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Chen-Liang TH, Martín-Santos T, Jerez A, Rodríguez-García G, Senent L, Martínez-Millán C, Muiña B, Orero M, Teruel A, Martín A, Gómez-Espuch J, Kennedy K, Benet C, Raya JM, Fernández-González M, de la Cruz F, Guinot M, Villegas C, Ballester I, Baile M, Moya M, López-Jiménez J, Frutos L, Navarro JL, Uña J, Fernández-López R, Igua C, Contreras J, Sánchez-Vañó R, Cozar MDP, Tamayo P, Mucientes J, Sánchez-Blanco JJ, Pérez-Ceballos E, Ortuño FJ. Bone marrow biopsy superiority over PET/CT in predicting progression-free survival in a homogeneously-treated cohort of diffuse large B-cell lymphoma. Cancer Med 2017; 6:2507-2514. [PMID: 28960797 PMCID: PMC5673915 DOI: 10.1002/cam4.1205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/12/2017] [Accepted: 08/28/2017] [Indexed: 12/11/2022] Open
Abstract
Several studies have reported uneven results when evaluating the prognostic value of bone marrow biopsy (BMB) and PET/CT as part of the staging of diffuse large B‐cell lymphoma (DLBCL). The heterogeneity of the inclusion criteria and not taking into account selection and collinearity biases in the analysis models might explain part of these discrepancies. To address this issue we have carried a retrospective multicenter study including 268 DLBCL patients with a BMB and a PET/CT available at diagnosis where we estimated both the prognosis impact and the diagnostic accuracy of each technique. Only patients treated with R‐CHOP/21 as first line (n = 203) were included in the survival analysis. With a median follow‐up of 25 months the estimated 3‐year progression‐free survival (PFS) and overall survival (OS) were 76.3% and 82.7% respectively. In a multivariate analysis designed to avoid a collinearity bias with IPI categories, BMB‐BMI [bone marrow involvement](+) (HR: 3.6) and ECOG PS > 1 (HR: 2.9) were independently associated with a shorter PFS and three factors, age >60 years old (HR: 2.4), ECOG PS >1 (HR: 2.4), and abnormally elevated B2‐microglobulin levels (HR: 2.2) were independently associated with a shorter OS. In our DLBCL cohort, treated with a uniform first‐line chemotherapy regimen, BMI by BMB complemented performance status in predicting those patients with a higher risk for relapse or progression. In this cohort BMI by PET/CT could not independently predict a shorter PFS and/or OS.
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Affiliation(s)
- Tzu-Hua Chen-Liang
- Servicio de Hematología y Oncología Médica. H.J.M. Morales Meseguer, IMIB-Arrixaca, Murcia, Spain
| | - Taida Martín-Santos
- Servicio de Hematología. H. Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Andrés Jerez
- Servicio de Hematología y Oncología Médica. H.J.M. Morales Meseguer, IMIB-Arrixaca, Murcia, Spain
| | | | | | | | - Begoña Muiña
- Servicio de Hematología. H. R. Méndez, Lorca, Murcia, Spain
| | - Mayte Orero
- Servicio de Hematología. H. General, Valencia, Spain
| | - Anabel Teruel
- Servicio de Hematología y Oncología Médica. H. Clínico, Valencia, Spain
| | - Alejandro Martín
- Servicio de Hematología. H. Clínico Universitario de Salamanca/IBSAL, Salamanca, Spain
| | | | - Kyra Kennedy
- Servicio de Hematología. H. Ramon y Cajal, Madrid, Spain
| | - Carmen Benet
- Servicio de Hematología. H. Arnau de Vilanova, Valencia, Spain
| | - José María Raya
- Servicio de Hematología. H. Universitario de Canarias, La Laguna, Tenerife, Spain
| | | | | | - Marta Guinot
- Servicio de Hematología. H. La Fe, Valencia, Spain
| | | | - Isabel Ballester
- Servicio de Hematología y Oncología Médica. H. Clínico, Valencia, Spain
| | - Mónica Baile
- Servicio de Hematología. H. Clínico Universitario de Salamanca/IBSAL, Salamanca, Spain
| | - María Moya
- Servicio de Hematología. H. Virgen de la Arrixaca, Murcia, Spain
| | | | - Laura Frutos
- Servicio de Medicina Nuclear. H. Virgen de la Arrixaca, Murcia, Spain
| | - José Luis Navarro
- Servicio de Medicina Nuclear. H. Virgen de la Arrixaca, Murcia, Spain
| | - Jon Uña
- Servicio de Medicina Nuclear. H. Universitario N.S. de la Candelaria, Tenerife, Spain
| | | | - Carolina Igua
- Servicio de Medicina Nuclear. H. La Fe, Valencia, Spain
| | - José Contreras
- Servicio de Medicina Nuclear. H. Sta Lucia, Cartagena, Murcia, Spain
| | | | | | - Pilar Tamayo
- Servicio de Medicina Nuclear. H. Clínico Universitario de Salamanca/IBSAL, Salamanca, Spain
| | - Jorge Mucientes
- Servicio de Medicina Nuclear. H. Puerta de Hierro, Madrid, Spain
| | | | - Elena Pérez-Ceballos
- Servicio de Hematología y Oncología Médica. H.J.M. Morales Meseguer, IMIB-Arrixaca, Murcia, Spain
| | - Francisco José Ortuño
- Servicio de Hematología y Oncología Médica. H.J.M. Morales Meseguer, IMIB-Arrixaca, Murcia, Spain
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Ferdová E, Ferda J, Baxa J. 18F-FDG-PET/MRI in lymphoma patients. Eur J Radiol 2017; 94:A52-A63. [PMID: 28132716 DOI: 10.1016/j.ejrad.2017.01.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/21/2017] [Indexed: 12/23/2022]
Abstract
The introduction of hybrid PET/MRI imaging using integrated systems into clinical practice has opened up the possibility of reducing the radiation dose from hybrid imaging by eliminating the contribution from computed tomography. Studies comparing the possibilities of PET/CT and PET/MRI imaging demonstrated it is possible to use the advantages of the high contrast resolution of magnetic resonance for soft tissue and bone marrow along with PET records in a quality comparable to PET/CT imaging. The significant feature for PET imaging in Hodgkińs lymphoma is that it is a tissue with high levels of radiopharmaceutical accumulation, which decreases proportionally after successful therapeutic effect, the effect of therapy is assessed using Deauville score system on interim examinations. While the efficacy of prognosis determined using the Deauville scale in HL is widely accepted, it turns out that in DLBCL, the prognostic value of PET imaging is bound to the evaluation of subtypes. PET/MRI scanning can be used to evaluate a relapse if follicular lymphoma has already been treated, or to confirm transformation into more aggressive forms. In children and adults with Burkitt's lymphoma, negative findings after induction therapy have a high negative predictive value for relapse prognosis.
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Affiliation(s)
- Eva Ferdová
- Clinic of the Imaging Methods, University Hospital Plzen, Alej Svobody 80, 304 60 Plzeň, Czechia.
| | - Jiří Ferda
- Clinic of the Imaging Methods, University Hospital Plzen, Alej Svobody 80, 304 60 Plzeň, Czechia.
| | - Jan Baxa
- Clinic of the Imaging Methods, University Hospital Plzen, Alej Svobody 80, 304 60 Plzeň, Czechia.
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