Colette Zwarthoed1, Tarec Cristoffer El-Galaly2, Maria Canepari3, Matthieu John Ouvrier1, Julien Viotti4, Marc Ettaiche4, Simonetta Viviani5, Luigi Rigacci6, Livio Trentin7, Chiara Rusconi8, Stefano Luminari9, Maria Cantonetti10, Silvia Bolis11, Anna Borra3, Jacques Darcourt1, Flavia Salvi12, Edyta Subocz13, Joanna Tajer14, Waldemar Kulikowski15, Bogdan Malkowski16, Jan Maciej Zaucha17, Andrea Gallamini18. 1. Nuclear Medicine Department, A. Lacassagne Cancer Center, Nice, France. 2. Hematology Department, Aalborg University Hospital, Aalborg, Denmark. 3. Hematology Department, S. Croce Hospital, Cuneo, Italy. 4. Research, Innovation and Statistics Department, A. Lacassagne Cancer Center, Nice, France. 5. Hematology Department and Paediatric Onco-Haematology, National Tumour Institute, Milan, Italy. 6. Hematology Chair University of Florence, Policlinico Careggi, Florence, Italy. 7. Hematology Section, Department of Medicine, Padua University, Padua, Italy. 8. Hematology Department, Ca-Granda Niguarda Hospital, Milan, Italy. 9. Hematology Department, Modena and Reggio Emilia University, Reggio Emilia, Italy. 10. Hematology Department, Tor Vergata University, Rome, Italy. 11. Hematology Department, San Gerardo Hospital, Monza, Italy. 12. Hematology Department, S. Antonio and Biagio Hospital, Alessandria, Italy. 13. Hematology Department, Military Institute of Medicine, Warszawa, Poland. 14. Lymphoproliferative Disease Department, Maria Sklodowska-Curie Memorial Institute, Warszawa, Poland. 15. Hematology Department, Interior Ministry Hospital, Warmia and Mazury Medical University, Olsztyn, Poland. 16. Nuclear Medicine Department, Oncology Center, Bydgoszcz, Poland; and. 17. Gdynia Oncology Center and Department of Oncological Propaedeutic, Medical University of Gdańsk, Gdańsk, Poland. 18. Research, Innovation and Statistics Department, A. Lacassagne Cancer Center, Nice, France andreagallamini@gmail.com.
Abstract
PET/CT-ascertained bone marrow involvement (BMI) constitutes the single most important reason for upstaging by PET/CT in Hodgkin lymphoma (HL). However, BMI assessment in PET/CT can be challenging. This study analyzed the clinicopathologic correlations and prognostic meaning of different patterns of bone marrow (BM) 18F-FDG uptake in HL. Methods: One hundred eighty newly diagnosed early unfavorable and advanced-stage HL patients, all scanned at baseline and after 2 adriamycin-bleomycin-vinblastine-dacarbazine (ABVD) courses with 18F-FDG PET, enrolled in 2 international studies aimed at assessing the role of interim PET scanning in HL, were retrospectively included. Patients were treated with ABVD × 4-6 cycles and involved-field radiation when needed, and no treatment adaptation on interim PET scanning was allowed. Two masked reviewers independently reported the scans. Results: Thirty-eight patients (21.1%) had focal lesions (fPET+), 10 of them with a single (unifocal) and 28 with multiple (multifocal) BM lesions. Fifty-three patients (29.4%) had pure strong (>liver) diffuse uptake (dPET+) and 89 (48.4%) showed no or faint (≤liver) BM uptake (nPET+). BM biopsy was positive in 6 of 38 patients (15.7%) for fPET+, in 1 of 53 (1.9%) for dPET+, and in 5 of 89 (5.6%) for nPET+ dPET+ was correlated with younger age, higher frequency of bulky disease, lower hemoglobin levels, higher leukocyte counts, and similar diffuse uptake in the spleen. Patients with pure dPET+ had a 3-y progression-free survival identical to patients without any 18F-FDG uptake (82.9% and 82.2%, respectively, P = 0.918). However, patients with fPET+ (either unifocal or multifocal) had a 3-y progression-free survival significantly inferior to patients with dPET+ and nPET+ (66.7% and 82.5%, respectively, P = 0.03). The κ values for interobserver agreement were 0.84 for focal uptake and 0.78 for diffuse uptake. Conclusion: We confirmed that 18F-FDG PET scanning is a reliable tool for BMI assessment in HL, and BM biopsy is no longer needed for routine staging. Moreover, the interobserver agreement for BMI in this study proved excellent and only focal 18F-FDG BM uptake should be considered as a harbinger of HL.
PET/CT-ascertained bone marrow involvement (BMI) constitutes the single most important reason for upstaging by PET/CT in Hodgkin lymphoma (HL). However, BMI assessment in PET/CT can be challenging. This study analyzed the clinicopathologic correlations and prognostic meaning of different patterns of bone marrow (BM) 18F-FDG uptake in HL. Methods: One hundred eighty newly diagnosed early unfavorable and advanced-stage HL patients, all scanned at baseline and after 2 adriamycin-bleomycin-vinblastine-dacarbazine (ABVD) courses with 18F-FDG PET, enrolled in 2 international studies aimed at assessing the role of interim PET scanning in HL, were retrospectively included. Patients were treated with ABVD × 4-6 cycles and involved-field radiation when needed, and no treatment adaptation on interim PET scanning was allowed. Two masked reviewers independently reported the scans. Results: Thirty-eight patients (21.1%) had focal lesions (fPET+), 10 of them with a single (unifocal) and 28 with multiple (multifocal) BM lesions. Fifty-three patients (29.4%) had pure strong (>liver) diffuse uptake (dPET+) and 89 (48.4%) showed no or faint (≤liver) BM uptake (nPET+). BM biopsy was positive in 6 of 38 patients (15.7%) for fPET+, in 1 of 53 (1.9%) for dPET+, and in 5 of 89 (5.6%) for nPET+ dPET+ was correlated with younger age, higher frequency of bulky disease, lower hemoglobin levels, higher leukocyte counts, and similar diffuse uptake in the spleen. Patients with pure dPET+ had a 3-y progression-free survival identical to patients without any 18F-FDG uptake (82.9% and 82.2%, respectively, P = 0.918). However, patients with fPET+ (either unifocal or multifocal) had a 3-y progression-free survival significantly inferior to patients with dPET+ and nPET+ (66.7% and 82.5%, respectively, P = 0.03). The κ values for interobserver agreement were 0.84 for focal uptake and 0.78 for diffuse uptake. Conclusion: We confirmed that 18F-FDG PET scanning is a reliable tool for BMI assessment in HL, and BM biopsy is no longer needed for routine staging. Moreover, the interobserver agreement for BMI in this study proved excellent and only focal 18F-FDG BM uptake should be considered as a harbinger of HL.
Authors: Juliano Júlio Cerci; Mateos Bogoni; Valeria Buccheri; Elba Cristina Sá de Camargo Etchebehere; Talita Maira Bueno da Silveira; Otavio Baiocchi; Carlos de Araujo Cunha Pereira Neto; Marcelo Tatit Sapienza; Jose Flavio Gomes Marin; José Cláudio Meneghetti; Yana Novis; Carmino Antonio de Souza; Carlos Chiattone; Marcia Torresan; Celso Dario Ramos Journal: Hematol Transfus Cell Ther Date: 2018-04-24