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Albano D, Calabrò A, Talin A, Dondi F, Pagani C, Tucci A, Treglia G, Bertagna F. 2-[ 18]F FDG PET/CT dissemination features in adult burkitt lymphoma Are predictive of outcome. Ann Hematol 2024; 103:2419-2427. [PMID: 38374254 DOI: 10.1007/s00277-024-05672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/17/2024] [Indexed: 02/21/2024]
Abstract
This retrospective study investigated the prognostic role of disease dissemination features (Dmax and Dmaxbsa) measured by 2-[18F]FDG PET/CT in newly diagnosed Burkitt Lymphoma (BL) patients, comparing their performance with other metabolic parameters. We included 78 patients diagnosed with BL between 2010 and 2022 with an available baseline PET, interim PET/CT (iPET) and end of treatment PET/CT (eotPET) and with a minimum of two 2-[18F]FDG avid lesions present at the baseline scan. Dmax was calculated from the three-dimensional coordinates of the baseline metabolic tumor volume (MTV) by using LIFEx software; Dmaxbsa was calculated as Dmax normalized for body surface area according to the Du Bois method. We evaluated their effect on metabolic treatment response evaluated by PET, on progression free survival (PFS) and on overall survival (OS). Dmaxbsa was significantly associated with tumor stage, bulky and extranodal disease, MTV and TLG. At a median follow-up of 49 months, the median PFS and OS were 45 and 48 months. Dmax and Dmaxbsa were significantly higher in not complete metabolic response than complete metabolic response group at iPET and eotPET.As far as PFS, parameters including iPET/CT, eotPET/CT outcomes, MTV and TLG showed to be independent prognostic factors while Dmax and Dmaxbsa were not significantly associated with the outcome. Dissemination features, together with eotPET/CT results, MTV and TLG, demonstrated to be significantly correlated with OS. In conclusion, in this study we demonstrated that dissemination features derived by 2[18F]-FDG PET/CT were significantly correlated with response to treatment and long-term outcome, independently from other PET features.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, 25123, Italy.
- Nuclear Medicine, University of Brescia, Brescia, Italy.
| | - Anna Calabrò
- Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, 25123, Italy
- Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Anna Talin
- Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, 25123, Italy
- Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Francesco Dondi
- Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, 25123, Italy
- Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Chiara Pagani
- Division of Hematology, ASST Spedali Civili Brescia, Brescia, Italy
| | - Alessandra Tucci
- Division of Hematology, ASST Spedali Civili Brescia, Brescia, Italy
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Francesco Bertagna
- Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, 25123, Italy
- Nuclear Medicine, University of Brescia, Brescia, Italy
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Thurgood LA, Best OG, Rowland A, Lower KM, Brooks DA, Kuss BJ. Lipid uptake in chronic lymphocytic leukemia. Exp Hematol 2021; 106:58-67. [PMID: 34896245 DOI: 10.1016/j.exphem.2021.12.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022]
Abstract
Many cancers rely on glucose as an energy source, but it is becoming increasingly apparent that some cancers use alternate substrates to fuel their proliferation. Chronic lymphocytic leukaemia (CLL) is one such cancer. Through the use of flow cytometry and confocal microscopy, low levels of glucose uptake were observed in the OSU-CLL and HG3 CLL cell lines relative to highly glucose-avid Raji cells (Burkitt's lymphoma). Glucose uptake in CLL cells correlated with low expression of the GLUT1 and GLUT3 receptors. In contrast, both CLL cell lines and primary CLL cells, but not healthy B cells, were found to rapidly internalise medium- and long-chain, but not short-chain, fatty acids (FAs). Differential FA uptake was also observed in primary cells taken from patients with unmutated immunoglobulin heavy variable chain usage (IGHV) compared with patients with mutated IGHV. Delipidation of serum in the culture medium slowed the proliferation and significantly reduced the viability of OSU-CLL and HG3 cells, effects that were partially reversed by supplementation with a chemically defined lipid concentrate. These observations highlight the potential importance of FAs in the pathogenesis of CLL and raise the possibility that targeting FA utilisation may represent a novel therapeutic and prognostic approach in this disease.
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Affiliation(s)
- Lauren A Thurgood
- Molecular Medicine and Genetics, College of Medicine and Public Health, Flinders University, Bedford Park, Australia.
| | - Oliver G Best
- Molecular Medicine and Genetics, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Ashley Rowland
- Molecular Medicine and Genetics, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Karen M Lower
- Molecular Medicine and Genetics, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Doug A Brooks
- Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Bryone J Kuss
- Molecular Medicine and Genetics, College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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Xiao Z, Mo Y, Long W, Li R, Li X, Wei Y, Fan W, Zhang X. Value of baseline and end of chemotherapy 18F-FDG PET/CT in pediatric patients with Burkitt lymphoma. Leuk Lymphoma 2021; 62:2873-2881. [PMID: 34165390 DOI: 10.1080/10428194.2021.1941933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to analyze whether the baseline metabolic parameters of 18F-FDG PET/CT in pediatric patients with Burkitt lymphoma (BL) can predict treatment response and prognosis. We retrospectively analyzed 68 pediatric patients with BL who underwent PET/CT before treatment. PET images were analyzed semi-quantitatively by measuring the maximum standardized uptake (SUVmax), total metabolic tumor volume (tMTV), and total lesion glycolysis (TLG). Survival curves were plotted according to the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards regression models were used to assess the relation between potential variables and outcomes. tMTV and TLG were significantly lower in patients with complete response compared with those with partial response at the end of treatment. PET metabolic parameters (tMTV and TLG) were the independent prognostic values for outcome. TMTV and TLG were significantly connected with treatment response and prognosis in pediatric with BL.
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Affiliation(s)
- Zizheng Xiao
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Canter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yiwen Mo
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Canter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wen Long
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Canter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ruping Li
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Canter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xinling Li
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Canter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yuan Wei
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Canter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wei Fan
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Canter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xu Zhang
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Canter, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Mo YW, Xiao ZZ, Wei Y, Li XL, Zhang X, Fan W. The Clinical Accuracy and Risk Stratification in End of Therapy 18F-FDG PET/CT in Burkitt Lymphoma. Front Oncol 2021; 11:625436. [PMID: 33968725 PMCID: PMC8098980 DOI: 10.3389/fonc.2021.625436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/26/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose Burkitt lymphoma (BL) is an invasive lymphoma subtype with FDG avid at 18F-FDG PET/CT, but there is currently no validated criterion in treatment evaluation and prognosis prediction. The aim of this study was to analyze the clinical accuracy of 18F-FDG PET/CT in Burkitt lymphoma in end of therapy PET/CT (EOT-PET) to assess the treatment response in BL and conduct a survival analysis with different Deauville 5-point score (DS) cutoff values. Materials and Methods A total of 189 patients were retrospectively included: 97 underwent baseline PET/CT and all underwent EOT-PET. Survival curves were plotted according to the Kaplan-Meier method. Different DS cutoff values in EOT-PET were evaluated for risk stratification in Burkitt lymphoma. Results The median progression free survival (PFS) and overall survival (OS) were 52 and 53 months, respectively. Applying the conventional DS 4 to 5, there was significant difference in outcome between EOT-PET negative and positive patients. However, the positive predictive value (PPV) (28.3% for PFS and 26.4% for OS) is low despite a high negative predictive value (NPV) (94.1% for OS and 94.9% for OS). When we moved the cutoff point to DS 5, the PPV was improved evidently (88.2% for PFS and 82.3% for OS) with the satisfactory NPV simultaneously (95.3% for PFS and 95.9% for OS). Conclusions EOT-PET results using DS significantly related with PFS and OS. DS of 5 may be a better cutoff point at the end of treatment to determine whether patients have a significant risk of recurrence or progress.
