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Gaylord WC, Trout AT, Audino AN, Belsky JA. An International Survey Investigating the Incidence and Management of Brown Fat Uptake on 18F-FDG PET/CT at Children's Hospitals and Interventions for Mitigation. J Nucl Med Technol 2024; 52:115-120. [PMID: 38839114 DOI: 10.2967/jnmt.123.266536] [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: 08/15/2023] [Revised: 11/02/2023] [Indexed: 06/07/2024] Open
Abstract
Brown fat can present challenges in patients with cancer who undergo 18F-FDG PET scans. Uptake of 18F-FDG by brown fat can obscure or appear similar to active oncologic lesions, causing clinical challenges in PET interpretation. Small, retrospective studies have reported environmental and pharmacologic interventions for suppressing brown fat uptake on PET; however, there is no clear consensus on best practices. We sought to characterize practice patterns for strategies to mitigate brown fat uptake of 18F-FDG during PET scanning. Methods: A survey was developed and distributed via e-mail LISTSERV to members of the Children's Oncology Group diagnostic imaging committee, the Society for Nuclear Medicine and Molecular Imaging pediatric imaging council, and the Society of Chiefs of Radiology at Children's Hospitals between April 2022 and February 2023. Responses were stored anonymously in REDCap, aggregated, and summarized using descriptive statistics. Results: Fifty-five complete responses were submitted: 51 (93%) faculty and fellow-level physicians, 2 (4%) technologists, and 2 (4%) respondents not reporting their rank. There were 43 unique institutions represented, including 5 (12%) outside the United States. Thirty-eight of 41 (93%) institutions that responded on environmental interventions reported using warm blankets in the infusion and scanning rooms. Less than a third (n = 13, 30%) of institutions reported use of a pharmacologic intervention, with propranolol (n = 5, 38%) being most common, followed by fentanyl (n = 4, 31%), diazepam (n = 2, 15%), and diazepam plus propranolol (n = 2, 15%). Selection criteria for pharmacologic intervention varied, with the most common criterion being brown fat uptake on a prior scan (n = 6, 45%). Conclusion: Clinical practices to mitigate brown fat uptake on pediatric 18F-FDG PET vary widely. Simple environmental interventions including warm blankets or increasing the temperature of the injection and scanning rooms were not universally reported. Less than a third of institutions use pharmacologic agents for brown fat mitigation.
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Affiliation(s)
- William C Gaylord
- Department of Pediatrics, University of Tennessee Health Science Center-Chattanooga, Chattanooga, Tennessee;
- Section of Pediatric Hematology/Oncology, Children's Hospital at Erlanger, Chattanooga, Tennessee
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Anthony N Audino
- Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | - Jennifer A Belsky
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and
- Section of Pediatric Hematology/Oncology, Riley Hospital for Children, Indianapolis, Indiana
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Biasoli I, Castro N, Colaço Villarim C, Traina F, Chiattone CS, Praxedes M, Solza C, Perobelli L, Baiocchi O, Gaiolla R, Boquimpani C, Buccheri V, Bonamin Sola C, de Oliveira de Paula e Silva R, Ribas AC, Steffenello G, Pagnano K, Soares A, de Souza C, Spector N. Treatment outcomes in classic Hodgkin lymphoma: 5-year update from the Brazilian Hodgkin Lymphoma Registry. EJHAEM 2023; 4:1191-1195. [PMID: 38024602 PMCID: PMC10660107 DOI: 10.1002/jha2.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Irene Biasoli
- School of MedicineUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
| | - Nelson Castro
- Hospital de Cancer de BarretosBarretosSão PauloBrazil
| | | | - Fabiola Traina
- Department of Medical ImagingHaematology, and OncologyRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoSão PauloBrazil
| | | | | | - Cristiana Solza
- Universidade do Estado do Rio de JaneiroRio de JaneiroBrazil
| | | | | | | | | | - Valeria Buccheri
- Instituto do Cancer do Estado de São Paulo/Hospital das Clinicas ‐ Faculdade de Medicina da Universidade de São PauloSão PauloBrazil
| | | | | | | | | | - Katia Pagnano
- Hematology and Hemotherapy CenterUniversity of CampinasSao PauloBrazil
| | - Andrea Soares
- Universidade do Estado do Rio de JaneiroRio de JaneiroBrazil
| | - Carmino de Souza
- Hematology and Hemotherapy CenterUniversity of CampinasSao PauloBrazil
| | - Nelson Spector
- School of MedicineUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
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Refractory DLBCL: Challenges and Treatment. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:140-148. [PMID: 34666950 DOI: 10.1016/j.clml.2021.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/09/2021] [Accepted: 09/16/2021] [Indexed: 01/22/2023]
