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Karpurmath SV, Rathnam K, Seshachalam A, Srinivasan A, Scott J, G. RS, Janarthinakani M, Prasad K, Patil C, Anoop P, Reddy N, Anumula SK, Roopa SP, Golamari KR, Danthala M, Malipatil B, Rangarajan B, Udupa KS, Nandennavar M, Niraimathi K. Role of Interim PET Scan after 2 Cycles of ABVD in Pediatric Hodgkin Lymphoma: Retrospective Multicenter Study from South India. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1730240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Introduction Most Indian centers use Adriamycin/Bleomycin/Vinblastine/Dacarba-zine (ABVD) chemotherapy for pediatric Hodgkin lymphoma (pHL). To reduce the late toxicity, robust predictive markers are needed to risk stratify pHL patients, thereby limiting the number of chemotherapy cycles and omitting radiation for low-risk and intensifying treatment for high-risk children.
Objective This study was conducted to analyze the outcome of pHL patients treated with ABVD and various factors predicting the outcome.
Materials and Methods This retrospective study analyzed the outcome of 113 consecutive pHL children treated with ABVD chemotherapy from 11 tertiary care centers in South India from 2009 to 2019.
Results The median duration of follow-up was 2.73 years. The median age was 13 years. B symptoms are seen in 50.5% patients, bulky disease in 23%, and stage IV in 28.3%. Of 113 pHL, 69% had a positron emission tomography (PET) and 31% had computed tomography (CT)-based staging. Stage IV (37.1%) and extranodal involvement (31.2%) were seen more often with PET than with CT staging (8.5 and 2.8%, respectively). Among 64 patients with interim PET scan after two cycles (iPET2), 20.3% did not achieve complete remission (CR) and no factors were significantly associated. The 4-year event-free survival (EFS) rate of the entire cohort was 86%. The 4-year EFS rate was 93% for patients with CR in iPET2 and 52% for patients not achieving CR. The only independent predictor of low EFS was iPET2 response (p < 0.05).
Conclusion Our study confirms the prognostic role of PET scan staging and response assessment. Not achieving CR on the iPET2 scan indicates poor prognosis and warrants clinical trial enrollment for a better outcome.
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Affiliation(s)
| | | | | | - Arathi Srinivasan
- Kanchi Kamakoti CHILDS Trust Hospital, Nungambakkam, Chennai, Tamil Nadu, India
| | - Julius Scott
- Sri Ramachandra Medical Center, Porur, Chennai, Tamil Nadu, India
| | - Raman S. G.
- Madras Cancer Care Foundation, Chennai, Tamil Nadu, India
| | | | - Krishna Prasad
- Mangalore Institute of Oncology, Mangaluru, Karnataka, India
| | | | | | | | | | | | | | | | | | | | | | - Manjunath Nandennavar
- Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
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2
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Ragheb SR, Louka AL, Sharara SM. Lugano classification: response evaluation criteria for positron emission tomography/computed tomography in lymphoma follow-up. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The purpose of this study is to assess the role of 18 fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET-CT) in the follow-up of patients with lymphoma after finishing therapy.
Results
This study included 42 lymphomas (25 non-Hodgkin’s lymphoma and 17 Hodgkin’s lymphoma); patients ranging in age from 18 to 70 years were examined by 18FDG PET-CT after therapy and analyzed retrospectively. Confirmatory biopsy was mandatory in cases of suspected disease recurrence and follow-up in cases of complete metabolic response. Positron emission tomography/computed tomography in assessment of lymphoma treatment response reveals significant statistical significance (P < 0.05). It shows 100% sensitivity, 92.8% specificity, and 95.2% accuracy in the prediction of response.
Conclusion
Positron emission tomography/computed tomography plays an important role in detection of response to treatment of lymphoma after finishing therapy.
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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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Malato A, Rossi E, Palumbo GA, Guglielmelli P, Pugliese N. Drug-Related Cutaneous Adverse Events in Philadelphia Chromosome-Negative Myeloproliferative Neoplasms: A Literature Review. Int J Mol Sci 2020; 21:ijms21113900. [PMID: 32486130 PMCID: PMC7312244 DOI: 10.3390/ijms21113900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023] Open
Abstract
Since myeloproliferative neoplasms (MPN) pose a significant risk for vascular and thrombotic complications, cytoreductive therapies, such as hydroxyurea (HU), interferon (IFN) inhibitors, and Janus kinase (JAK) inhibitors are recommended for patients at high risk. However, these agents also place patients at increased risk for drug-related cutaneous adverse events. Herein, we review the literature on skin toxicity related to the use of drugs for the treatment of MPN. Overall, the cytoreductive agents used for MPN are generally well tolerated and considered to be safe, except IFN, for which dropout rates as high as 25% have been reported. While IFN is known to give rise to flu syndrome, it rarely leads to hematological alterations. The most common hematological side effects of HU are mild and include granulocytopenia, anemia, and thrombocytopenia. The JAK inhibitor ruxolitinib has been associated with cytopenia and a higher incidence of viral infections, as well as increased risk for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Based on the present analysis, it can be concluded that cutaneous toxicity is not a negligible complication of commonly used treatments for MPN. While further research is needed, patients on these agents, and especially those with a history of cutaneous malignancies, should undergo thorough skin examination before and during therapy. In addition, detailed history is critical since many patients who develop non-melanoma skin cancer have multiple preexisting risk factors for cutaneous carcinogenesis.