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Affiliation(s)
- Yi Wen Mo
- Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China
| | - Zi Zheng Xiao
- Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China
| | - Yuan Wei
- Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China
| | - Xin Ling Li
- Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China
| | - Xu Zhang
- Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China
| | - Wei Fan
- Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China
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Fox TA, Carpenter B, Taj M, Perisoglou M, Nicholson E, Castleton A, Elliot J, Uttenthal B, Wright C, Halsey R, Khwaja A, Grandage V, Mansour MR, Fielding AK, Hough R. Utility of 18F-FDG-PET/CT in lymphoblastic lymphoma. Leuk Lymphoma 2020; 62:1010-1012. [PMID: 33275056 DOI: 10.1080/10428194.2020.1855346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Thomas A Fox
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ben Carpenter
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary Taj
- Department of Clinical Haematology, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Martha Perisoglou
- Department of Clinical Haematology, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Emma Nicholson
- Department of Clinical Haematology, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Anna Castleton
- Department of Clinical Haematology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Johnathon Elliot
- Department of Clinical Haematology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Ben Uttenthal
- Department of Clinical Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Callum Wright
- Department of Clinical Haematology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Richard Halsey
- Department of Nuclear Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Asim Khwaja
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Cancer Institute, University College London, London, UK
| | - Victoria Grandage
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Marc R Mansour
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Cancer Institute, University College London, London, UK
| | - Adele K Fielding
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK.,UCL Cancer Institute, University College London, London, UK
| | - Rachael Hough
- Department of Clinical Haematology, University College London Hospitals NHS Foundation Trust, London, UK
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6
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Cwynarski K, Khwaja J, Montoto S. 'CARMEN': is less, more? Lessons from trials in human immunodeficiency virus-Burkitt lymphoma (HIV-BL). Br J Haematol 2020; 192:13-14. [PMID: 33090470 DOI: 10.1111/bjh.17187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Kate Cwynarski
- Department of Haematology, University College London Hospital, London, UK
| | - Jahanzaib Khwaja
- Department of Haematology, University College London Hospital, London, UK
| | - Silvia Montoto
- Department of Haematology, St Bartholomew's and The Royal London NHS Trust, London, UK
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Abstract
Hematologic malignancies include several lymphoproliferative and myeloproliferative disorders, many of which are frequently encountered in current health care settings. These malignancies frequently affect the gastrointestinal (GI) tract, either by secondary extranodal or extramedullary extension to the GI tract, or as a primary process arising in the GI tract. In fact, the GI tract may represent the most common extranodal site of involvement in many of them, such as lymphoma. Furthermore, in the current era of improved cancer treatment and advanced transplant procedures with increased survival, it has been quite common to encounter GI involvement by these malignancies through the disease course. Post-transplant lymphoproliferative disorder following kidney transplantation, for example, very commonly involves the GI tract. Other conditions that can involve the GI tract include multiple myeloma, plasmacytoma, myeloid sarcoma, mastocytosis, and Castleman disease. Imaging diagnosis of these malignancies can be challenging, since they are much less common than primary GI cancers and both share many common imaging features as well. However, certain imaging features, particularly in combination with a matching clinical scenario, play a pivotal role in diagnosing these conditions and directing further evaluation. In this article, we review common and rare hematologic malignancies of the GI tract and discuss their pathophysiologic, clinical, and imaging features.
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Rahman HA, El Semary SF, Ahmed G, Kenaai NE, Omar W, Zaky I, Nagy N. Can FDG-PET replace biopsy for the evaluation of residual tumor in pediatric mature B-cell non-Hodgkin lymphoma? Pediatr Blood Cancer 2020; 67:e28310. [PMID: 32634295 DOI: 10.1002/pbc.28310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/08/2020] [Accepted: 03/16/2020] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The aim of our study is to evaluate the role of 18 F-labeled fluorodeoxy glucose positron emission tomography (18 FDG-PET) scan for the detection of viable residual mass in pediatric mature B-cell non-Hodgkin lymphoma (NHL). This study also aims to detect the negative predictive value, positive predictive value (PPV), sensitivity, and specificity of 18 FDG-PET. PATIENTS AND METHODS A retrospective, cross-sectional nonrandomized study was carried out. We included all patients with newly diagnosed mature B-cell NHL treated at the Children Cancer Hospital Egypt during the period between July 2007 and the end of May 2018. Patients were included in the study if they (a) had a residual tumor mass, (b) underwent an 18 FDG-PET scan, and (c) had a pathologic documentation of this residual tumor. Patients were followed up till June 2019. RESULTS Thirty-six patients were included, for whom 39 biopsies were performed. Mean age was 7.7 years. Median follow-up period was 52.8, range 6.1 to 117 months.18 FDG-PET scan was positive (Deauville score 3, 4, or 5) in 24 of 39 patients (61.5%), while it was negative (Deauville score 1 or 2) in 15 patients (38.5%). Positive 18 FDG-PET scan and biopsy were performed in 15 of 39 samples (38.4%; true positive, TP), while they were both negative in 13 samples (33.3%; true negative). Nine patients (23%) had positive scan and a negative biopsy (false positive), while 2 patients had negative uptake and a positive biopsy (false negative, FN)). Sensitivity of the 18 FDG-PET scan was 88.2% and specificity was 59.1%. PPV was 62.5% and NPPV was 86.6%. CONCLUSION Changing therapy on the basis of a positive finding alone at the time of evaluation is not recommended. FN results exist, so biopsy confirmation is required to avoid the missing refractory disease. If negative, 18 FDG- PET can replace a biopsy if the latter is inaccessible or carries an unnecessary risk.