Abstract
Despite a greater understanding of pathologic factors that increase the chance for treatment failure, initial therapy of diffuse large B cell lymphoma (DLBCL) has not evolved from R/CHOP. Although it was anticipated that the genetic underpinnings of the cell or origin would dramatically change treatment, thus far, this has not been realized. Similarly, contrary to the situation with Hodgkin lymphoma, meaningful early treatment response assessment with PET-CT has yet to be established in DLBCL. Nevertheless, there is tremendous enthusiasm that circulating tumor DNA, possibly in combination with PET- T may facilitate earlier recognition of treatment failure or relapse. And, in contrast to the situation with front-line treatment, therapy for recurrent disease appears to be on the cusp of dramatically improving. Thus, in addition to high dose therapy with autologous transplant, a treatment that is not feasible for many older patients, CAR-T cells, bispecific T-cell engagers (BiTEs), antibody-drug conjugates and new monoclonal antibodies are all offering the possibility of long-term disease control and possible cure. The success of the cell and immunotherapies even offer hope for a chemotherapy-free strategy, initially for recurrent disease. Herein, we review the landscape of the novel agents in resistant DLBCL and speculate about their appropriate sequencing and possible migration to earlier use.
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Lockney NA, Yang JC. Radiation Therapy for Advanced-Stage Hodgkin Lymphoma. Adv Radiat Oncol 2020; 5:809-816. [PMID: 33083642 PMCID: PMC7557128 DOI: 10.1016/j.adro.2020.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/27/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022] Open
Abstract
The backbone of treatment for patients with advanced-stage Hodgkin lymphoma is systemic therapy. The use of radiation therapy as a component of combined-modality treatment in this setting is controversial. In this review, we describe the data in support of and against the use of radiation therapy for stage III and IV Hodgkin lymphoma. Specifically, we review the data for the use of radiation therapy in the consolidation and partial-response settings, including for patients with initial bulky disease. We also discuss the use of radiation therapy in the era of more modern systemic therapies, including checkpoint inhibitors and brentuximab vedotin.
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Affiliation(s)
- Natalie A Lockney
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Joanna C Yang
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
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Zhao M, Zhang W. Early detection value of 18F-FDG-PET/CT for drug-induced lung injury in lymphoma. Ann Hematol 2018; 98:909-914. [PMID: 30460376 DOI: 10.1007/s00277-018-3558-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Meixin Zhao
- Department of Nuclear Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Weifang Zhang
- Department of Nuclear Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
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Routine blood investigations have limited utility in surveillance of aggressive lymphoma in asymptomatic patients in complete remission. Br J Cancer 2018; 119:546-550. [PMID: 30033446 PMCID: PMC6162229 DOI: 10.1038/s41416-018-0183-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/03/2018] [Accepted: 06/25/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Patients with aggressive lymphoma achieving complete remission (CR) after first-line combination chemotherapy undergo regular surveillance to detect relapse. Current international guidelines recommend routine follow-up blood tests in this context, but evidence supporting this practice is limited. METHODS We conducted a multi-centre retrospective analysis of all patients diagnosed with aggressive lymphoma treated with curative-intent chemotherapy who achieved CR for at least 3 months between 2000 and 2015. An abnormal blood test was defined as any new and unexplained abnormality for full blood examination, lactate dehydrogenase or erythrocyte sedimentation rate. RESULTS Three hundred and forty-six patients attended a total of 3084 outpatient visits; blood tests were performed at 90% of these appointments. Fifty-six (16%) patients relapsed. Routine laboratory testing detected relapse in only three patients (5% of relapses); in the remaining patients, relapse was suspected clinically (80%) or detected by imaging (15%). The sensitivity of all blood tests was 42% and the positive predictive value was 9%. No significant difference in survival was shown in patients who underwent a routine blood test within 3 months prior to relapse versus those who did not (p = 0.88). CONCLUSIONS Routine blood tests demonstrate unacceptably poor performance characteristics, have no impact on survival and thus have limited value in the detection of relapse in routine surveillance.
