Clinical usefulness of PET/CT in initial staging and response evaluation of primary gastric lymphoma

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19541-e19541
Author(s):  
J. Yi ◽  
S. Kim ◽  
S. Lee ◽  
S. Park ◽  
Y. Ko ◽  
...  
Keyword(s):  
Ct Scan ◽  
B Cell ◽  
Cell Lymphoma ◽  
Gastric Lymphoma ◽  
B Cell Lymphoma ◽  
Ct Scans ◽  
Primary Gastric Lymphoma ◽  
Pet Ct ◽  
Pet Ct Scan

e19541 Background: Positron emission tomography (PET)/computed tomography (CT) scan has a well-established role in the management of non-Hodgkin's lymphoma (NHL). However, in case of the primary gastric lymphoma, which is the most frequent extranodal NHL, the role of PET/CT scan is still controversial. Methods: We retrospectively analyzed 42 patients with primary gastric lymphoma who underwent PET/CT scans; 32 patients with diffuse large B-cell lymphoma (DLBCL) and 10 patients with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) were analyzed. The PET/CT scans were compared with clinicopathologic features and the results of CT and endoscopy. After corresponding treatment, response was evaluated by conventional CT scans or PET/CT scans and endoscopy with biopsy Results: Nine patients were up-staged based on the results of their PET/CT scan compared to CT (7 DLBCL, 2 MALT lymphomas) while six patients were down-staged by the PET/CT scan. The high SUVmax group, defined as SUVmax ≥ median value, was significantly associated with an advanced Lugano stage (P < 0.001). Three patients with DLBCL, who showed an initially high SUVmax, died of disease progression. Although not statistically significant, there was a tendency of inferior outcome in the group with high SUVmax. Among 24 patients for whom follow-up PET/CT scan with endoscopy was performed, 11 patients with ulcerative or mucosal lesions showed residual FDG uptake. All of these gastric lesions were grossly and pathologically benign lesions without evidence of lymphoma cells. Conclusions: PET/CT scan can help staging patients with primary gastric lymphoma, and the maximum SUV has possibility to have prognostic value. However, the residual FDG uptake observed during follow-up should be interpreted cautiously in association with the results of endoscopy and multiple gastric biopsies. No significant financial relationships to disclose.

scholarly journals Lack of Prognostic Significance of Pre-Treatment Total Metabolic Tumor Volume (TMTV) in Diffuse Large B-Cell Lymphoma (DLBCL)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1720-1720
Author(s):  
Mayur Narkhede ◽  
Sadaf Qureshi ◽  
Maryam Yazdy ◽  
Roxanna Juarez ◽  
Giuseppe Esposito
Keyword(s):  
Ct Scan ◽  
B Cell ◽  
Prognostic Significance ◽  
B Cell Lymphoma ◽  
Pet Ct ◽  
The Mean ◽  
Pre Treatment ◽  
Pet Ct Scan ◽  
Stage Stage