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Affiliation(s)
- Hany Abdel Rahman
- Department of Pediatric Oncology, National Cancer Institute, Cairo University and Children Cancer Hospital Egypt, Cairo, Egypt
| | - Samah Fathy El Semary
- Department of Clinical Oncology, Faculty of Medicine, Beni Suef University and Children Cancer Hospital Egypt, Beni Suef, Egypt
| | - Gehad Ahmed
- Department of Surgery, Helwan University, and Children Cancer Hospital Egypt
| | - Naglaa El Kenaai
- Department of Pathology, National Cancer Institute Cairo University, and Children Cancer Hospital Egypt, Cairo, Egypt
| | - Walid Omar
- Department of Nuclear Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Iman Zaky
- Department of Radio-diagnosis, National Cancer Institute, Cairo University and Children Cancer Hospital Egypt, Cairo, Egypt
| | - Nouran Nagy
- Department of Clinical Research, Children Cancer Hospital Egypt, Cairo, Egypt
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Davies K, Barth M, Armenian S, Audino AN, Barnette P, Cuglievan B, Ding H, Ford JB, Galardy PJ, Gardner R, Hanna R, Hayashi R, Kovach AE, Machnitz AJ, Maloney KW, Marks L, Page K, Reilly AF, Weinstein JL, Xavier AC, McMillian NR, Freedman-Cass DA. Pediatric Aggressive Mature B-Cell Lymphomas, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:1105-1123. [PMID: 32755986 DOI: 10.6004/jnccn.2020.0036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pediatric aggressive mature B-cell lymphomas are the most common types of non-Hodgkin lymphoma in children, and they include Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL). These diseases are highly aggressive but curable, the treatment is complex, and patients may have many complicated supportive care issues. The NCCN Guidelines for Pediatric Aggressive Mature B-Cell Lymphomas provide guidance regarding pathology and diagnosis, staging, initial treatment, disease reassessment, surveillance, therapy for relapsed/refractory disease, and supportive care for clinicians who treat sporadic pediatric BL and DLBCL.
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Affiliation(s)
- Kimberly Davies
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center
| | | | | | - Anthony N Audino
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Hilda Ding
- UCSD Rady Children's Hospital/UC San Diego Moores Cancer Center
| | | | | | - Rebecca Gardner
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Rabi Hanna
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Robert Hayashi
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Kelly W Maloney
- Children's Hospital of Colorado/University of Colorado Cancer Center
| | | | | | - Anne F Reilly
- Abramson Cancer Center at the University of Pennsylvania
| | | | - Ana C Xavier
- Children's of Alabama/O'Neal Comprehensive Cancer Center at UAB; and
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Morgan JE, Walker R, Harden M, Phillips RS. A systematic review of evidence for and against routine surveillance imaging after completing treatment for childhood extracranial solid tumors. Cancer Med 2020; 9:4949-4961. [PMID: 32431088 PMCID: PMC7367646 DOI: 10.1002/cam4.3110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Regular off-treatment imaging is often used to assess for recurrence of disease after childhood cancer treatment. It is unclear if this increases survival, or what burden surveillance places on patients, families, or health-care services. This systematic review examines the impact of routine surveillance imaging after treatment of pediatric extracranial solid tumors. METHODS Collaborative patient and public involvement informed the design and interpretation of this work. Thirteen electronic databases, conference proceedings, and trial registries were searched alongside reference list checking and forward citation searching from 1990 onwards. Studies were screened and data were extracted by two researchers. Risk of bias was assessed using a modified ROBINS-I tool. Relevant outcomes were overall survival, psychological distress indicators, number of imaging tests, cost-effectiveness, and qualitative data regarding experiences of surveillance programs. PROSPERO (CRD42018103764). RESULTS Of 17 727 records identified, 55 studies of 10 207 patients were included. All studies used observational methods. Risk of bias for all except one study was moderate, serious, or critical. Data were too few to conduct meta-analysis; however, narrative synthesis was performed. Surveillance strategies varied, and poorly reported, involving many scans and substantial radiation exposure (eg, neuroblastoma, median 133.5 mSv). For most diseases, surveillance imaging was not associated with increased overall survival, with the probable exception of Wilms tumor. No qualitative or psychological distress data were identified. CONCLUSIONS At present, there is insufficient evidence to evaluate the effects of routine surveillance imaging on survival in most pediatric extracranial solid tumors. More high-quality data are required, preferably through randomized controlled trials with well-conducted qualitative elements.
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Affiliation(s)
- Jessica E. Morgan
- Centre for Reviews and DisseminationUniversity of YorkYorkUK
- Department of Paediatric OncologyLeeds Children's HospitalLeedsUK
| | - Ruth Walker
- Centre for Reviews and DisseminationUniversity of YorkYorkUK
| | - Melissa Harden
- Centre for Reviews and DisseminationUniversity of YorkYorkUK
| | - Robert S. Phillips
- Centre for Reviews and DisseminationUniversity of YorkYorkUK
- Department of Paediatric OncologyLeeds Children's HospitalLeedsUK
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12
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Carrasquillo JA, Chen CC, Price S, Whatley M, Avila NA, Pittaluga S, Jaffe ES, Rao VK. 18F-FDG PET Imaging Features of Patients With Autoimmune Lymphoproliferative Syndrome. Clin Nucl Med 2019; 44:949-955. [PMID: 31689275 PMCID: PMC8189160 DOI: 10.1097/rlu.0000000000002816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Autoimmune lymphoproliferative syndrome (ALPS) is a rare immune dysregulatory condition, usually presenting in childhood with massive lymphadenopathy, splenomegaly, and an increased incidence of lymphoma. Methods to differentiate between benign ALPS adenopathy and lymphoma are needed. To this end, we evaluated the usefulness of FDG PET. METHODS We prospectively evaluated 76 ALPS/ALPS-like patients including FS-7-associated surface antigen (FAS) germline mutation with (n = 4) and without lymphoma (n = 50), FAS-somatic (n = 6), ALPS-unknown (n = 6), and others (n = 10) who underwent FDG PET. Uptakes in 14 nodal sites, liver, and spleen were determined. RESULTS In 76 ALPS patients, FDG PET showed uptake in multiple nodal sites in all but 1 patient. The highest SUVmax values in FAS mutation without lymphoma, FAS mutation with lymphoma, FAS somatic, ALPS-unknown, and other genetic mutations were a median (range) 9.2 (4.3-25), 16.2 (10.7-37.2), 7.6 (4.6-18.1), 11.5 (4.8-17.2), and 5.5 (0-15.3), respectively. Differences between uptake in the FAS group with and without lymphoma were statistically significant, but overlapped, making discrimination between individuals with/without lymphoma impossible. The spleen:liver uptake ratio was greater than 1 in 82% of patients. CONCLUSIONS While statistically significant differences were observed in FAS mutation ALPS with and without lymphoma, the significant overlap in FDG uptake and visual appearance in many patients prevents discrimination between patients with and without lymphoma. Similar patterns of FDG biodistribution were noted between the various ALPS subgroups.
