lymphoma Staged by 18F-FDG-PET/CT: A German Monocenter Study

Biomedicines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 561
Author(s):  
Imke E. Karsten ◽  
Gabriele Reinartz ◽  
Michaela Pixberg ◽  
Kai Kröger ◽  
Michael Oertel ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Survival Rates ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Stage I ◽  
University Hospital ◽  
Positron Emission ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

This retrospective study examined the role of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) in stage-related therapy of follicular lymphomas (FL). Twelve patients each in stages I and II, 13 in stage III and 11 in stage IV were treated in the Department of Radiation Oncology, University Hospital of Muenster, Germany from 2004 to 2016. Radiotherapy (RT), as well as additional chemoimmunotherapy were analyzed with a median follow-up of 87.6 months. Ultrasound (US), CT and 18F-FDG-PET/CT were used to determine progression-free survival (PFS), overall survival (OS) and lymphoma-specific survival (LSS) over 5- and 10- years. 23 of 24 patients with stage I/II (95.8%) had complete remissions (CR) and 17 of 24 patients with stages III/IV FL showed CR (70.8%). 5- and 10-year PFS in stages I/II was 90.0%/78.1% vs. 44.3%/28.5% in stages III/IV. 5- and 10-year OS rates in stages I/II was 100%/93.3% vs. 53.7%/48.4% in stages III/IV. 5- and 10-year LSS of stages I/II was 100%/93.8% vs. 69.2%/62.3% in stages III/IV. FL of stages I/II, staged by 18F-FDG-PET/CT, revealed better survival rates and lower risk of recurrence compared to studies without PET/CT-staging. Especially, patients with PET/CT proven stage I disease showed significantly better survival and lower relapses rates after RT.

scholarly journals 18f-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (PET/CT) for Assessment of Bone Marrow Metabolism in Patients with Myelofibrosis

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1866-1866
Author(s):  
Thorsten Derlin ◽  
Haefaa Alchalby ◽  
Peter Bannas ◽  
Simon Veldhoen ◽  
Guntram Büsche ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Metabolic Activity ◽  
Bone Marrow Involvement ◽  
Tracer Uptake ◽  
Positron Emission ◽  
Pet Ct ◽  
Marrow Space ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Glucose Analogue

Abstract Introduction Myelofibrosis is a hematopoetic stem cell neoplasm characterized by bone marrow inflammation, reactive marrow fibrosis and extramedullary hematopoiesis. Myelofibrosis is associated with a chronic inflammatory state, including, but not limited to the bone marrow space. Chronic inflammation is triggering the initiation of fibrogenesis, and bone marrow fibrosis is a hallmark of terminal phase myelofibrosis. Positron emission tomography/computed tomography (PET/CT) using the glucose analogue 18F-fluorodeoxyglucose (18F-FDG) is widely used for imaging of both inflammatory and malignant processes due to increased glucose consumption in inflammatory and neoplastic cells. A noninvasive method to visualize and quantify the extent of active myelofibrosis would be highly desirable, e.g. for therapy monitoring studies. Therefore, the aim of this study was to assess if 18F-FDG PET/CT provides noninvasive insights into the metabolic implications of the disease. Methods In 30 patients, the biodistribution of the glucose analogue 18F-FDG was analyzed 60 min after intravenous injection of 350 MBq of 18F-FDG. The extent of bone marrow involvement was graded using a four-point scale. Bone marrow metabolism was quantified by measuring the mean and maximum standardized uptake value (SUV) in the bone marrow space. Imaging findings were compared with laboratory, cytogenetic and histopathological data. Results Retention of 18F-FDG was observed in bone marrow and spleen. Bone marrow involvement varied, and 4 different patterns could be found. Ten (33.3%) of the 30 patients showed only mildly increased 18F-FDG uptake in the central skeleton and the proximal extremities (PET grade 1). Three (10%) patients showed markedly increased tracer uptake in the central skeleton and the proximal extremities extending into the distal half of the femoral bone (PET grade 2). In 8 (26.7%) patients, increased tracer uptake in the central skeleton and the extremities extending into the tibial bone was found (PET grade 3). Nine (30.0%) patients demonstrated increased 18F-FDG uptake in the central skeleton and the extremities extending into the small bones of the feet (PET grade 4). Extent of bone marrow involvement (PET grade) decreased over time from initial diagnosis (rs = -0.43, p = 0.019). Metabolic activity of the bone marrow decreased as the histopathological grade of fibrosis increased (rs = -0.37, p = 0.04) and as splenic volume increased (rs = -0.40, p = 0.03). There was a significant positive correlation between the metabolic activity of the bone marrow and splenic metabolic activity (p = 0.04), indicating that splenic uptake is parainflammatory. Conclusions 18F-FDG PET/CT emerges as a promising technique for visualization and quantitation of bone marrow metabolism in myelofibrosis. We conclude that the increased bone marrow metabolism mainly reflects inflammatory activity within the bone marrow space. Further evaluation in prospective studies is required to determine the potential clinical impact and prognostic significance of PET. Disclosures No relevant conflicts of interest to declare.