Abstract Background DLBCL is the most common non-Hodgkin lymphoma (NHL), making up about 30%-40% of NHL in the U.S. PET-CT is recommended as the most accurate imaging technique in DLBCL for staging and response assessment. Pretreatment assessment of PET-CT scan derived metrics such as TMTV has been shown to correlate with PFS and/or overall survival (OS) in DLBCL (Sasanelli 2014) We attempted to replicate this finding using EFS at 24 months as a primary endpoint and compare it with pre-treatment TMTV, TLG and cell of origin (COO). Methods 47 pts with newly diagnosed DLBCL and treated with R-CHOP at our institution between 2014 to 2018 were identified from our electronic medical record system for retrospective analysis after IRB approval. All pts had a pretreatment PET-CT scan available for TMTV measurement. All pts had a pretreatment biopsy which were reviewed along with their clinical information regarding treatment outcome and follow up. Patients were classified as to germinal center B cell (GCB) and non-GCB based on immunochemistry using the Hahn's algorithm. PET-CT scans were reviewed by two nuclear medicine physicians using synovia software, and measurements for TMTV and TLG were recorded. TMTV was calculated using a threshold of 41% of the max pixel value (based on prior studies) to draw the volume of interest (VOI) for a lesion. Pooled t-test was performed to compare TMTV, TLG and COO with EFS at 24 mos. Chi-Square test compared TMTV with COO Results Median age of pts was 58 years, with a median duration of follow up of 26 months. There were 33% with limited stage (Stage I or II) and 67% were advanced stage (Stage III or IV). The mean pretreatment TMTV and pretreatment TLG was 295cm3 and 4519 units. 49% were GCB subtype and 47 % non-GCB. Amongst all patients 19.2 % had an event within 24 mos. When TMTV was compared to EFS at 24 months the mean TMTV was 304 for those who had an event versus 294 without (p=0.95). TLG compared to EFS at 24 months showed a mean TLG of 3391 for those who had an event versus 4914 without (P=0.40). GCB and non-GCB had mean TMTV of 264 and 339 respectively with p =0.59. COO when compared to TLG had means of 4365 and 4933 for GCB and non-GBB respectively with p=0.79.Whereas there was no correlation between stage and COO (p=0.4296) TMTV correlated with Ann Arbor staging (p=0.0002). Conclusion This retrospective study failed to demonstrate a correlation between pre-treatment TMTV, TLG, COO and EFS at 24 months revealing the lack of prognostic significance of pretreatment PET scan derived metrics in DLBCL. Prior studies with TMTV did not evaluate EFS at 24 months as an endpoint and therefore, longer follow up might be needed to demonstrate prognostic significance of pretreatment TMTV minimizing it clinical significance. The different subtypes of DLBCL based on COO as assessed by Hahns algorithm also did not differ in their disease burden as measured by TMTV. Disclosures No relevant conflicts of interest to declare.

scholarly journals Effect of Steroid Treatment on the Diagnostic Yield of Baseline PET CT in Aggressive B Cell Lymphoma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1453-1453
Author(s):  
Karyn Revital Geiger ◽  
Oren Pasvolsky ◽  
Tamar Berger ◽  
Pia Raanani ◽  
Tzippy Shochat ◽  
...  
Keyword(s):  
Ct Scan ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Treated Group ◽  
Steroid Treatment ◽  
Naive Group ◽  
Pet Ct ◽  
Pet Ct Scan ◽  
Aggressive B Cell Lymphoma