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Affiliation(s)
- Alessandra Malato
- UOC di Ematologia I ad Indirizzo Oncologico, Ospedali Riuniti Villa Sofia-Cervello, 90146 Palermo, Italy
| | - Elena Rossi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli IRCCS, 00168 Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Alberto Palumbo
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, 95123 Catania, Italy
| | - Paola Guglielmelli
- CRIMM-Centro Ricerca e Innovazione delle Malattie Mieloproliferative, Department of Experimental and Clinical Medicine, Azienda ospedaliera-Universitaria Careggi, University of Florence, 50139 Florence, Italy
| | - Novella Pugliese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
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5
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Karls S, Shah H, Jacene H. PET/CT for Lymphoma Post-therapy Response Assessment in Other Lymphomas, Response Assessment for Autologous Stem Cell Transplant, and Lymphoma Follow-up. Semin Nucl Med 2018; 48:37-49. [DOI: 10.1053/j.semnuclmed.2017.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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6
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Wareham NE, Lundgren JD, Da Cunha-Bang C, Gustafsson F, Iversen M, Johannesen HH, Kjær A, Rasmussen A, Sengeløv H, Sørensen SS, Fischer BM. The clinical utility of FDG PET/CT among solid organ transplant recipients suspected of malignancy or infection. Eur J Nucl Med Mol Imaging 2017; 44:421-431. [PMID: 27838763 PMCID: PMC5281676 DOI: 10.1007/s00259-016-3564-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/28/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE Solid organ transplant (SOT) recipients are at high risk of developing infections and malignancies. 18F-FDG PET/CT may enable timely detection of these diseases and help to ensure early intervention. We aimed to describe the clinical utility of FDG PET/CT in consecutive, diagnostic unresolved SOT recipients transplanted from January 2004 to May 2015. METHODS Recipients with a post-transplant FDG PET/CT performed as part of diagnostic work-up were included. Detailed chart reviews were done to extract relevant clinical information and determine the final diagnosis related to the FDG PET/CT. Based on á priori defined criteria and the final diagnosis, results from each scan were classified as true or false, and diagnostic values determined. RESULTS Among the 1,814 recipients in the cohort, 145 had an FDG PET/CT performed; 122 under the indication of diagnostically unresolved symptoms with a suspicion of malignancy or infection. The remaining (N = 23) had an FDG PET/CT to follow-up on a known disease or to stage a known malignancy. The 122 recipients underwent a total of 133 FDG PET/CT scans performed for a suspected malignancy (66 %) or an infection (34 %). Sensitivity, specificity, and positive and negative predictive values of the FDG PET/CT in diagnosing these conditions were 97, 84, 87, and 96 %, respectively. CONCLUSION FDG PET/CT is an accurate diagnostic tool for the work-up of diagnostic unresolved SOT recipients suspected of malignancy or infection. The high sensitivity and NPV underlines the potential usefulness of PET/CT for excluding malignancy or focal infections in this often complex clinical situation.
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Affiliation(s)
- Neval E Wareham
- Centre for Health and Infectious Disease Research (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - J D Lundgren
- Centre for Health and Infectious Disease Research (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - C Da Cunha-Bang
- Department of Haematology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - F Gustafsson
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - M Iversen
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - H H Johannesen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - A Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - A Rasmussen
- Department of Surgical Gastroenterology, Rigshospitalet, Blegdamsvek 9, 2100 Copenhagen Ø, Denmark
| | - H Sengeløv
- Department of Haematology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - S S Sørensen
- Department of Nephrology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - B M Fischer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
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7
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Ferrari C, Niccoli Asabella A, Merenda N, Altini C, Fanelli M, Muggeo P, De Leonardis F, Perillo T, Santoro N, Rubini G. Pediatric Hodgkin Lymphoma: Predictive value of interim 18F-FDG PET/CT in therapy response assessment. Medicine (Baltimore) 2017; 96:e5973. [PMID: 28151888 PMCID: PMC5293451 DOI: 10.1097/md.0000000000005973] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We investigated the prognostic value of interim F-FDG PET/CT (PET-2) in pediatric Hodgkin lymphoma (pHL), evaluating both visual and semiquantitative analysis.Thirty pHL patients (age ≤16) underwent serial F-FDG PET/CT: at baseline (PET-0), after 2 cycles of chemotherapy (PET-2) and at the end of first-line chemotherapy (PET-T). PET response assessment was carried out visually according to the Deauville Score (DS), as well as semiquantitatively by using the semiquantitative parameters reduction from PET-0 to PET-2 (ΔΣSUVmax0-2, ΔΣSUVmean0-2). Final clinical response assessment (outcome) at the end of first-line chemotherapy was the criterion standard, considering patients as responders (R) or nonresponders (NR). Disease status was followed identifying patients with absence or relapsed/progression disease (mean follow-up: 24 months, range 3-78).Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of visual and semiquantitative assessment were calculated; furthermore, Fisher exact test was performed to evaluate the association between both visual and semiquantitative assessment and outcome at the end of the first-line chemotherapy. The prognostic capability of PET-2 semiquantitative parameters was calculated by ROC analysis and expressed as area under curve (AUC). Finally, progression-free survival (PFS) was analyzed according to PET-2 results based on the 5-point scale and semiquantitative criteria, using the Kaplan-Meier method.Based on the outcome at the end of first-line chemotherapy, 5 of 30 patients were NR, the remnant 25 of 30 were R. Sensitivity, specificity, PPV, NPV, and accuracy of visual analysis were 60%,72%,30%,90%,70%; conversely, sensitivity, specificity, PPV, NPV, and accuracy of semiquantitative assessment were 80%, 92%, 66.7%, 95.8%, 90%. The highest AUC resulted for ΔΣSUVmax0-2 (0.836; cut-off <12.5; sensitivity 80%; specificity 91%). The association between ΔΣSUVmax0-2 and outcome at the end of first-line chemotherapy resulted to have a strong statistical significance (P = 0.0026). Both methods demonstrated to influence PFS, even if the semiquantitative assessment allowed a more accurate identification of patients with a high risk of treatment failure (P = 0.005).Our preliminary results showed that PET-2 visual assessment, by using Deauville criteria, can be improved by using the semiquantitative analysis. The SUV max reduction (ΔΣSUVmax0-2) evaluation might provide a support for the interpretation of intermediate scores, predicting with good confidence those patients who will have a poor outcome and require alternative therapies.