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Affiliation(s)
- Jorge A. Carrasquillo
- Nuclear Medicine Division, Department of Radiology & Imaging Science, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD
- Currently at Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Clara C. Chen
- Nuclear Medicine Division, Department of Radiology & Imaging Science, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD
| | - Susan Price
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Millie Whatley
- Nuclear Medicine Division, Department of Radiology & Imaging Science, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD
| | - Nilo A. Avila
- Department of Radiology &Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD
| | - Stefania Pittaluga
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | - Elaine S. Jaffe
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | - V. Koneti Rao
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD
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13
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Imaging for diagnosis, staging and response assessment of Hodgkin lymphoma and non-Hodgkin lymphoma. Pediatr Radiol 2019; 49:1545-1564. [PMID: 31620854 DOI: 10.1007/s00247-019-04529-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/14/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023]
Abstract
Hodgkin lymphoma and non-Hodgkin lymphoma are common malignancies in children and are now highly treatable. Imaging plays a major role in diagnosis, staging and response using conventional CT and MRI and metabolic imaging with positron emission tomography (PET)/CT and PET/MRI. Cross-sectional imaging has replaced staging laparotomy and splenectomy by demonstrating abdominal nodal groups and organ involvement. [F-18]2-fluoro-2-deoxyglucose (FDG) PET provides information on bone marrow involvement, and MRI elucidates details of cortical bone and confirmation of bone marrow involvement. The staging system for Hodgkin lymphoma is the Ann Arbor system with Cotswald modifications and is based on imaging, whereas the non-Hodgkin staging system is the St. Jude Classification by Murphy or the more recent revised International Pediatric Non-Hodgkin Lymphoma Staging System (IPNHLSS). Because all pediatric lymphomas are metabolically FDG-avid and identify all nodal, solid organ, cortical bone and bone marrow disease, staging evaluations require FDG PET as PET/CT or PET/MRI in both Hodgkin and non-Hodgkin lymphoma. Both diseases have in common issues of airway compromise at presentation demonstrated by imaging. Differences exist in that Hodgkin lymphoma has several independent poor prognostic factors seen by imaging such as large mediastinal adenopathy, Stage IV disease, systemic symptoms, pleural effusion and pericardial effusion. Non-Hodgkin lymphoma includes more organ involvement such as renal, ovary, central nervous system and skin. Early or interim PET-negative scans are a reliable indicator of improved clinical outcome and optimize risk-adapted therapy and patient management; imaging may not, however, predict who will relapse. A recent multicenter trial has concluded that it is usually sufficient for pediatric lymphoma at staging and interim assessment to evaluate children with PET imaging from skull base to mid-thigh. Various systems of assessment of presence of disease or response are used, including the Deauville visual scale, where avidity is compared to liver; Lugano, which includes size change as part of response; or quantitative PET, which uses standardized uptake values to define more accurate response. Newer methods of immunotherapy can produce challenges in FDG PET evaluation because of inflammatory changes that may not represent disease.
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Abstract
OBJECTIVE. The objective of our study was to evaluate the clinical utility of FDG PET/CT in staging and restaging pediatric patients with yolk sac tumor (YST). MATERIALS AND METHODS. We retrospectively reviewed the data from 31 pediatric patients with pathologically confirmed YST who underwent 34 PET/CT studies for the purpose of staging or restaging. The PET/CT studies were read by two nuclear medicine doctors in consensus. Histopathology combined with clinical and imaging follow-up was taken as the reference standard. The results of PET/CT were also compared with conventional imaging and α-fetoprotein (AFP) levels when available. RESULTS. Of the total 34 studies, six were performed for initial staging and the other 28 for posttherapy evaluation. FDG PET/CT was true-positive in all six staging studies, detected only a few more metastatic foci than conventional imaging, and changed the therapeutic regimen in none of the six patients. Nevertheless, PET/CT showed high accuracy in the restaging group, with a sensitivity of 100% and specificity of 85.7%. The treatment regimen was changed in 46.4% of the patients in the restaging group according to the PET/CT study. In addition, PET/CT had higher accuracy than AFP levels in YST restaging. Overall, the per-study performance of PET/CT was a sensitivity of 100%, specificity of 85.7%, positive predictive value of 90.9%, and negative predictive value of 100%. CONCLUSION. FDG PET/CT was only slightly superior to conventional imaging in staging YST in pediatric patients. However, PET/CT of posttherapy patients with YST showed high diagnostic accuracy and had a great impact on therapeutic management.
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Kalisz K, Alessandrino F, Beck R, Smith D, Kikano E, Ramaiya NH, Tirumani SH. An update on Burkitt lymphoma: a review of pathogenesis and multimodality imaging assessment of disease presentation, treatment response, and recurrence. Insights Imaging 2019; 10:56. [PMID: 31115699 PMCID: PMC6529494 DOI: 10.1186/s13244-019-0733-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/13/2019] [Indexed: 12/12/2022] Open
Abstract
Burkitt lymphoma (BL) is a highly aggressive, rapidly growing B cell non-Hodgkin lymphoma, which manifests in several subtypes including sporadic, endemic, and immunodeficiency-associated forms. Pathologically, BL is classically characterized by translocations of chromosomes 8 and 14 resulting in upregulation of the c-myc protein transcription factor with upregulation of cell proliferation. BL affects nearly every organ system, most commonly the abdomen and pelvis in the sporadic form. Imaging using a multimodality approach plays a crucial role in the management of BL from diagnosis, staging, and evaluation of treatment response to therapy-related complications with ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography playing roles. In this article, we review the pathobiology and classification of BL, illustrate a multimodality imaging approach in evaluating common and uncommon sites of involvement within the trunk and head and neck, and review common therapies and treatment-related complications.
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Affiliation(s)
- Kevin Kalisz
- Department of Radiology, Duke University, Durham, NC, USA
| | - Francesco Alessandrino
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA. .,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Rose Beck
- Department of Pathology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Daniel Smith
- Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Elias Kikano
- Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Nikhil H Ramaiya
- Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sree Harsha Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Maschan A, Myakova N, Aleinikova O, Abugova Y, Ponomareva N, Belogurova M, Fechina L, Fedorova A, Grigor'eva N, Lebedev V, Nikonova O, Shamardina A, Sharapova G, Smirnova N, Rudneva A, Volchkov E, Samochatova E. Rituximab and reduced-intensity chemotherapy in children and adolescents with mature B-cell lymphoma: interim results for 231 patients enrolled in the second Russian-Belorussian multicentre study B-NHL-2010M. Br J Haematol 2019; 186:477-483. [PMID: 31069789 DOI: 10.1111/bjh.15944] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/12/2019] [Indexed: 01/03/2023]
Abstract
The value of adding rituximab to chemotherapy in children with aggressive B-cell non-Hodgkin lymphoma (B-NHL) is still insufficiently studied. We enrolled 231 patients [mean age 9 years old (range 2-17); male:female ratio 3·4:1] with Burkitt (BL, 179 patients, 76·7%), diffuse large B-cell (32 patients, 14%), primary mediastinal B-cell (14 patients, 6%), and other (6 patients, 2·6%) B-cell lymphomas in a prospective study of immuno-chemotherapy. Stages were I-II in 32% and III-IV in 68% of the patients. Four doses of 375 mg/m2 rituximab were added to the Berlin-Frankfurt-Munster-NHL-90-like chemotherapy, with methotrexate being reduced or omitted in the first 2 induction blocks. The complete remission rate was 100% in limited-stage and 91·4% in advanced-stage patients. Five advanced-stage patients (2·2%) died in induction and 1 patient with stage 2 B-NHL died in remission; 11 patients in the high-risk group progressed on therapy (3 non-BL are alive after salvage) and 5 relapsed. Sixteen patients (9·7%) with advanced stage disease proceeded to transplant. With a median follow-up of 46 months, 98·5 ± 1% of patients with limited disease and 88·1 ± 2% (88·1% in Risk Group 3; 82·6% in Risk Group 4) in advanced stages are alive. This study confirmed that combined immunochemotherapy for B-lymphomas is highly effective in children, despite reducing the intensity of the induction blocks.
