Combined PET and Biopsy Evidence of Marrow Involvement Improves Prognostic Prediction in Diffuse Large B-Cell Lymphoma

Journal of Nuclear Medicine

Monica Celli¹  Robert Carr¹  Charity Gorospe¹  Tim P. Morris¹  José Cláudio Meneghetti¹  Sumeet Gujral¹  Francisca Redondo¹  Juliano J. Cerci¹  Maurizio Dondi¹  Maejoy V. Campo¹  Chirayu Auewarakul¹  Venkatesh Rangarajan¹  June-Key Chung¹  Stefano Fanti¹  Diana Paez¹  Tamás Györke¹ 

关键词: positron emission tomography;    diffuse large B-cell lymphoma;    bone marrow;    International Prognostic Index;   

DOI  :  10.2967/jnumed.113.134486

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

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 18F-FDG uptake identified on the staging PET scan. Abnormal 18F-FDG uptake in marrow, when iliac crest biopsy histology is normal, has no adverse effect on outcomes.

【 授权许可】

Unknown