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Affiliation(s)
| | | | | | | | | | - Paola Muggeo
- Department of Pediatric Hematology and Oncology, University of Bari “Aldo Moro”, Bari, Italy
| | - Francesco De Leonardis
- Department of Pediatric Hematology and Oncology, University of Bari “Aldo Moro”, Bari, Italy
| | - Teresa Perillo
- Department of Pediatric Hematology and Oncology, University of Bari “Aldo Moro”, Bari, Italy
| | - Nicola Santoro
- Department of Pediatric Hematology and Oncology, University of Bari “Aldo Moro”, Bari, Italy
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8
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Bakhshi S, Bhethanabhotla S, Kumar R, Agarwal K, Sharma P, Thulkar S, Malhotra A, Dhawan D, Vishnubhatla S. Posttreatment PET/CT Rather Than Interim PET/CT Using Deauville Criteria Predicts Outcome in Pediatric Hodgkin Lymphoma: A Prospective Study Comparing PET/CT with Conventional Imaging. J Nucl Med 2016; 58:577-583. [PMID: 27754902 DOI: 10.2967/jnumed.116.176511] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 09/08/2016] [Indexed: 11/16/2022] Open
Abstract
Data about the significance of 18F-FDG PET at interim assessment and end of treatment in pediatric Hodgkin lymphoma (HL) are limited. Methods: Patients (≤18 y) with HL were prospectively evaluated with contrast-enhanced CT (CECT) and PET combined with low-dose CT (PET/CT) at baseline, after 2 cycles of chemotherapy, and after completion of treatment. Revised International Working Group (RIW) criteria and Deauville 5 point-scale for response assessment by PET/CT were used. All patients received doxorubicin (Adriamycin), bleomycin, vinblastine, dacarbazine chemotherapy along with involved-field radiotherapy (25 Gy) for early stage (IA, IB, and IIA) and advanced stage (IIB-IV) with bulky disease. Results: Of the 57 enrolled patients, median follow-up was 81.6 mo (range, 11-97.5 mo). Treatment decisions were based on CECT. At baseline, PET/CT versus CECT identified 67 more disease sites; 23 patients (40.3%) were upstaged and of them in 9 patients (39%) upstaging would have affected treatment decision; notably none of these patients relapsed. The specificity of interim PET/CT based on RIW criteria (61.5%) and Deauville criteria (91.4%) for predicting relapse was higher than CECT (40.3%) (P = 0.03 and P < 0.0001, respectively). Event-free survival based on interim PET/CT (RIW) response was 93.3 ± 4.1 versus 89.6 ± 3.8 (positive vs. negative scan, respectively; P = 0.44). The specificity of posttreatment PET/CT (Deauville) was 95.7% versus 76.4% by CECT (P = 0.006). Posttreatment PET/CT (Deauville) showed significantly inferior overall survival in patients with positive scan versus negative scan results (66.4 ± 22.5 vs. 94.5 ± 2.0, P = 0.029). Conclusion: Interim PET/CT has better specificity, and use of Deauville criteria further improves it. Escalation of therapy based on interim PET in pediatric HL needs further conclusive evidence to justify its use. Posttreatment PET/CT (Deauville) predicts overall survival and has better specificity in comparison to conventional imaging.
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Affiliation(s)
- Sameer Bakhshi
- Department of Medical Oncology, Dr. B. R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sainath Bhethanabhotla
- Department of Medical Oncology, Dr. B. R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Krishankant Agarwal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Punit Sharma
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiology, Dr. B. R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India; and
| | - Arun Malhotra
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa Dhawan
- Department of Medical Oncology, Dr. B. R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Jakobsen LH, Hutchings M, de Nully Brown P, Linderoth J, Mylam KJ, Molin D, Johnsen HE, Bøgsted M, Jerkeman M, El-Galaly TC. No survival benefit associated with routine surveillance imaging for Hodgkin lymphoma in first remission: a Danish-Swedish population-based observational study. Br J Haematol 2016; 173:236-44. [PMID: 26846879 DOI: 10.1111/bjh.13943] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/07/2015] [Indexed: 11/28/2022]
Abstract
The use of routine imaging for patients with classical Hodgkin lymphoma (HL) in complete remission (CR) is controversial. In a population-based study, we examined the post-remission survival of Danish and Swedish HL patients for whom follow-up practices were different. Follow-up in Denmark included routine imaging, usually for a minimum of 2 years, whereas clinical follow-up without routine imaging was standard in Sweden. A total of 317 Danish and 454 Swedish comparable HL patients aged 18-65 years, diagnosed in the period 2007-2012 and having achieved CR following ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)/BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone) therapy, were included in the study. The cumulative progression rates in the first 2 years were 4% (95% confidence interval [CI] 1-7) for patients with stage I-II disease vs. 12% (95% CI 6-18) for patients with stage III-IV disease. An imaging-based follow-up practice was not associated with a better post-remission survival in general (P = 0·2) or in stage-specific subgroups (P = 0·5 for I-II and P = 0·4 for III-IV). Age ≥45 years was the only independent adverse prognostic factor for survival. In conclusion, relapse of HL patients with CR is infrequent and systematic use of routine imaging in these patients does not improve post-remission survival. The present study supports clinical follow-up without routine imaging, as encouraged by the recent Lugano classification.