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Adams HJA, Kwee TC. An evidence-based review on the value of interim FDG-PET in assessing response to therapy in lymphoma. Semin Oncol 2018; 44:404-419. [PMID: 29935902 DOI: 10.1053/j.seminoncol.2018.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/11/2018] [Accepted: 01/21/2018] [Indexed: 11/11/2022]
Abstract
Assessing response to therapy in lymphoma is important for determining patients' prognosis, guiding subsequent treatment, and may be used as an outcome measure of prognostic and therapeutic trials. Traditionally, computed tomography was the mainstay for response assessment and was predominantly performed at the end of treatment, whereas the most recent guidelines propose 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) for this purpose. However, the value of FDG-PET performed during treatment (interim FDG-PET) is still a topic of debate. The purpose of this scientific communication is to provide an evidence-based overview of the value of interim FDG-PET in patients with lymphoma. The article first describes the development of imaging-based response assessment in lymphoma, the rationale and limitations of using FDG-PET for this purpose, and continues with the evidence-based clinical utility of interim FDG-PET in three major lymphoma subtypes (Hodgkin lymphoma, diffuse large B-cell lymphoma, and follicular lymphoma), and finishes with conclusions and recommendations for standard care and future research.
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Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, Deventer Ziekenhuis, Deventer, The Netherlands.
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Mikkilineni L, Whitaker-Menezes D, Domingo-Vidal M, Sprandio J, Avena P, Cotzia P, Dulau-Florea A, Gong J, Uppal G, Zhan T, Leiby B, Lin Z, Pro B, Sotgia F, Lisanti MP, Martinez-Outschoorn U. Hodgkin lymphoma: A complex metabolic ecosystem with glycolytic reprogramming of the tumor microenvironment. Semin Oncol 2017; 44:218-225. [PMID: 29248133 PMCID: PMC5737784 DOI: 10.1053/j.seminoncol.2017.10.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Twenty percent of patients with classical Hodgkin Lymphoma (cHL) have aggressive disease defined as relapsed or refractory disease to initial therapy. At present we cannot identify these patients pre-treatment. The microenvironment is very important in cHL because non-cancer cells constitute the majority of the cells in these tumors. Non-cancer intra-tumoral cells, such as tumor-associated macrophages (TAMs) have been shown to promote tumor growth in cHL via crosstalk with the cancer cells. Metabolic heterogeneity is defined as high mitochondrial metabolism in some tumor cells and glycolysis in others. We hypothesized that there are metabolic differences between cancer cells and non-cancer tumor cells, such as TAMs and tumor-infiltrating lymphocytes in cHL and that greater metabolic differences between cancer cells and TAMs are associated with poor outcomes. METHODS A case-control study was conducted with 22 tissue samples of cHL at diagnosis from a single institution. The case samples were from 11 patients with aggressive cHL who had relapsed after standard treatment with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) or were refractory to this treatment. The control samples were from 11 patients with cHL who achieved a remission and never relapsed after ABVD. Reactive non-cancerous lymph nodes from four subjects served as additional controls. Samples were stained by immunohistochemistry for three metabolic markers: translocase of the outer mitochondrial membrane 20 (TOMM20), monocarboxylate transporter 1 (MCT1), and monocarboxylate transporter 4 (MCT4). TOMM20 is a marker of mitochondrial oxidative phosphorylation (OXPHOS) metabolism. Monocarboxylate transporter 1 (MCT1) is the main importer of lactate into cells and is a