Juliano J Cerci1, Tamás Györke2, Stefano Fanti3, Diana Paez4, José Cláudio Meneghetti5, Francisca Redondo6, Monica Celli3, Chirayu Auewarakul7, Venkatesh Rangarajan8, Sumeet Gujral8, Charity Gorospe9, Maejoy V Campo9, June-Key Chung10, Tim P Morris11, Maurizio Dondi3, Robert Carr12. 1. Quanta Diagnóstico e Terapia, Curitiba, Brazil cercijuliano@hotmail.com. 2. ScanoMed Medical Diagnostic Ltd., Budapest, Hungary Department of Nuclear Medicine, Semmelweis University, Budapest, Hungary. 3. Policlinico S. Orsola Malpighi, Universita de Bologna, Bologna, Italy. 4. Division of Human Health, Department of Nuclear Sciences and Application, International Atomic Energy Agency (IAEA), Vienna, Austria. 5. Hospital de Clinicas, Universidade de São Paulo, São Paulo, Brazil. 6. Oncologic Clinic, Fundación Arturo Lopez Perez, Santiago, Chile. 7. Chulabhorn Cancer Centre and Faculty of Medicine Siriraj Hospital, Bangkok, Thailand. 8. Departments of Nuclear Medicine and Pathology, Tata Memorial Hospital, Mumbai, India. 9. St. Luke's Medical Center, Quezon City, Manila, Philippines. 10. Seoul National University Hospital, Seoul, South Korea. 11. MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom; and. 12. Department of Haematology, Guy's and St Thomas' Hospital, London, United Kingdom.
Abstract
UNLABELLED: Bone marrow is an important extranodal site in diffuse large B-cell lymphoma (DLBCL), and marrow histology has been incorporated into the new National Comprehensive Cancer Network international prognostic index. Marrow involvement demonstrated histologically confers poor prognosis but is identified by staging PET in more cases. How information from staging PET and biopsy should be combined to optimize outcome prediction remains unclear. METHODS: The International Atomic Energy Agency sponsored a prospective international cohort study to better define the use of PET in DLBCL. As a planned subsidiary analysis, we examined the interplay of marrow involvement identified by PET and biopsy on clinical outcomes. RESULTS: Eight countries contributed 327 cases with a median follow-up of 35 mo. The 2-y outcomes of cases with no evidence of marrow involvement (n = 231) were 81% (95% confidence interval [CI], 76%-86%) for event-free survival (EFS) and 88% (83%-91%) for overall survival (OS); cases identified only on PET (n = 61), 81% (69%-89%) for EFS and 88% (77%-94%) for OS; cases indentified only on biopsy (n = 10), 80% (41%-95%) for EFS and 100% for OS; or cases identified by both PET and biopsy (n = 25), 45% (25%-64%) for EFS and 55% (32%-73%) for OS. The hazard ratios for PET-negative/biopsy-negative cases versus PET-positive/biopsy-positive cases were 2.67 (95% CI, 1.48-4.79) for EFS and 3.94 (1.93-8.06) for OS. CONCLUSION: This large study demonstrates that positive iliac crest biopsy histology only confers poor prognosis for patients who also have abnormal marrow (18)F-FDG uptake identified on the staging PET scan. Abnormal (18)F-FDG uptake in marrow, when iliac crest biopsy histology is normal, has no adverse effect on outcomes.
UNLABELLED: Bone marrow is an important extranodal site in diffuse large B-cell lymphoma (DLBCL), and marrow histology has been incorporated into the new National Comprehensive Cancer Network international prognostic index. Marrow involvement demonstrated histologically confers poor prognosis but is identified by staging PET in more cases. How information from staging PET and biopsy should be combined to optimize outcome prediction remains unclear. METHODS: The International Atomic Energy Agency sponsored a prospective international cohort study to better define the use of PET in DLBCL. As a planned subsidiary analysis, we examined the interplay of marrow involvement identified by PET and biopsy on clinical outcomes. RESULTS: Eight countries contributed 327 cases with a median follow-up of 35 mo. The 2-y outcomes of cases with no evidence of marrow involvement (n = 231) were 81% (95% confidence interval [CI], 76%-86%) for event-free survival (EFS) and 88% (83%-91%) for overall survival (OS); cases identified only on PET (n = 61), 81% (69%-89%) for EFS and 88% (77%-94%) for OS; cases indentified only on biopsy (n = 10), 80% (41%-95%) for EFS and 100% for OS; or cases identified by both PET and biopsy (n = 25), 45% (25%-64%) for EFS and 55% (32%-73%) for OS. The hazard ratios for PET-negative/biopsy-negative cases versus PET-positive/biopsy-positive cases were 2.67 (95% CI, 1.48-4.79) for EFS and 3.94 (1.93-8.06) for OS. CONCLUSION: This large study demonstrates that positive iliac crest biopsy histology only confers poor prognosis for patients who also have abnormal marrow (18)F-FDG uptake identified on the staging PET scan. Abnormal (18)F-FDG uptake in marrow, when iliac crest biopsy histology is normal, has no adverse effect on outcomes.
Authors: L Kurch; R Kluge; O Sabri; L Fischer; S Wendt; H Graf Einsiedel; S Starke; J-S Kühl; H Christiansen; F W Hirsch; I Sorge; C Roth Journal: EJNMMI Res Date: 2021-07-03 Impact factor: 3.138