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Affiliation(s)
- Lasse H Jakobsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Martin Hutchings
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Peter de Nully Brown
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Johan Linderoth
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Karen J Mylam
- Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Daniel Molin
- Experimental and Clinical Oncology, Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Hans E Johnsen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Cancer Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Martin Bøgsted
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Cancer Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Unit of Clinical Biostatistics, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mats Jerkeman
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Tarec C El-Galaly
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Cancer Research Unit, Aalborg University Hospital, Aalborg, Denmark
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10
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Paediatric and adolescent Hodgkin lymphoma: information derived from diffuse organ uptake of 18 F-fluorodeoxyglucose on pre-treatment and on interim PET/CT. Eur J Nucl Med Mol Imaging 2015; 43:1220-30. [DOI: 10.1007/s00259-015-3280-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/01/2015] [Indexed: 12/31/2022]
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Abstract
Although there have been dramatic improvements in the treatment of children with non-hodgkin lymphoma, hodgkin lymphoma and histiocytic disorders over the past 3 decades, many still relapse or are refractory to primary therapy. In addition, late effects such as 2nd malignancies, cardiomyopathy and infertility remain a major concern. Thus, this review focuses on the current state of the science and, in particular, novel treatment strategies that are aimed at improving outcomes for all pediatric patients with lymphoma and histiocytic disorders while reducing treatment related morbidity.
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Affiliation(s)
- Carl E Allen
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, 1102 Bates St, Houston, TX 77030, USA
| | - Kara M Kelly
- Herbert Irving Child and Adolescent Oncology Center, Morgan Stanley Children's Hospital, New York-Presbyterian, Columbia University Medical Center, 161 Fort Washington Ave, New York, NY 10032, USA
| | - Catherine M Bollard
- Program for Cell Enhancement and Technologies for Immunotherapy, BMT Division, Department of Pediatrics, Children's National Health System, The George Washington University, 111 Michigan Avenue, Northwest, Washington, DC 20010, USA.
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12
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Abstract
The role of PET and PET/computed tomography (CT) has evolved significantly in the last few decades. 2-Deoxy-2-[18F]-fluoro-d-glucose (FDG)-PET/CT is now an integral part of the management of patients with lymphoma. FDG-PET/CT at the time of initial staging can help in appropriate staging of the patients. Both interim and end-of-therapy PETs have significant prognostic value in patients with Hodgkin lymphoma and aggressive non-Hodgkin lymphoma and more accurately assess for the presence of residual malignancy than anatomic imaging. The impact of interim FDG-PET/CT on risk-adapted strategies is an area of active investigation and the results of ongoing clinical trials will be informative.
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13
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Uslu L, Donig J, Link M, Rosenberg J, Quon A, Daldrup-Link HE. Value of 18F-FDG PET and PET/CT for evaluation of pediatric malignancies. J Nucl Med 2015; 56:274-86. [PMID: 25572088 DOI: 10.2967/jnumed.114.146290] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Successful management of solid tumors in children requires imaging tests for accurate disease detection, characterization, and treatment monitoring. Technologic developments aim toward the creation of integrated imaging approaches that provide a comprehensive diagnosis with a single visit. These integrated diagnostic tests not only are convenient for young patients but also save direct and indirect health-care costs by streamlining procedures, minimizing hospitalizations, and minimizing lost school or work time for children and their parents. (18)F-FDG PET/CT is a highly sensitive and specific imaging modality for whole-body evaluation of pediatric malignancies. However, recent concerns about ionizing radiation exposure have led to a search for alternative imaging methods, such as whole-body MR imaging and PET/MR. As we develop new approaches for tumor staging, it is important to understand current benchmarks. This review article will synthesize the current literature on (18)F-FDG PET/CT for tumor staging in children, summarizing questions that have been solved and providing an outlook on unsolved avenues.
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Affiliation(s)
- Lebriz Uslu
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Jessica Donig
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Michael Link
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jarrett Rosenberg
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Andrew Quon
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
| | - Heike E Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California; and
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Picardi M, Pugliese N, Cirillo M, Zeppa P, Cozzolino I, Ciancia G, Pettinato G, Salvatore C, Quintarelli C, Pane F. Advanced-stage Hodgkin Lymphoma: US/Chest Radiography for Detection of Relapse in Patients in First Complete Remission—A Randomized Trial of Routine Surveillance Imaging Procedures. Radiology 2014; 272:262-74. [DOI: 10.1148/radiol.14132154] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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El-Galaly TC, Mylam KJ, Bøgsted M, Brown P, Rossing M, Gang AO, Haglund A, Arboe B, Clausen MR, Jensen P, Pedersen M, Bukh A, Jensen BA, Poulsen CB, d'Amore F, Hutchings M. Role of routine imaging in detecting recurrent lymphoma: A review of 258 patients with relapsed aggressive non-Hodgkin and Hodgkin lymphoma. Am J Hematol 2014; 89:575-80. [PMID: 24493389 DOI: 10.1002/ajh.23688] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 01/29/2014] [Indexed: 11/10/2022]
Abstract
After first-line therapy, patients with Hodgkin lymphoma (HL) and aggressive non-HL are followed up closely for early signs of relapse. The current follow-up practice with frequent use of surveillance imaging is highly controversial and warrants a critical evaluation. Therefore, a retrospective multicenter study of relapsed HL and aggressive non-HL (nodal T-cell and diffuse large B-cell lymphomas) was conducted. All included patients had been diagnosed during the period 2002-2011 and relapsed after achieving complete remission on first-line therapy. Characteristics and outcome of imaging-detected relapses were compared with other relapses. A total of 258 patients with recurrent lymphoma were included in the study. Relapse investigations were initiated outside preplanned visits in 52% of the patients. Relapse detection could be attributed to patient-reported symptoms alone or in combination with abnormal blood tests or physical examination in 64% of the patients. Routine imaging prompted relapse investigations in 27% of the patients. The estimated number of routine scans per relapse was 91-255 depending on the lymphoma subtype. Patients with imaging-detected relapse had lower disease burden (P = 0.045) and reduced risk of death following relapse (hazard ratio = 0.62, P = 0.02 in multivariate analysis). Patient-reported symptoms are still the most common factor for detecting lymphoma relapse and the high number of scans per relapse calls for improved criteria for use of surveillance imaging. However, imaging-detected relapse was associated with lower disease burden and a possible survival advantage. The future role of routine surveillance imaging should be defined in a randomized trial.