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Affiliation(s)
- Alexey Maschan
- Dmitri Rogachev National Research Centre for Paediatric Haematology, Oncology and Immunology, Moscow, Russian Federation
| | - Natalia Myakova
- Dmitri Rogachev National Research Centre for Paediatric Haematology, Oncology and Immunology, Moscow, Russian Federation
| | - Olga Aleinikova
- Belorussian Research Centre for Paediatric Oncology, Haematology and Immunology, Minsk, Russian Federation
| | - Yulia Abugova
- Dmitri Rogachev National Research Centre for Paediatric Haematology, Oncology and Immunology, Moscow, Russian Federation
| | | | | | - Larisa Fechina
- Regional Children's Clinical Hospital No. 1, Ekaterinburg, Russian Federation
| | - Alina Fedorova
- Belorussian Research Centre for Paediatric Oncology, Haematology and Immunology, Minsk, Russian Federation
| | | | - Vladimir Lebedev
- Regional Children's Clinical Hospital, Krasnodar, Russian Federation
| | - Olga Nikonova
- Regional Children's Clinical Hospital, Perm, Russian Federation
| | | | - Guzel Sharapova
- District Clinical Children's Hospital, Nizhnevartovsk, Russian Federation
| | - Nadezhda Smirnova
- Dmitri Rogachev National Research Centre for Paediatric Haematology, Oncology and Immunology, Moscow, Russian Federation
| | - Anastassia Rudneva
- Dmitri Rogachev National Research Centre for Paediatric Haematology, Oncology and Immunology, Moscow, Russian Federation
| | - Egor Volchkov
- Dmitri Rogachev National Research Centre for Paediatric Haematology, Oncology and Immunology, Moscow, Russian Federation
| | - Elena Samochatova
- Dmitri Rogachev National Research Centre for Paediatric Haematology, Oncology and Immunology, Moscow, Russian Federation
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Albano D, Re A, Tucci A, Giubbini R, Bertagna F. Prognostic role of ΔMTV and ΔTLG in Burkitt lymphoma. Ann Nucl Med 2019; 33:280-287. [PMID: 30788775 DOI: 10.1007/s12149-019-01338-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/09/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Burkitt's lymphoma (BL) is an aggressive lymphoma sub-type with high 18F-FDG avidity, but no well established evidence of PET/CT's role in treatment evaluation or prognosis is currently available. The prognostic role of visual analysis and Deauville criteria for BL have already been demonstrated, while the potential usefulness of semi-quantitative PET/CT features remains unclear, especially the value of the rate of reduction in metabolic tumor volume (MTV) and total lesion glycolysis (TLG). The aim of this retrospective study was to investigate whether ΔMTV and ΔTLG can predict treatment response at the end of therapy and prognosis in BL. METHODS We retrospectively included 61 patients (mean age 61; 40 male, 21 female) who underwent baseline, interim and end-of-treatment 18F-FDG PET/CT. The PET/CT images were analyzed visually and semi-quantitatively by measuring total metabolic tumor volume (MTV) and total lesion glycolysis (TLG) for every scan. Then we calculated volume changes based on the percentage of MTV and TLG reduction between the baseline and interim PET (ΔMTVi and ΔTLGi) and between baseline and end-of-treatment PET/CT (ΔMTVeot and ΔTLGeot) and correlated them with clinical response and progression-free survival (PFS) and overall survival (OS). Survival curves were plotted according to the Kaplan-Meier method. RESULTS Forty patients had a complete response and 21 patients a partial response on interim 18F-FDG PET/CT. At end of treatment, 45 had a complete response, 11 partial response and 5 disease progression. At a median follow-up of 43 months, relapse/progression occurred in 18 patients and death in 11. ΔMTV and ΔTLG values were significantly higher in patients with complete response compared to no complete response. ΔMTVeot and ΔTLGeot were demonstrated to be independent prognostic factors for both PFS and OS, while ΔMTVi and ΔTLGi were not related to survival. CONCLUSIONS Metabolic tumor features (ΔMTV and ΔTLG) were significantly correlated with response to treatment and long-term outcome in BL.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Alessandro Re
- Division of Hematology, Spedali Civili, Brescia, Italy
| | | | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy
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Albano D, Bosio G, Pagani C, Re A, Tucci A, Giubbini R, Bertagna F. Prognostic role of baseline 18F-FDG PET/CT metabolic parameters in Burkitt lymphoma. Eur J Nucl Med Mol Imaging 2018; 46:87-96. [PMID: 30276438 DOI: 10.1007/s00259-018-4173-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/17/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Burkitt's lymphoma (BL) is an aggressive lymphoma subtype with high 18F-FDG avidity at 18F-FDG-PET/CT, but no validated criteria for PET/CT in treatment evaluation or prediction of outcome in BL are available. The aim of our study was to investigate whether the metabolic baseline PET/CT parameters can predict treatment response and prognosis in BL. MATERIALS AND METHODS We retrospectively enrolled 65 patients who underwent baseline 18F-FDG-PET/CT, interim and end of treatment PET/CT. The PET images were analyzed visually and semi-quantitatively by measuring the maximum standardized uptake value body weight (SUVbw), the maximum standardized uptake value lean body mass (SUVlbm), the maximum standardized uptake value body surface area (SUVbsa), lesion to liver SUVmax ratio (L-L SUV R), lesion to blood-pool SUVmax ratio (L-BP SUV R), total metabolic tumor volume (tMTV) and total lesion glycolysis (TLG). Survival curves were plotted according to the Kaplan-Meier method. RESULTS At a median follow-up of 40 months, the median PFS and OS were 34 and 39 months. MTV and TLG were significantly higher in patients with partial response compared to complete response group at end of treatment, while no significant differences were found at interim. Other metabolic PET/CT parameters were not related to treatment response. MTV and TLG were demonstrated to be independent prognostic factors for both PFS and OS; instead SUVbw, SUVlbm, SUVbsa, L-L SUV R and L-BP SUV R were not related to outcome survival. CONCLUSIONS Metabolic tumour features (MTV and TLG) were significantly correlated with response to treatment and long-term outcome.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Giovanni Bosio
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Chiara Pagani
- Division of Hematology, Spedali Civili, Brescia, Italy
| | - Alessandro Re
- Division of Hematology, Spedali Civili, Brescia, Italy
| | | | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
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Davidson T, Priel E, Schiby G, Raskin S, Chikman B, Nissan E, Benjamini O, Nissan J, Goshen E, Ben-Haim S, Salomon O, Avigdor A. Low rate of spleen involvement in sporadic Burkitt lymphoma at staging on PET-CT. Abdom Radiol (NY) 2018; 43:2369-2374. [PMID: 29460043 DOI: 10.1007/s00261-017-1454-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Burkitt lymphoma is a highly aggressive B cell non-Hodgkin lymphoma. Cross-sectional imaging techniques that are used to detect liver and spleen involvement by lymphoma have high rates of false negative and false positive findings, and as such may reduce the accuracy of staging. PURPOSE This retrospective study evaluated the use of FDG PET-CT in determining splenic involvement at staging, in a relatively large cohort of adult patients with the sporadic form of Burkitt lymphoma (SBL). PATIENTS AND METHODS All adult patients who underwent FDG PET-CT for staging of SBL at one medical center during 2005-2014 were enrolled for this retrospective study. RESULTS Data were analyzed of 20 patients, with median age 49 years; 17 were male. PET-CT revealed highly intense FDG uptake, mean SUV max 11.4 ± 7.49 (range 4.3-38) in various tissues. None of the 20 patients had either focal or diffuse increased uptake of FDG in the spleen parenchyma. In 2 patients, there were highly FDG-avid soft tissue masses adjacent to the spleen, both in the context of direct peritoneal disease extension. CONCLUSION The spleen is rarely involved in SBL at the time of staging, according to PET-CT, except in cases with direct extension from adjacent peritoneal mass. The low rate of spleen involvement according to PET-CT may serve as a specific characteristic of SBL. Larger-scale clinical studies incorporating PET-CT scans in SBL are needed to confirm our observation.