marker of OXPHOS. Monocarboxylate transporter 4 (MCT4) is the main lactate exporter out of cells and is a marker of glycolysis. The immunoreactivity for TOMM20, MCT1, and MCT4 was scored based on staining intensity and percentage of positive cells, as follows: 0 for no detectable staining in > 50% of cells; 1+ for faint to moderate staining in > 50% of cells, and 2+ for high or strong staining in > 50% of cells. RESULTS TOMM20, MCT1, and MCT4 expression was significantly different in Hodgkin and Reed Sternberg (HRS) cells, which are the cancerous cells in cHL compared with TAMs and tumor-associated lymphocytes. HRS have high expression of TOMM20 and MCT1, while TAMs have absent expression of TOMM20 and MCT1 in all but two cases. Tumor-infiltrating lymphocytes have low TOMM20 expression and absent MCT1 expression. Conversely, high MCT4 expression was found in TAMs, but absent in HRS cells in all but one case. Tumor-infiltrating lymphocytes had absent MCT4 expression. Reactive lymph nodes in contrast to cHL tumors had low TOMM20, MCT1, and MCT4 expression in lymphocytes and macrophages. High TOMM20 and MCT1 expression in cancer cells with high MCT4 expression in TAMs is a signature of high metabolic heterogeneity between cancer cells and the tumor microenvironment. A high metabolic heterogeneity signature was associated with relapsed or refractory cHL with a hazard ratio of 5.87 (1.16-29.71; two-sided P < .05) compared with the low metabolic heterogeneity signature. CONCLUSION Aggressive cHL exhibits features of metabolic heterogeneity with high mitochondrial metabolism in cancer cells and high glycolysis in TAMs, which is not seen in reactive lymph nodes. Future studies will need to confirm the value of these markers as prognostic and predictive biomarkers in clinical practice. Treatment intensity may be tailored in the future to the metabolic profile of the tumor microenvironment and drugs that target metabolic heterogeneity may be valuable in this disease.
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Affiliation(s)
- Lekha Mikkilineni
- Department of Medical Oncology, National Cancer Institute, Bethesda, MD
| | | | | | - John Sprandio
- Department of Medical Oncology, Chester County Memorial Hospital, West Chester, PA
| | - Paola Avena
- Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, Calabria, Italy
| | - Paolo Cotzia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jerald Gong
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Guldeep Uppal
- Department of Pathology, Thomas Jefferson University, Philadelphia, PA
| | - Tingting Zhan
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - Benjamin Leiby
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - Zhao Lin
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Barbara Pro
- Division of Medical Oncology, Northwestern University, Evanston, IL
| | - Federica Sotgia
- School of Environment and Life Sciences, University of Salford, Salford, UK
| | - Michael P Lisanti
- School of Environment and Life Sciences, University of Salford, Salford, UK
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Kaste SC, Metzger M, Shulkin BL. Reply: The Need for Prudence When Using 18F-FDG PET as a Reference Standard for Lymphoma Detection. J Nucl Med 2017; 58:1355. [PMID: 28450559 DOI: 10.2967/jnumed.117.190652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sue C Kaste
- St. Jude Children's Research Hospital 262 Danny Thomas Place, Mail Stop 220 Memphis, Tennessee 38105 E-mail:
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Adams HJA, Kwee TC. Reply: Interim PET in Hodgkin Lymphoma: Is It So Useless? J Nucl Med 2017; 58:1180-1182. [PMID: 28280222 DOI: 10.2967/jnumed.117.192294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Hugo J A Adams
- Deventer Ziekenhuis Nico Bolkesteinlaan 75 7416 SE Deventer, The Netherlands E-mail:
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