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Affiliation(s)
- TC El-Galaly
- Department of Hematology; Aalborg University Hospital; Aalborg Denmark
- Department of Hematology; Aarhus University Hospital; Aarhus Denmark
| | - Karen Juul Mylam
- Department of Hematology; Odense University Hospital; Odense Denmark
| | - Martin Bøgsted
- Department of Hematology; Aalborg University Hospital; Aalborg Denmark
- Department of Mathematical Sciences; Aalborg University; Aalborg Denmark
| | - Peter Brown
- Department of Hematology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Maria Rossing
- Department of Hematology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
| | - Anne Ortved Gang
- Department of Hematology; Herlev; Copenhagen University Hospital; Herlev Denmark
| | - Anne Haglund
- Department of Hematology; Aalborg University Hospital; Aalborg Denmark
| | - Bente Arboe
- Department of Hematology; Roskilde Hospital; Roskilde Denmark
| | | | - Paw Jensen
- Department of Hematology; Aalborg University Hospital; Aalborg Denmark
| | - Michael Pedersen
- Department of Hematology; Herlev; Copenhagen University Hospital; Herlev Denmark
| | - Anne Bukh
- Department of Hematology; Aarhus University Hospital; Aarhus Denmark
| | - Bo Amdi Jensen
- Department of Hematology; Odense University Hospital; Odense Denmark
| | | | - Francesco d'Amore
- Department of Hematology; Aarhus University Hospital; Aarhus Denmark
| | - Martin Hutchings
- Department of Hematology; Rigshospitalet; Copenhagen University Hospital; Copenhagen Denmark
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Positron Emission Tomography/Computed Tomography False Positivity for Xanthogranulomatous Inflammation in an Adolescent with Hodgkin's Lymphoma. JOURNAL OF CANCER RESEARCH AND PRACTICE 2014. [DOI: 10.1016/s2311-3006(16)30024-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Friedmann AM, Wolfson JA, Hudson MM, Weinstein HJ, Link MP, Billett A, Larsen EC, Yock T, Donaldson SS, Marcus K, Krasin MJ, Howard SC, Metzger ML. Relapse after treatment of pediatric Hodgkin lymphoma: outcome and role of surveillance after end of therapy. Pediatr Blood Cancer 2013; 60:1458-63. [PMID: 23677874 PMCID: PMC4313350 DOI: 10.1002/pbc.24568] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/26/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND The outcome of treatment for pediatric Hodgkin lymphoma (HL) is excellent using chemotherapy and radiation. However, a minority of patients will relapse after treatment, but additional therapy achieves durable second remission in many cases. The optimal surveillance strategy after modern therapy for HL has not been well defined. PROCEDURES We reviewed the outcomes of pediatric patients with HL treated between 1990 and 2006 to determine the primary event that led to the detection of relapse. We determined the probability of relapse detection by routine follow-up procedures, including history, physical examination, laboratory tests, and imaging, and determined the impact of each of these screening methods on the likelihood of survival after relapse. RESULTS Relapse occurred in 64 of 402 evaluable patients (15.9%) at a median of 1.7 years from the time of diagnosis. The majority of relapses (60%) were diagnosed at a routine visit, and patient complaint was the most common initial finding that led to a diagnosis of relapse (47% of relapses). An abnormal finding on physical examination was the primary event in another 17% of relapses, and imaging abnormalities led to the diagnosis in the remaining 36%. Laboratory abnormalities were never the primary finding. The method of detection of relapse and timing (whether detected at a routine visit or an extra visit) did not impact survival. CONCLUSIONS In pediatric HL, most relapses are identified through history and physical examination. Frequent imaging of asymptomatic patients does not appear to impact survival and is probably not warranted.
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Seth R, Puri K, Singh P, Selvam P, Kumar R. The role of fluorodeoxyglucose positron emission tomography-computerized tomography in resolving therapeutic dilemmas in pediatric Hodgkin lymphoma. INDIAN JOURNAL OF NUCLEAR MEDICINE : IJNM : THE OFFICIAL JOURNAL OF THE SOCIETY OF NUCLEAR MEDICINE, INDIA 2013; 27:141-4. [PMID: 23919065 PMCID: PMC3728733 DOI: 10.4103/0972-3919.112717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction: Hodgkin lymphoma (HL) is a highly curable lymphoma with cure rates of over 80% and even higher with limited stage disease. Computerized tomography (CT) scan is currently the recommended modality in staging and assessment of response to therapy in patients with HL. However, CT has its limitations. This study describes our experience with patients of HL where fluorodeoxyglucose positron emission tomography (FDG-PET)-CT scan helped decide further management, after completion of chemotherapy. Methodology: This is a retrospective review of the records of children diagnosed with HL at our center. Patients with post-treatment CT scan showing evidence of residual disease, who underwent FDG-PET-CT for deciding further management, were included in the study. Results: Thirty one patients were diagnosed with HL during this period. Nine patients were eligible and underwent PET-CT. In 8 out of 9 patients, PET-CT showed no scan evidence of active disease. In one patient, FDG-PET-CT carried out after completion of chemotherapy showed evidence of active disease and was given radiotherapy. Conclusion: FDG-PET-CT is a promising modality in deciding further management when there is discordance between the post-treatment CT scan and clinical condition of the patient with HL thus avoiding unnecessary chemotherapy/radiotherapy.