Abstract Aggressive B cell lymphomas often require prompt steroid treatment prior to baseline 18f-fluorodeoxyglucose positron-emission tomography (PET CT) scan and definitive treatment in order to alleviate symptoms and/or prevent organ damage. Since lymphomas are a steroid sensitive malignancy, there is a concern that steroid prophase might affect PET CT results and diagnostic yield. We conducted a retrospective cohort study to evaluate the effect of steroid treatment prior to baseline PET CT scan on the standardized uptake value (SUV) max and additional PET CT parameters by examining two groups of patients: steroid-naïve and steroid-treated patients. The effect of steroid administration on SUV max was examined across different daily and weekly steroid doses and durations of treatment. Between January of 2017 and May 2020, 187 newly diagnosed patients with aggressive B cell lymphoma who had a pre-treatment PET CT scan were evaluated. 160 patients (85.5%) had Diffuse large B-cell lymphoma (DLBCL)/ High-grade B-cell lymphoma, 13 patients (7%) had primary mediastinal (thymic) large B-cell lymphoma, 9 patients (4.8%) had primary DLBCL of the central nervous system and 5 patients (2.7%) had Burkitt lymphoma. 132 patients (70.6%) were included in the steroid-naïve group and 55 patients (29.4%) in the steroid-treated group. In the steroid-treated group, the mean duration of steroid treatment was 10.49 (±9.28) days. Average daily dose of steroid treatment was equivalent to 72.27 (±36) mg of prednisone and the mean cumulative prednisone dose during the week prior to PET CT scan was equivalent to 367.95 (±239.9) mg of prednisone. There was no statistical significant difference between the groups in age, gender or KI67. However, patients in the steroid treated group had a significantly higher stage of disease compared to the steroid-naïve group (mean 3.44 compared to 2.99, respectively, p=0.01). The steroid-treated group also had a trend towards a higher IPI score (mean 2.45 versus 2.08, p=0.08) and a trend towards a higher LDH level (mean 2309.89 U/L, range 250-81374 versus mean 877.65 U/L, range 272-22036, p= 0.07), as depicted in table 1. There was no statistical difference in SUV max between the steroid-naïve and steroid-treated groups (p=0.97). This was consistent across various steroid treatment durations and dosage regimes. Patients in the steroid-treated group had a trend towards a higher tumor burden and a larger tumor volume compared to the steroid-naïve group, however it did not reach statistical significance. Mean tumor volume was 179.04 cm 3 in the steroid naïve group and 337.06 cm 3 in the steroid treated group (p=0.17). Mean tumor burden was 1944.84 in the steroid-naïve group and 3016.94 in the steroid-treated group (p=0.09). There was no difference in additional PET CT parameters including SUV mean, SUV max and SUV mean of liver and mediastinum between the groups as depicted in table 2. In conclusion, in aggressive B cell lymphoma, pre-treatment with steroids prior to initial PET CT scan does not affect SUV max or other PET CT parameters and does not reduce PET CT diagnostic yield. Figure 1 Figure 1. Disclosures Gurion: Medison: Consultancy; Gilead Sciences: Consultancy; Takeda Pharmaceuticals: Consultancy; JC Health Care: Honoraria; Roche: Honoraria.

scholarly journals PB1837 THE PREDICTIVE VALUE OF PET/CT SCAN IN DIFFUSE LARGE B-CELL LYMPHOMA IN OPTIMIZING THE TREATMENT DECISION

HemaSphere ◽  
2019 ◽  
Vol 3 (S1) ◽  
pp. 840 ◽  
Author(s):  
H. Zawam ◽  
S. Alrefai ◽  
M. Abougabal ◽  
R. Salama ◽  
H. Zawam ◽  
...  
Keyword(s):  
Ct Scan ◽  
B Cell ◽  
Predictive Value ◽  
Cell Lymphoma ◽  
Treatment Decision ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Pet Ct Scan ◽  
Large B Cell

scholarly journals METABOLIC HETEROGENEITY OF BASELINE 18-FDG PET-CT SCAN PREDICTS OUTCOME IN PRIMARY MEDIASTINAL B-CELL LYMPHOMA.

2017 ◽  
Vol 35 ◽  
pp. 60-61 ◽  
Author(s):  
L. Ceriani ◽  
L. Milan ◽  
M. Martelli ◽  
A.J. Ferreri ◽  
A. Di Rocco ◽  
...  
Keyword(s):  
Ct Scan ◽  
B Cell ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Pet Ct ◽  
Metabolic Heterogeneity ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

Surveillance PET-CT Scanning Is Useful in the First 18 Months Following Completion of Therapy for Patients with Diffuse Large B-Cell Lymphoma with IPI≥3.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2652-2652
Author(s):  
Chan Y Cheah ◽  
Michael S Hofman ◽  
Michael J. Dickinson ◽  
Andrew Wirth ◽  
David A Westerman ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
High Sensitivity ◽  
B Cell Lymphoma ◽  
Ct Scanning ◽  
Primary Therapy ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Large B Cell