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Albano D, Bosio G, Re A, Pagani C, Giubbini R, Bertagna F. Metabolic behavior and prognostic value of early and end of treatment 18F-FDG PET/CT in adult Burkitt's lymphoma: the role of Deauville and IHP criteria. Leuk Lymphoma 2018; 60:326-333. [PMID: 29966473 DOI: 10.1080/10428194.2018.1482541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Burkitt's lymphoma is a lymphoma with unclear metabolic behavior at 18F-FDG-PET/CT and no validated criteria in treatment evaluation and prediction of outcome exist. Sixty-five patients were retrospectively included: all underwent baseline 18F-FDG-PET/CT, 56 interim PET/CT (iPET/CT) and 54 end of treatment PET/CT (eotPET/CT) after chemotherapy. Interim and eotPET/CT results were visually interpreted according to the criteria of the IHP and Deauville-five-point-scale. Results were correlated with PFS and OS to assess and to compare the predictive value of iPET and eotPET according to each criterion. All baseline PET/CT showed increased 18F-FDG uptake in nodal and extranodal lesions. The median PFS and OS were 44.6 and 48.2 months with 3-year and 5-year PFS of 76% and 62% and 3-year and 5-year OS of 71% and 57%, respectively. EotPET/CT results using DC and IHP significantly correlate with OS and PFS; while iPET/CT did not correlated with OS and PFS.
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Affiliation(s)
- Domenico Albano
- a Nuclear Medicine , Spedali Civili Brescia , Brescia , Italy
| | - Giovanni Bosio
- a Nuclear Medicine , Spedali Civili Brescia , Brescia , Italy
| | - Alessandro Re
- b Division of Hematology , Spedali Civili , Brescia , Italy
| | - Chiara Pagani
- b Division of Hematology , Spedali Civili , Brescia , Italy
| | - Raffaele Giubbini
- c Nuclear Medicine , University of Brescia and Spedali Civili Brescia , Brescia , Italy
| | - Francesco Bertagna
- c Nuclear Medicine , University of Brescia and Spedali Civili Brescia , Brescia , Italy
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Pathogenesis and FDG-PET/CT findings of Epstein-Barr virus-related lymphoid neoplasms. Ann Nucl Med 2017; 31:425-436. [PMID: 28497429 DOI: 10.1007/s12149-017-1180-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/08/2017] [Indexed: 12/19/2022]
Abstract
Epstein-Barr virus (EBV) is one of the most common viruses, infecting more than 90% of the adult population worldwide. EBV genome is detected in some lymphoid neoplasms. Not only their histopathological subtypes, but also their backgrounds and their clinical courses are variable. A number of B-cell lymphoproliferative disorders associated with the immunocompromised state are related to EBV infection. The incidences of these disorders have been increasing along with generalization of organ transplantations and use of immunosuppressive treatments. Furthermore, some EBV-positive lymphoma can also occur in immunocompetent patients. While evaluating patients with generalized lymphadenopathy of unknown cause by positron emission tomography/computed tomography with 2-deoxy-2-[18F]fluoro-D-glucose (FDG-PET/CT), the possibility of lymphoid neoplasms should be considered in some patients, and a careful review of the background and previous history of the patients is necessary. In this review article, we describe the pathogenesis of EBV-related lymphoid neoplasms and then present FDG-PET/CT images of representative diseases. In addition, we also present a review of other EBV-related diseases, such as infectious mononucleosis and nasopharyngeal carcinoma.
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Abdel Rahman H, Sedky M, Hamoda A, Raafat T, Youssef A, Omar W, Hassanein O, Moussa E. Role of FDG-PET scan in the management of pediatric mature B cell non-Hodgkin's lymphoma. CCHE experience. J Egypt Natl Canc Inst 2016; 28:95-9. [PMID: 27133974 DOI: 10.1016/j.jnci.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/26/2016] [Accepted: 03/30/2016] [Indexed: 10/21/2022] Open
Abstract
AIM OF WORK To evaluate the sensitivity (Se), specificity (Sp), and predictive values (PV) of PET scan during management of pediatric mature B cell non-Hodgkin's lymphoma (NHL) in comparison with conventional computed tomography (CT) scan. PATIENTS AND METHODS A retrospective study enrolled on pediatric NHL patients at Children Cancer Hospital Egypt (CCHE) during the period from July 2007 to the end of June 2013. RESULTS For 115 pediatric patients diagnosed with mature B cell NHL, 152 PET and 152 CT scans were done simultaneously. Median age was 5.7years. They were 85 males (74%) and 30 females (26%). One hundred twenty six scans (82.9%) were done for 100 (87%) Burkitt lymphoma (BL) patients, while 26 scans (17.1%) were done for 15 (13.0%) patients with diffuse large B cell NHL (DLBC). Nineteen examination (12.5%) were done before starting chemotherapy (group 1), 107 (70.3%) at time of evaluation (group 2), and 26 (17.1%) during follow up (group C). Overall sensitivity was 91.6% for PET and 70.0% for conventional CT (p=0.02). Specificity was 84.1% for PET and 58.9% for CT (p<0.001). Positive predictive value (PPV) for PET was 50%, while was 22% for CT scan (p<0.001). Negative predictive value (NPV) for PET was 98%, and 92% for CT (p=0.01). CONCLUSION PET scan is significantly more sensitive than conventional CT in the management of aggressive pediatric mature B cell NHL. PET negativity is an excellent indicator of tumor response.