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Affiliation(s)
- Rachna Seth
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Value of 18F-FDG PET versus iliac biopsy in the initial evaluation of bone marrow infiltration in the case of Hodgkin's disease: a meta-analysis. Nucl Med Commun 2013; 34:25-31. [PMID: 23111383 DOI: 10.1097/mnm.0b013e32835afc19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We carried out a meta-analysis to evaluate the performance of 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) PET and PET/CT against bone marrow biopsy (BMB) in the initial diagnosis of bone marrow infiltration (BMI) in patients with Hodgkin's disease (HD). MATERIALS AND METHODS Retrospective and prospective studies with direct comparison of (18)F-FDG PET with BMB in the initial evaluation of BMI in HD were included. Seven eligible studies were included in the meta-analysis comprising a total of 687 patients. RESULTS Both (18)F-FDG PET and BMB had excellent specificity in detecting BMI. However, (18)F-FDG PET had excellent pooled sensitivity (94.5%; 95% confidence interval: 89.0-97.8%) in detecting BMI in the initial staging of HD patients, whereas the pooled sensitivity of iliac BMB was very poor (39.4%; 95% confidence interval: 30.8-48.4%). The diagnostic odds ratio, a measure of the overall diagnostic power of the test, was much higher for PET (pooled value of 1591) than for iliac BMB (pooled value of 137). CONCLUSION (18)F-FDG PET significantly outperforms iliac BMB in the detection of BMI in the initial staging of HD patients and therefore should be used as a first-line study. Iliac BMB has low sensitivity and a high rate of false-negative findings. Thus, a negative BMB finding cannot rule out marrow involvement in HD patients on initial staging.
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Sioka C. The utility of FDG PET in diagnosis and follow-up of lymphoma in childhood. Eur J Pediatr 2013; 172:733-8. [PMID: 23559330 DOI: 10.1007/s00431-013-1993-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/19/2013] [Indexed: 11/27/2022]
Abstract
Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) are among the most common malignancies of childhood. (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) can be employed for accurate staging, treatment planning, and response assessment in pediatric patients with lymphomas, taking advantage of the increased FDG uptake of the malignant cells, secondary to their increased metabolic needs. FDG PET has higher sensitivity than other imaging modalities to detect nodular or diffuse lesions and higher sensitivity than bone marrow biopsy to detect bone marrow infiltration. FDG PET consists of an invaluable imaging modality during evaluation and treatment of pediatric lymphomas.
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Affiliation(s)
- Chrissa Sioka
- Neurosurgical Research Institute, University of Ioannina, Ioannina 45500, Greece.
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Patel V, Buckstein M, Perini R, Hill-Kayser C, Svoboda J, Plastaras JP. Computed tomography and positron emission tomography/computed tomography surveillance after combined modality treatment of supradiaphragmatic Hodgkin lymphoma: a clinical and economic perspective. Leuk Lymphoma 2013; 54:2168-76. [DOI: 10.3109/10428194.2013.767902] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shaikh F, Ngan BY, Alexander S, Grant R. Progressive transformation of germinal centers in children and adolescents: an intriguing cause of lymphadenopathy. Pediatr Blood Cancer 2013; 60:26-30. [PMID: 22707034 DOI: 10.1002/pbc.24234] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 05/22/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The clinical implications of a diagnosis of progressive transformation of germinal centers (PTGC) in children are not well known. METHODS To better understand this entity, we conducted a retrospective review of all patients aged 0-18 years diagnosed with PTGC at our center between 1998 and 2010. RESULTS Twenty-nine patients were identified. Median age at diagnosis was 11.5 years, and median duration of follow-up was 2.8 years. Thirteen patients (45%) had a single episode of PTGC with no other associated features. Five patients (17%) had recurrent PTGC. Four patients (14%) had PTGC associated with Hodgkin lymphoma (HL): one preceding, two concurrent, and one subsequently developed HL. The most commonly associated HL was nodular lymphocyte-predominant HL. Seven patients (24%) had PTGC associated with immune disorders, including lupus, Castleman disease, and probable autoimmune lymphoproliferative syndrome. Overall, 15 patients (52%) had more than one lymph node biopsy. The cumulative incidence of a second biopsy after a diagnosis of PTGC was 42.3% ± 12.2% at 4 years. PTGC was PET-avid in all four patients tested. CONCLUSIONS PTGC is a nonspecific manifestation of a variety of associated conditions. There is a small risk of subsequent HL, and a larger risk of requiring multiple biopsies for recurrent PTGC. The presence of an immune disorder should be considered in patients who present with generalized lymphadenopathy, splenomegaly, immune cytopenias, and/or progression to HL. Routine surveillance imaging may not be required. Future research should determine the optimal surveillance strategy for patients with PTGC and the indications for repeat biopsies.