Abstract Abstract 2652 Introduction Despite improvements in cure rates for patients with diffuse large B-cell lymphoma (DLBCL), up to 40% relapse after achieving initial remission, mostly within 18 months from treatment. There is no consensus as to role, or most appropriate form of post-remission surveillance. Our aim was to explore the role of Positron Emission Tomography combined with computer tomography (PET-CT) scanning in the follow up of patients with diffuse large B-cell lymphoma (DLBCL) achieving complete metabolic response (CMR) after primary therapy, identify patterns of relapse and define a risk-adapted strategy. Results We included 116 patients with de novo DLBCL treated at our centre between 2002 and 2009 with a negative post-treatment PET-CT, and at least one surveillance PET-CT scan. International Prognostic Index (IPI) was <3 in 77 (66%) and ≥3 in 37 (32%) patients. With a median follow up of 53 months (range 8–133), 456 surveillance scans were performed (range 1–10 per patient). 13 patients (11%) relapsed, with an actuarial 5 year relapse free survival of 86%. Two-thirds of relapses occurred in the first 18 months following completion of treatment. In seven cases (54%), the relapse was suspected based on symptoms and in six (46%) the relapse was subclinical and detected with PET. There was no difference in survival (P=0.76) or second line IPI (P=1.00) between the groups, as the number of relapses was small. PET-CT had very high sensitivity (100%), specificity (98%) and negative predictive value (NPV, 100%) with positive predictive value (PPV) 56% in the cohort of patients with a low IPI (<3) compared with 80% if the IPI was ≥3. Across the entire cohort, the average number of patients in remission needed to scan to detect one subclinical relapse within the first 18 months was 42. However, for those with an IPI ≥3 the number needed to scan to detect one subclinical relapse was 22. Surveillance PET-CT had a very low yield after 18 months had elapsed from the conclusion of primary therapy (1 true positive among 170 scans). Interim response PET-CT was performed in 81 (70%) patients; achieving CMR was not a predictor of time to relapse (P=0.65) or having a positive surveillance scan, irrespective of IPI (P=1.00). Second malignancies were detected by PET-CT in eight patients (7%). Conclusion The achievement of CMR at the completion of primary therapy identifies a group of patients with favourable outlook and a low risk of relapse. Surveillance PET-CT scanning within this select cohort has high sensitivity, specificity and NPV and despite the low number of relapses retains a high PPV, particularly in patients with IPI≥3. Surveillance PET-CT is useful in the first 18 months following completion of primary therapy in patients in whom IPI at diagnosis is ≥3. We feel that such a strategy would be appropriate to evaluate in a prospective comparative trial. Disclosures: No relevant conflicts of interest to declare.