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Affiliation(s)
- Hany Abdel Rahman
- Department of Pediatric Oncology, National Cancer Institute and Children Cancer Hospital, Egypt.
| | - Mohamed Sedky
- Department of Pediatrics, National Research Centre and Children Cancer Hospital, Egypt
| | - Asmaa Hamoda
- Department of Pediatric Oncology, National Cancer Institute and Children Cancer Hospital, Egypt
| | - Tarek Raafat
- Department of Radiodiagnosis, National Cancer Institute and Children Cancer Hospital, Egypt
| | - Ayda Youssef
- Department of Radiodiagnosis, National Cancer Institute and Children Cancer Hospital, Egypt
| | - Walid Omar
- Department of Nuclear Medicine, National Cancer Institute and Children Cancer Hospital, Egypt
| | - Omneya Hassanein
- Department of Clinical Research, Children Cancer Hospital, Egypt
| | - Emad Moussa
- Department of Medical Oncology, Menoufiah University and Children Cancer Hospital, Egypt
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Wei WX, Huang JJ, Li WY, Zhang X, Xia Y, Jiang WQ, Fan W, Li ZM. Prognostic values of interim and post-therapy 18F-FDG PET/CT scanning in adult patients with Burkitt's lymphoma. CHINESE JOURNAL OF CANCER 2015; 34:608-13. [PMID: 26630874 PMCID: PMC4668634 DOI: 10.1186/s40880-015-0057-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/27/2015] [Indexed: 12/16/2022]
Abstract
Background The prognostic values of interim and post-therapy fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and PET/computed tomography (CT) scanning have been confirmed in several subtypes of lymphoma. However, its prognostic value in Burkitt’s lymphoma has not been clearly defined. The aim of the present study was to assess the prognostic value of PET/CT scanning during different treatment processes of Burkitt’s lymphoma. Methods A total of 29 adult patients with newly diagnosed Burkitt’s lymphoma were retrospectively involved in this study; of them, 23 patients underwent baseline PET/CT, 15 patients underwent mid-therapy PET/CT after 1–4 cycles of chemotherapy, and 17 patients underwent post-therapy PET/CT after all planned first-line chemotherapy cycles. Mid-therapy and post-therapy PET/CT results (positive vs. negative) were visually interpreted according to the criteria of the International Harmonization Project. The reduction in the maximum standardizes uptake values (∆SUVmax) of 25%, 50%, and 75% were regarded as cutoff points. Overall survival (OS) and progression-free survival (PFS) were regarded as the major endpoints. Results The median OS and PFS were 27.6 months (range 6.5–78.3 months) and 27.2 months (range 3.0–78.3 months), respectively. The median SUVmax of the baseline PET/CT was 18.3 (range 1.6–35.9), whereas the median SUVmax of the mid-therapy and post-therapy PET/CT decreased to 4.0 (range 0–17.6) and 3.0 (range 0–14.5), respectively. The patients’ Eastern Cooperative Oncology Group (ECOG) scores (<2 vs. ≥2) were significantly associated with the baseline PET/CT SUVmax. The mid-therapy and post-therapy PET/CT results (positive vs. negative) showed no significant association with OS or PFS. The optimal cutoff ∆SUVmax from the baseline to the post-therapy PET/CT that could predict a change in OS in patients with Burkitt’s lymphoma was 50% (P = 0.019). Conclusions 18F-FDG uptake was intense in Burkitt’s lymphoma, and there was a significant reduction in SUVmax during the interim and post-therapy PET/CT procedures. A ∆SUVmax of greater than 50% was a favorable cutoff point to predict the OS of Burkitt’s lymphoma patients.
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Affiliation(s)
- Wen-Xiao Wei
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
| | - Jia-Jia Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
| | - Wen-Yu Li
- Lymphoma Division, Cancer Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, P.R. China.
| | - Xu Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
| | - Yi Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
| | - Wen-Qi Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
| | - Wei Fan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
| | - Zhi-Ming Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
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Lewis RB, Mehrotra AK, Rodríguez P, Manning MA, Levine MS. From the radiologic pathology archives: gastrointestinal lymphoma: radiologic and pathologic findings. Radiographics 2015; 34:1934-53. [PMID: 25384294 DOI: 10.1148/rg.347140148] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Gastrointestinal (GI) lymphoma encompasses a heterogeneous group of neoplasms that have a common lymphoid origin but variable pathologic and imaging features. Extranodal marginal zone B-cell lymphoma (ENMZL) and diffuse large B-cell lymphoma (DLBCL) are the most common. ENMZL usually occurs in the stomach, where it is associated with chronic infection by Helicobacter pylori, and is typically a superficial spreading lesion that causes mucosal nodularity or ulceration and mild wall thickening. DLBCL may arise de novo or from transformation of ENMZL or other low-grade lymphomas. This form of lymphoma produces extensive wall thickening or a bulky mass, but obstruction is uncommon. Mantle cell lymphoma is the classic cause of lymphomatous polyposis, but multiple polyps or nodules can also be seen with ENMZL and follicular lymphoma. Burkitt lymphoma is usually characterized by an ileocecal mass or wall thickening in the terminal ileum in young children, often in the setting of widespread disease. Primary GI Hodgkin lymphoma, which is rare, may be manifested by a variety of findings, though stenosis is more common than with non-Hodgkin lymphoma. Enteropathy-associated T-cell lymphoma is frequently associated with celiac disease and is characterized by wall thickening, ulceration, and even perforation of the jejunum. Accurate radiologic diagnosis of GI lymphoma requires a multifactorial approach based on the clinical findings, site of involvement, imaging findings, and associated complications.
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Affiliation(s)
- Rachel B Lewis
- From the American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910 (R.B.L., M.A.M.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (R.B.L.); the Joint Pathology Center, Silver Spring, Md (A.K.M.); Department of Radiology, La Princesa University Hospital, Madrid, Spain (P.R.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (M.A.M.); and Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
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Carrillo-Cruz E, Marín-Oyaga VA, Solé Rodríguez M, Borrego-Dorado I, de la Cruz Vicente F, Quiroga Cantero E, Manzanares Pérez M, Capote FJ, Ramírez Sánchez MJ, Espigado Tocino I, Pérez-Vega H, Vázquez-Albertino R, Pérez-Simón JA. Role of 18F-FDG-PET/CT in the management of Burkitt lymphoma. Eur J Haematol 2015; 94:23-30. [PMID: 24520874 DOI: 10.1111/ejh.12284] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED Burkitt lymphoma (BL) is highly FDG-avid even though its usefulness in the management of these patients is still controversial. AIM We analyzed the role of positron emission tomography/computerized tomography (PET/CT) in staging newly diagnosed patients with BL and evaluating disease after first-line chemotherapy. METHODS Fifty-two PET/CTs were performed in 32 patients (20 at diagnosis, 27 after treatment, five to monitor residual disease). Involved areas were retrospectively compared with those observed in contrast-enhanced CT. RESULTS Discrepancies were found in 64.7% of patients for whom results of both tests at diagnosis were available (n = 17), most of them involving extranodal sites. Regarding response assessment, discrepancies were observed in 38% of patients with both tests (5/13): residual masses detected by CT with negative PET/CT. Of 27 patients with post-treatment PET/CT, 22 were in complete remission whereas one true-positive and four false-positive lesions (two nodal and two extranodal) were detected. With a median follow-up of 27 months, 22 patients with negative PET/CT did not relapse. Thus, negative predictive value (NPV) was 100%. With respect to positive predictive value (PPV), one of five patients with positive assays after treatment died due to progression while the remaining four had false-positive lesions. Nevertheless, for these four patients, mean SUVmax at nodal sites was 4.1 vs. 14.9 at diagnosis, while mean SUVmax at extranodal sites was 3.8 vs. 12.1. Thus, with a cutoff value for SUVmax < 66% of that observed at diagnosis, PPV was also 100%. CONCLUSION More accurate staging can be achieved using PET/CT. NPV reaches 100%, and using a ΔSUV < 66%, a high PPV is also observed.