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Affiliation(s)
- Furqan Shaikh
- Paediatric Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Ilivitzki A, Radan L, Ben-Arush M, Israel O, Ben-Barak A. Early interim FDG PET/CT prediction of treatment response and prognosis in pediatric Hodgkin disease-added value of low-dose CT. Pediatr Radiol 2013; 43:86-92. [PMID: 23151729 DOI: 10.1007/s00247-012-2517-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 06/20/2012] [Accepted: 06/23/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interim 18F-FDG PET helps predict outcome and tailor treatment in adults with Hodgkin disease (HD). OBJECTIVE The purpose of this study was to assess predictive values of interim 18F-FDG PET/CT in children with HD and to define the potential added value to interim PET of low-dose CT. MATERIALS AND METHODS Children were prospectively enrolled August 2002-April 2007. PET/low-dose CT was performed at staging, after 2 cycles, at the end of treatment and during follow-up (mean 45 months). Treatment was unchanged regardless of interim results. PET and low-dose CT were read independently. RESULTS Of 34 enrolled children (ages 3-17 years), 27 achieved complete response, 4 had progressive disease and 3 had relapse. Interim PET alone had positive and negative predictive values of 67% and 89%, respectively. Interim low-dose CT alone had positive and negative predictive values of 35% and 100%, respectively. Interim PET/CT had positive and negative predictive values of 75% and 96%, respectively. CONCLUSIONS Early interim PET/CT was a good predictor of outcome. Integrated PET and low-dose CT improved the predictive value in children with HD.
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Affiliation(s)
- Anat Ilivitzki
- Department of Diagnostic Imaging, Rambam Health Care Campus, Haifa, Israel.
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Hartmann S, Agostinelli C, Diener J, Döring C, Fanti S, Zinzani PL, Gallamini A, Bergmann L, Pileri S, Hansmann ML. GLUT1 expression patterns in different Hodgkin lymphoma subtypes and progressively transformed germinal centers. BMC Cancer 2012; 12:586. [PMID: 23228169 PMCID: PMC3537691 DOI: 10.1186/1471-2407-12-586] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 12/02/2012] [Indexed: 11/10/2022] Open
Abstract
Background Increased glycolytic activity is a hallmark of cancer, allowing staging and restaging with 18F-fluorodeoxyglucose-positron-emission-tomography (PET). Since interim-PET is an important prognostic tool in Hodgkin lymphoma (HL), the aim of this study was to investigate the expression of proteins involved in the regulation of glucose metabolism in the different HL subtypes and their impact on clinical outcome. Methods Lymph node biopsies from 54 HL cases and reactive lymphoid tissue were stained for glucose transporter 1 (GLUT1), lactate dehydrogenase A (LDHA) and lactate exporter proteins MCT1 and MCT4. In a second series, samples from additional 153 HL cases with available clinical data were stained for GLUT1 and LDHA. Results Membrane bound GLUT1 expression was frequently observed in the tumor cells of HL (49% of all cases) but showed a broad variety between the different Hodgkin lymphoma subtypes: Nodular sclerosing HL subtype displayed a membrane bound GLUT1 expression in the Hodgkin-and Reed-Sternberg cells in 56% of the cases. However, membrane bound GLUT1 expression was more rarely observed in tumor cells of lymphocyte rich classical HL subtype (30%) or nodular lymphocyte predominant HL subtype (15%). Interestingly, in both of these lymphocyte rich HL subtypes as well as in progressively transformed germinal centers, reactive B cells displayed strong expression of GLUT1. LDHA, acting downstream of glycolysis, was also expressed in 44% of all cases. We evaluated the prognostic value of different GLUT1 and LDHA expression patterns; however, no significant differences in progression free or overall survival were found between patients exhibiting different GLUT1 or LDHA expression patterns. There was no correlation between GLUT1 expression in HRS cells and PET standard uptake values. Conclusions In a large number of cases, HRS cells in classical HL express high levels of GLUT1 and LDHA indicating glycolytic activity in the tumor cells. Although interim-PET is an important prognostic tool, a predictive value of GLUT1 or LDHA staining of the primary diagnostic biopsy could not be demonstrated. However, we observed GLUT1 expression in progressively transformed germinal centers and hyperplastic follicles, explaining false positive results in PET. Therefore, PET findings suggestive of HL relapse should always be confirmed by histology.
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Affiliation(s)
- Sylvia Hartmann
- Senckenberg Institute of Pathology, Goethe University, Frankfurt am Main, Germany.
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Furth C, Meseck RM, Steffen IG, Schoenberger S, Denecke T, Henze G, Hautzel H, Hofheinz F, Großer O, Hundsdoerfer P, Amthauer H, Ruf J. SUV-measurements and patient-specific corrections in pediatric Hodgkin-lymphoma: is there a benefit for PPV in early response assessment by FDG-PET? Pediatr Blood Cancer 2012; 59:475-80. [PMID: 22190514 DOI: 10.1002/pbc.24047] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 11/18/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND To evaluate the influence of different SUV-measurements and patient-specific corrections thereof on the positive predictive value (PPV) of FDG-PET in pediatric Hodgkin lymphoma (pHL) using SUV-based response assessment. METHODS PET-datasets of 33 children [female, n = 13, male, n = 20; range of age, 8.0-17.8 (mean, 15.0) years; follow-up, 44.5-83.3 (mean 63.0) months] with HL were analyzed retrospectively. PET-scans were obtained baseline (PET1) and after two cycles of chemotherapy (PET2). Within the leading lesion maximal SUV (SUVmax) and mean SUVs were generated by using isocontur-thresholds for different volumes of interest: Absolute, SUV2.5; relative to SUVmax, SUVmean40% to SUVmean70%. Generated SUVs were adjusted to body weight (SUV) and corrected for body surface area (SUV_BSA), patient's blood glucose and a combination thereof. The decrease in SUV or respective derivates thereof between PET1 and PET2 (ΔSUV) was assessed for response prediction using receiver operating characteristics (ROC)-analysis. RESULTS Three patients had recurrence of disease. ROC-analysis showed the most accurate differentiation of responders and non-responders for ΔSUVmax_BSA [AUC, 0.97; P = 0.0026; sensitivity, 100%; specificity, 93.3%; PPV, 60.0%; negative predictive value (NPV), 100%; accuracy, 93.3%]. However, comparable results were obtained for conventional ΔSUVmax-determination (AUC, 0.96; P = 0.0112; sensitivity, 100%; specificity, 90.0%; PPV, 50.0%; NPV, 100%; accuracy, 90.9%). Threshold-based approaches were less effective or technically not performable in all patients. CONCLUSIONS At early response assessment by FDG-PET, patient-specific correction of ΔSUVmax by BSA improves PPV without impairment of excellent NPV in pHL. However, it is not statistically superior to simple ΔSUVmax-analyses. Larger cohorts are needed to investigate this observation.