Clinical Relevance Of Cachexia Assessed By An Anthropometric Tool In Elderly Patients With Diffuse Large B-Cell Lymphoma Treated By Immunochemotherapy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2926-2926
Author(s):  
Helene Lanic ◽  
Jerome Kraut ◽  
Romain Modzelewski ◽  
Florian Clatot ◽  
Jean-Michel Picquenot ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Weight Loss ◽  
Elderly Patients ◽  
Ct Scan ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background Cancer Cachexia is a metabolic syndrome that can be present even in absence of weight loss and associated with significantly impaired survival. Muscle wasting represents a key-symptom of this syndrome and we recently demonstrated the strong prognosis impact of sarcopenia assessed by computed tomography (CT)-scan in diffuse large B-cell lymphoma (DLBCL) (Lanic et al. Leukemia & Lymphoma 2013). Conversely, the clinical relevance of loss of fat mass (adipopenia) remains unclear. The aim of this study was (i) to investigate the prognostic impact of a multidimensional tool combining a nutritional parameter (albuminemia) and body composition measurements (skeletal muscle and body fat composition) in elderly patients with DLBCL treated by chemotherapy and rituximab (R) (ii) to document the evolution of sarcopenia after immunochemotherapy. Methods This retrospective analysis included 80 DLBCL patients older than 70 years (y) and treated by R-CHOP or R-miniCHOP. Skeletal muscle (SM), visceral (V) and subcutaneal (S) adipose (A) tissues were measured by analysis of stored CT images at the Lumbar vertebrae 3 (L3) level. The surface of the muscular and adipose tissues was selected according to CT Hounsfield unit. Values were normalized for stature to calculate the L3 SM index (LSMI, in cm2/m2), the LVAI and the LSAI and used to define sarcopenia and visceral/subcutaneal adipopenia. Results The characteristics of the patients were as follows: median age = 78 y [70-95]; 36 males; IPI 0-2 = 22, 3-5 = 58; treatment by R-CHOP (n = 45) or R-miniCHOP (n = 35); median body mass index (BMI; in kg/m2) = 23.9. According to the sex-specific defined cut-offs for LSMI (< 55.8 cm²/m² for men and 38.9 cm²/m² for women), 44 DLBCL patients (55 %, 23 males) were considered as sarcopenic. With a median follow-up of 39 months, the 2y overall survival (OS) in the sarcopenic population was 46% as compared to 84% in the non-sarcopenic group (HR = 3.12; CI95%, 1.66-5.88; p=0.0004). The median LSAI was 76.3 cm2/m2 [10-167] in females and 47.4 cm2/m2[22-100] in males. The median LVSAI was 43.5 cm2/m2[3-141] in females and 50.4 cm2/m2[14-159] in males. Adipopenia, defined by a low LVAI and/or a low LSAI was also highly predictive of the outcome. The 2y OS of the low LVAI population was 48% as compared to 82% for the non-adipopenic group (HR = 2.20; CI95%, 1.19-4.05; p=0.01). The 2y OS in the low LSAI population was 48% as compared to 80% in the non-adipopenic group (HR = 2.28; CI95%, 1.23-4.21; p=0.008). A Three-point cachexia score (CS) including adipopenia, sarcopenia and hypo-albuminemia (defined by an albuminemia < 35 g/L) was build and delineates three distinct risk-groups (Figure 1). More importantly the CS remains predictive of the prognosis in a multivariate analysis including BMI (< or >= 25 kg/m2), age (< or >= 80y), IPI and gender (HR=2.5; CI95%= 1.14-5.39; p =0.02). LMSI was subsequently reassessed in thirty seven patients during the routine CT scan follow-up [mean = 10 months after pre-treatment CT scan (range 2.8-19.2)]. 15 (40%) patients displayed a 5% decrease of their LSMI, whereas 13 (35%) and 9 (25%) displayed no significant change or increase (>5%) of the LMSI respectively. Conclusion Our study demonstrates that sarcopenia and adipopenia estimated by CT-scan define cachexia more accurately than BMI or weight loss in elderly DLBCL patients. These factors can be integrated in a cachexia scoring tool which predicts the outcome independently of the BMI and of the IPI. CT scan follow-up indicates that cachexia is a reversible process that should be integrated as part of the therapeutic target in combination with lymphoma treatment. A prospective multicentric trial (registered as NCT01715961/Clinical.gov) is ongoing to validate these anthropometric and nutritional parameters and compare to geriatric assessment scales. Disclosures: No relevant conflicts of interest to declare.

Clonal Ig DNA Detection In Plasma From Patients with Untreated Diffuse Large B-Cell Lymphoma (DLBCL)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3127-3127
Author(s):  
Nina Wagner-Johnston ◽  
Nancy L. Bartlett ◽  
Jacqueline E. Payton ◽  
Kathryn Trinkaus ◽  
Akash Sharma ◽  
...  
Keyword(s):  
B Cell ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Ct Scans ◽  
Molecular Diagnostic ◽  
Newly Diagnosed ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Large B Cell