Utility of quantitative FDG-PET/CT for the detection of bone marrow involvement in follicular lymphoma: a histopathological correlation study

2014 ◽  
Vol 43 (9) ◽  
pp. 1231-1236 ◽  
Author(s):  
Hugo J. A. Adams ◽  
Thomas C. Kwee ◽  
Rob Fijnheer ◽  
Stefan V. Dubois ◽  
Peter E. Blase ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Follicular Lymphoma ◽  
Fdg Pet ◽  
Bone Marrow Involvement ◽  
Correlation Study ◽  
Histopathological Correlation ◽  
Pet Ct ◽  
Fdg Pet Ct

scholarly journals FDG PET/CT to detect bone marrow involvement in the initial staging of patients with aggressive non-Hodgkin lymphoma: results from the prospective, multicenter PETAL and OPTIMAL>60 trials

2021 ◽  
Author(s):  
Dominic Kaddu-Mulindwa ◽  
Bettina Altmann ◽  
Gerhard Held ◽  
Stephanie Angel ◽  
Stephan Stilgenbauer ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Hodgkin Lymphoma ◽  
Predictive Value ◽  
Fdg Pet ◽  
Bone Marrow Involvement ◽  
Non Hodgkin Lymphoma ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Initial Staging

Abstract Purpose Fluorine-18 fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG PET/CT) is the standard for staging aggressive non-Hodgkin lymphoma (NHL). Limited data from prospective studies is available to determine whether initial staging by FDG PET/CT provides treatment-relevant information of bone marrow (BM) involvement (BMI) and thus could spare BM biopsy (BMB). Methods Patients from PETAL (NCT00554164) and OPTIMAL>60 (NCT01478542) with aggressive B-cell NHL initially staged by FDG PET/CT and BMB were included in this pooled analysis. The reference standard to confirm BMI included a positive BMB and/or FDG PET/CT confirmed by targeted biopsy, complementary imaging (CT or magnetic resonance imaging), or concurrent disappearance of focal FDG-avid BM lesions with other lymphoma manifestations during immunochemotherapy. Results Among 930 patients, BMI was detected by BMB in 85 (prevalence 9%) and by FDG PET/CT in 185 (20%) cases, for a total of 221 cases (24%). All 185 PET-positive cases were true positive, and 709 of 745 PET-negative cases were true negative. For BMB and FDG PET/CT, sensitivity was 38% (95% confidence interval [CI]: 32–45%) and 84% (CI: 78–88%), specificity 100% (CI: 99–100%) and 100% (CI: 99–100%), positive predictive value 100% (CI: 96–100%) and 100% (CI: 98–100%), and negative predictive value 84% (CI: 81–86%) and 95% (CI: 93–97%), respectively. In all of the 36 PET-negative cases with confirmed BMI patients had other adverse factors according to IPI that precluded a change of standard treatment. Thus, the BMB would not have influenced the patient management. Conclusion In patients with aggressive B-cell NHL, routine BMB provides no critical staging information compared to FDG PET/CT and could therefore be omitted. Trial registration NCT00554164 and NCT01478542

scholarly journals The Value of PET/CT in Detecting Bone Marrow Involvement in Patients With Follicular Lymphoma

Medicine ◽  
2016 ◽  
Vol 95 (9) ◽  
pp. e2910 ◽  
Author(s):  
Chava Perry ◽  
Hedva Lerman ◽  
Erel Joffe ◽  
Nadav Sarid ◽  
Odelia Amit ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Follicular Lymphoma ◽  
Bone Marrow Involvement ◽  
Pet Ct

Aggressive systemic mastocytosis with diffuse bone marrow 18F-FDG uptake

2021 ◽  
Author(s):  
Renata Koukalová ◽  
Jiří Vašina ◽  
Jiří Štika ◽  
Michael Doubek ◽  
Petr Szturz
Keyword(s):  
Bone Marrow ◽  
Digestive System ◽  
Systemic Mastocytosis ◽  
Primary Tumour ◽  
Bone Marrow Involvement ◽  
Abdominal Ct ◽  
Splenic Parenchyma ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

AbstractMastocytosis is a clonal hematopoietic disorder characterized by proliferation of abnormal mast cells in various organs including the skin, digestive system, lymph nodes, and bone marrow. We report on a 75-year-old woman presenting with abdominal pain, vomiting, diarrhoea, myalgia, and weight loss. Abdominal CT showed hepatosplenomegaly with heterogeneous splenic parenchyma, lymphadenopathy, and osteopenia with areas of osteosclerosis but no primary tumour. An 18F-FDG PET/CT revealed an overall low metabolic activity of the lesions with a diffuse bone marrow involvement raising suspicion of a haematological neoplasm. Subsequently, bone marrow and peripheral blood examinations confirmed the diagnosis of aggressive systemic mastocytosis.

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