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Affiliation(s)
- Estrella Carrillo-Cruz
- Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
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Current status of FDG-PET/CT in the treatment setting of Hodgkin’s lymphoma in childhood and adolescence. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0126-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chung EM, Biko DM, Arzamendi AM, Meldrum JT, Stocker JT. Solid Tumors of the Peritoneum, Omentum, and Mesentery in Children: Radiologic-Pathologic Correlation:From the Radiologic Pathology Archives. Radiographics 2015; 35:521-46. [DOI: 10.1148/rg.352140273] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Bailly C, Eugène T, Couec ML, Strullu M, Frampas E, Campion L, Kraeber-Bodéré F, Bodet-Milin C. Prognostic Value and Clinical Impact of (18)FDG-PET in the Management of Children with Burkitt Lymphoma after Induction Chemotherapy. Front Med (Lausanne) 2014; 1:54. [PMID: 25593926 PMCID: PMC4292173 DOI: 10.3389/fmed.2014.00054] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/02/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Burkitt lymphoma (BL) is a rare and aggressive form of B-cell lymphoma that is curable using intensive chemotherapy. Obtaining a complete response (CR) at the end of induction chemotherapy is a major prognostic factor. This study retrospectively evaluates the potential impact of (18)FDG-PET in the management of children with BL after induction chemotherapy, and the prognostic performance of the Deauville criteria. METHODS Nineteen children with BL treated according to the French LMB2001 protocol between 2005 and 2012 were included. (18)FDG-PET and conventional imaging (CI) were performed after induction chemotherapy to confirm CR. (18)FDG-PET was interpreted according to Deauville criteria with follow-up and/or histology as the gold standard. RESULTS (18)FDG-PET was negative in 15 cases, in agreement with CI in 9/15 cases. The six discordant cases confirmed to be negative by histology, were considered as true negative for (18)FDG-PET. Negative predictive value (NPV) of CI and (18)FDG-PET were 73 and 93%, respectively. The 5-year progression-free survival (PFS) was significantly higher in patients with negative (18)FDG-PET than those with positive (18)FDG-PET (p = 0.011). CONCLUSION (18)FDG-PET interpreted using Deauville criteria can help confirm CR at the end of induction chemotherapy, with a prognostic impact on 5-year PFS. Its high NPV could limit the use of residual mass biopsy. Given the small size of our population, these results need to be confirmed by future prospective studies on a larger population.
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Affiliation(s)
- Clément Bailly
- Department of Nuclear Medicine, University Hospital , Nantes , France
| | - Thomas Eugène
- Department of Nuclear Medicine, University Hospital , Nantes , France
| | - Marie-Laure Couec
- Department of Pediatric Oncology, University Hospital , Nantes , France
| | - Marion Strullu
- Department of Pediatric Oncology, University Hospital , Nantes , France
| | - Eric Frampas
- Department of Radiology, University Hospital , Nantes , France ; U892, CNRS UMR 6299, CRCNA, INSERM , Nantes , France
| | - Loïc Campion
- U892, CNRS UMR 6299, CRCNA, INSERM , Nantes , France ; Department of Biometrics, Cancer Center ICO René Gauducheau , Nantes , France
| | - Françoise Kraeber-Bodéré
- Department of Nuclear Medicine, University Hospital , Nantes , France ; U892, CNRS UMR 6299, CRCNA, INSERM , Nantes , France
| | - Caroline Bodet-Milin
- Department of Nuclear Medicine, University Hospital , Nantes , France ; U892, CNRS UMR 6299, CRCNA, INSERM , Nantes , France
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Abstract
The aim of this review is to give an overview of FDG PET/CT applications in children and adolescents with lymphoma. Today, FDG PET is used for tailoring treatment intensity in children with Hodgkin lymphoma within the framework of international treatment optimisation protocols. In contrast, the role of this method in children with Non-Hodgkin lymphoma is not well defined. This paper overviews clinical appearance and metabolic behaviour of the most frequent lymphoma subtypes in childhood. The main focus of the review is to summarise knowledge about the role of FDG PET/CT for initial staging and early response assessment.
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Abstract
Adult Burkitt lymphoma (BL) is an aggressive disease characterized by frequent extranodal presentation, bulky disease and a rapid clinical course. Although intensive chemotherapeutic regimes result in long-term disease-free survival in most patients, a significant proportion of patients will have high-risk disease that may be refractory or that will relapse. In these patients, the role of hematopoietic SCT is not well defined, especially in the era of modern chemoimmunotherapy. Upfront auto-SCT has been reported to be feasible in patients who have high-risk features at presentation, and in whom it is a clinical option. In patients with relapsed disease, auto-SCT can result in a PFS of 30-40%. Allo-SCT is an option in relapsing patients with a sibling or matched related donor who may not be eligible for, or may have previously received, an auto-SCT; the role of RIC and T-cell depletion is not well defined. Disease status at transplant is the most significant predictor of outcome in patients undergoing SCT. Here we review the available evidence pertaining to SCT in patients with BL, including in those who are HIV positive (HIV+) and those with B-cell lymphoma unclassified (BCLU). Prospective studies in the era of modern intensive chemoimmunotherapeutic regimes are required to delineate the precise role of transplantation for BL. Developments in molecular diagnostics, incorporation of FDG-PET and minimal residual disease monitoring along with new therapies may further assist in refining treatment algorithms.
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Affiliation(s)
- David C Linch
- Department of Haematology, Cancer Institute, University College London, 72 Huntley Street, London, UK.
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Mohamedbhai SG, Sibson K, Marafioti T, Kayani I, Lowry L, Goldstone AH, Linch DC, Ardeshna KM. Rituximab in combination with CODOX-M/IVAC: a retrospective analysis of 23 cases of non-HIV related B-cell non-Hodgkin lymphoma with proliferation index >95%. Br J Haematol 2010; 152:175-81. [DOI: 10.1111/j.1365-2141.2010.08447.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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