Abstract Abstract 3127 Background: Circulating nucleic acids have been explored as tumor markers in several malignancies. Lymphoma offers a special opportunity to develop tumor DNA markers. Normal B cells undergo Ig rearrangements to generate antibody diversity. In B cell malignancies, the Ig gene rearrangements are monoclonal. Molecular diagnostic tests are widely employed in tumor specimens to detect these clone-specific Ig rearrangements when histology and immunohistochemistry are ambiguous. While long-lived plasma cells can secrete Ig over years, a B cell can only release its unique clone once. In order to sustain the presence of Ig DNA, ongoing cellular proliferation and death is required, suggesting that detection in the plasma may be a specific marker for presence of lymphoma. We previously reported our experience in screening plasma from patients (pts) with AIDS-related lymphomas (Blood 110(11):1579, 2007). The feasibility of this approach and promising results led to a pilot study evaluating clonal Ig DNA in pts with newly diagnosed diffuse large B cell lymphoma (DLBCL) without HIV. Methods: Plasma is screened for clonal Ig DNA using standardized fluorescently-labeled multiplex primers (InVivoScribe) targeting IgH rearrangements. Rearranged Ig DNA is amplified by polymerase chain reaction (PCR), and the amplified products are separated by size using capillary electrophoresis. International prognostic index (IPI) scores and results of baseline PET/CT scans, including standardized uptake value (SUV)max scores are collected from pts to determine the impact of these findings on the ability to detect clonal Ig DNA. Results: Of 36 plasma specimens evaluated to date, 28 (78%) had clonal IgH rearrangements. Clonal and polyclonal controls yielded appropriate results. Tumor specimens are available from 22 patients, including 19 formalin-fixed paraffin-embedded (FFPE) and 5 fresh frozen tissue (FFT) specimens (2 pts have both FFPE and FFT). Eight FFPE tumor specimens have been evaluated; monoclonal IgH rearrangements were present in 5 (63%), 2 had polyclonal rearrangements, and 1 had no detectable IgH rearrangements. The median IPI scores were 1.5 (75% of pts had scores of 0–2) for the group without detectable plasma clonal Ig DNA and 2 (67% of pts had scores of 0–2) for the group with detectable plasma clonal Ig DNA. Wilcoxon 2-sample test demonstrated no difference between the 2 groups with respect to IPI scores (p= 0.50). Pre-treatment PET/CT scans were interpreted as positive in 30 of 33 pts. Two pts with negative PET/CT and corresponding IPI scores of 0 and 1 respectively, did not have detectable plasma clonal Ig DNA. One pt with a negative PET/CT had an IPI score of 0 and had detectable clonal Ig DNA in the plasma. In a T-test comparison, there was no evidence for a difference in SUVmax among pts with and without detectable clonal Ig DNA (p = 0.31). Conclusions: Circulating clonal Ig DNA is detectable in pts with newly diagnosed DLBCL even with low IPI scores and negative PET/CT scans. Relatively small pt numbers limit the interpretation of the IPI/FDG-PET findings with respect to the detection of clonal Ig DNA in the plasma, and larger studies are needed to better appreciate if there is any correlation. Studies are ongoing to determine whether clonal Ig plasma DNA persists after the initiation of therapy, and whether the presence of clonal Ig DNA in plasma might complement information obtained from early interim FDG-PET in identifying patients likely to fail conventional therapy. Continued analysis of paired tumor/plasma specimens will clarify if plasma clonal Ig DNA is tumor derived. Disclosures: No relevant conflicts of interest to declare.

Clinical Symptom Or Sign-Directed Surveillance Can Be More Useful In Detecting Relapse Compared To Routine Imaging In Patients With Diffuse Large B-Cell Lymphoma In Remission

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2914-2914
Author(s):  
Junshik Hong ◽  
Ji Hyun Kim ◽  
Jinny Park ◽  
Jae Hoon Lee
Keyword(s):  
Ct Scan ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Disease Relapse ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Positive Results

Abstract Background For patients with aggressive lymphoma in complete remission (CR) after primary therapy, efficient detection of relapse with maintenance of performance status is important because there is the second chance for cure by salvage therapy. Contrary to initial staging workup, treatment, and its response evaluation, there is ambiguity in the field of surveillance of patients with lymphoma in CR: intervals of outpatient department (OPD) follow-up, lists of required laboratory tests, and especially routing imaging by computed tomography (CT) scan or 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), have not been firmly standardized according to experts and guidelines. Despite a lack of evidence, routine imaging (RI) with CT or FDG-PET/CT has been widely adopted. The aim of the current study was to analyze the patterns and outcomes of OPD surveillance and to evaluate the role of RI and unplanned early OPD visits in patients with diffuse large B-cell lymphoma (DLBCL) in remission. Methods Patients 1) diagnosed as DLBCL according to 2008 WHO criteria, 2) age °Ã 20 years, 3) achieved CR according to 2007 Revised Criteria after receiving R-CHOP immunochemotherapy with or without following radiotherapy or high dose therapy, and 4) had °Ã 1 OPD visit for the surveillance of relapse, were included. The institutional policy of OPD visits in patients with DLBCL in CR was as follows: OPD visit every 2 to 3 months for the first 2 years, then every 4 to 6 months for the next 3 years, and annually thereafter. History taking, physical examination, and checking complete blood cell count were performed routinely during each visit. Every single OPD visit was reviewed and classified with regard to whether or not it was planned. If an OPD visit was scheduled during the last OPD visit for purpose of surveillance of asymptomatic patients, the visit was classified as a 'planned OPD visit'. An 'unplanned early visit' was defined as any OPD visit earlier than the appointed next visit decided by the patient because of any abnormal symptom or sign. RI was defined as a CT or FDG-PET/CT scheduled by a physician at least 2 months prior to actual scanning for routine surveillance of lymphoma, i.e., without any symptom or sign of relapse. There was no specific institutional policy of RI, and three physicians (Hong J, Park J, and Lee JH) decided whether or not to perform RI during the next visit with consideration of the patient's opinion. Result One hundred and six patients diagnosed between May 2004 and February 2012, satisfied the inclusion criteria. During a median follow-up duration of 38.1 months, 15 patients (14.2%) experienced disease relapse. A total of 856 OPD visits (median 6, range 1-25) were analyzed from the 106 patients; 501 visits were planned OPD visits with RI, 322 visits were planned visits without RI, and 33 visits (33/856 = 3.9%) were unplanned early visits (Fig. 1). RI showed a perfect sensitivity and negative predictive value but low positive predictive value due to frequent false-positive results (Fig. 2). Six of seven patients who underwent routine CT scan and 17 of 21 patients who underwent a surveillance FDG-PET/CT received unnecessary further evaluations, even including biopsy with general anesthesia. Compared to enhanced CT scan, FDG-PET/CT showed a higher rate of false positive results [7/407 (13.7%) for CT vs. 23/165 (13.7%) for FDG-PET/CT]. Unplanned early visits of patients showed a strong association with disease relapse compared to planned OPD visits; one third of the unplanned early visits were due to disease relapse (Fig 3). Due to the small number of patients, it was impossible to determine whether RI can prolong the survival of relapsed patients with DLBCL, although there appeared to be no significant difference between the groups. Conclusions Considering limited diagnostic values in addition to the risk of radiation exposure, financial cost, and anxiety of the patients, RI appears not to be an ideal strategy for surveillance in patients with DLBCL who achieved a CR in the rituximab era. Clinical symptom or sign-directed surveillance can be more useful in detecting relapse compared to RI, at least in patients with DLBCL in remission. It should be emphasized that patients should be encouraged to visit the hospital earlier if they experience any discomfort. Disclosures: Off Label Use: lenalidomide in newly diagnosed myeloma.

Evaluation of the Role of Radiological Imaging and Bone Marrow Biopsy in Staging of Cutaneous B-Cell Lymphoma

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5326-5326
Author(s):  
Pankit Vachhani ◽  
Christopher J. Cancino ◽  
Paul Bogner ◽  
Charles L. Roche ◽  
Gyorgy Paragh ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Ct Scan ◽  
B Cell ◽  
Bone Marrow Biopsy ◽  
Cell Lymphoma ◽  
Systemic Disease ◽  
B Cell Lymphoma ◽  
Radiological Imaging ◽  
Pet Ct ◽  
Large B Cell

Abstract Background: Primary cutaneous B-cell lymphoma (PCBCL) refers to B-lymphocyte derived lymphoma that develops in the skin without any extracutaneous involvement at the time of diagnosis. Primary cutaneous follicle center lymphoma (PCFCL), primary cutaneous marginal zone lymphoma (PCMZL), and primary cutaneous large B-cell lymphoma (PCLBCL) are the three major entities of PCBCL under the World Health Organization/European Organization for Research and Treatment of Cancer (WHO/EORTC) classification of cutaneous lymphomas. Current guidelines recommend obtaining staging Positron emission tomography/computed tomography (PET/CT) scan or CT scan for all PCBCL, and bone marrow biopsy for at least PCLBCL-leg type variant. However, evidence supporting these recommendations, especially radiological imaging, is lacking. Methods: Data including demographics, white blood cell (WBC) count at diagnosis, lactate dehydrogenase (LDH) at diagnosis, and results of staging CT-scan, PET/CT-scan, single-photon emission computed tomography scan (SPECT-scan), and bone marrow biopsy were collected through chart review on all patients seen at Roswell Park Cancer Institute between 2001-2016 who presented with a skin lesion and had a biopsy diagnostic of B-cell lymphoma. Patients without any radiological imaging at diagnosis and those diagnosed of diffuse large B-cell lymphoma (DLBCL), marginal zone lymphoma (MZL), or follicular lymphoma (FL) prior to cutaneous manifestation were excluded. Results: 67 patients met criteria for this study of whom 97% were Caucasian and 60% were male. Cutaneous biopsies noted follicle center cell histology (16 patients; 24%), marginal zone histology (32 patients; 48%), or large B-cell histology (19 patients; 29%). Staging CT-scan, functional imaging (PET/CT-scan or SPECT-scan), and bone marrow biopsy were performed for 59 (88%), 48 (72%), and 36 (54%) patients respectively (distribution across B-cell lymphomas shown in Figure 1). Radiological imaging studies were over-interpreted in 13 patients. Radiological imaging upstaged diagnosis in 13 patients (8 DLBCL, 3 MZL, 2 FL) while bone marrow biopsy alone upstaged diagnosis in only 1 patient (DLBCL). Together, work-up upstaged diagnosis in patients with cutaneous high-grade lymphoma (large B-cell lymphoma) significantly more than it did for cutaneous low-grade lymphoma (follicle center cell and marginal zone lymphoma) histology (47% vs. 10%; p=0.0018). Presence of B-symptoms correlated with systemic disease (0 patients with PCBCL vs. 4 patients with systemic disease; p=0.0013). However, age (p=0.059), gender (p=0.5418), WBC (p=0.6676), and LDH (p=0.1736) had no correlation with systemic disease. Conclusion: Our single center retrospective analysis showed that staging work-up including radiological imaging (CT-scan or functional imaging like PET/CT-scan) and bone marrow biopsy upstaged the diagnosis in a small minority (10%) of low-grade cutaneous B-cell lymphomas. However, nearly half (47%) of those with cutaneous large B-cell lymphoma histology were found to have systemic disease upon staging. Given the aggressive disease course of large B-cell lymphomas, staging through radiological imaging and bone marrow biopsy should be pursued as currently recommended. However, for low-grade B-cell lymphomas, where even observation is a reasonable management option in selected stage IV patients, staging radiological imaging and bone marrow biopsies could be avoided unless dictated by clinical judgment. Figure 1 Staging radiologic imaging and bone marrow biopsies (BM bx) performed in patients with cutaneous B-cell lymphoma Figure 1. Staging radiologic imaging and bone marrow biopsies (BM bx) performed in patients with cutaneous B-cell lymphoma Disclosures No relevant conflicts of interest to declare.

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