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Affiliation(s)
- Christian Furth
- Department of Radiology and Nuclear Medicine, Medical School, Otto-von-Guericke University Magdeburg A.ö.R., Magdeburg, Germany.
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Initiation of c-ART in HIV-1 Infected Patients Is Associated With a Decrease of the Metabolic Activity of the Thymus Evaluated Using FDG-PET/Computed Tomography. J Acquir Immune Defic Syndr 2012; 61:56-63. [DOI: 10.1097/qai.0b013e3182615b62] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cheng G, Akers SR, Zhuang H, Alavi A. Review of Clinical Applications of Fluorodeoxyglucose-PET/Computed Tomography in Pediatric Patients with Lymphoma. PET Clin 2012; 7:47-56. [PMID: 27157017 DOI: 10.1016/j.cpet.2011.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
[(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) imaging is routinely used in the initial diagnosis and response assessment during and immediately after therapy, as well as in the follow-up surveillance. FDG PET/CT outperforms diagnostic CT and other conventional imaging modalities in the evaluation of pediatric patients with lymphoma, with higher sensitivity and specificity, leading to more accurate staging/restaging and modifications of therapeutic strategies. Resolution of FDG-avid lesions in the early post-therapy phase often indicates good response to treatment and better prognosis. FDG PET/CT also outperforms bone marrow biopsy in detecting bone marrow infiltration of lymphoma.
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Affiliation(s)
- Gang Cheng
- Department of Radiology, Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Scott R Akers
- Department of Radiology, Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Hongming Zhuang
- Department of Radiology, Children's Hospital of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19102, USA
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García Vicente A, Bellón Guardia M, Soriano Castrejón A, Calle Primo C, Cordero García J, Palomar Muñoz A, Pilkington Woll J, Talavera Rubio M, Hernández Ruiz B. 18F-FDG-PET/CT in the surveillance of patients with lymphoma: Detection of asymptomatic recurrences. Rev Esp Med Nucl Imagen Mol 2012. [DOI: 10.1016/j.remngl.2011.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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El-Galaly TC, Mylam KJ, Brown P, Specht L, Christiansen I, Munksgaard L, Johnsen HE, Loft A, Bukh A, Iyer V, Nielsen AL, Hutchings M. Positron emission tomography/computed tomography surveillance in patients with Hodgkin lymphoma in first remission has a low positive predictive value and high costs. Haematologica 2011; 97:931-6. [PMID: 22207683 DOI: 10.3324/haematol.2011.056010] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The value of performing post-therapy routine surveillance imaging in patients with Hodgkin lymphoma is controversial. This study evaluates the utility of positron emission tomography/computed tomography using 2-[18F]fluoro-2-deoxyglucose for this purpose and in situations with suspected lymphoma relapse. DESIGN AND METHODS We conducted a multicenter retrospective study. Patients with newly diagnosed Hodgkin lymphoma achieving at least a partial remission on first-line therapy were eligible if they received positron emission tomography/computed tomography surveillance during follow-up. Two types of imaging surveillance were analyzed: "routine" when patients showed no signs of relapse at referral to positron emission tomography/computed tomography, and "clinically indicated" when recurrence was suspected. RESULTS A total of 211 routine and 88 clinically indicated positron emission tomography/computed tomography studies were performed in 161 patients. In ten of 22 patients with recurrence of Hodgkin lymphoma, routine imaging surveillance was the primary tool for the diagnosis of the relapse. Extranodal disease, interim positron emission tomography-positive lesions and positron emission tomography activity at response evaluation were all associated with a positron emission tomography/computed tomography-diagnosed preclinical relapse. The true positive rates of routine and clinically indicated imaging were 5% and 13%, respectively (P = 0.02). The overall positive predictive value and negative predictive value of positron emission tomography/computed tomography were 28% and 100%, respectively. The estimated cost per routine imaging diagnosed relapse was US$ 50,778. CONCLUSIONS Negative positron emission tomography/computed tomography reliably rules out a relapse. The high false positive rate is, however, an important limitation and a confirmatory biopsy is mandatory for the diagnosis of a relapse. With no proven survival benefit for patients with a pre-clinically diagnosed relapse, the high costs and low positive predictive value make positron emission tomography/computed tomography unsuitable for routine surveillance of patients with Hodgkin lymphoma.
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18F-FDG-PET/CT in the surveillance of patients with lymphoma: detection of asymptomatic recurrences. Rev Esp Med Nucl Imagen Mol 2011; 31:22-7. [PMID: 21742419 DOI: 10.1016/j.remn.2011.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 04/20/2011] [Accepted: 04/21/2011] [Indexed: 11/20/2022]
Abstract
AIM To assess the diagnostic accuracy of (18)F-FDG-PET/CT in detecting asymptomatic recurrences in patients with lymphoma. To define uptake patterns of recurrence indicative of recurrence. MATERIAL AND METHODS Those patients with lymphoma who fulfilled the following inclusion criteria of clinical complete remission and negative PET/CT study were included retrospectively and longitudinally. Conventional surveillance of these patients was performed only by (18)F-FDG PET/CT following a standardized procedure. Pathologic locations (supra- and infradiaphragmatic) and their character (single or multiple) were analyzed in order to determine reliable metabolic patterns of recurrence. The final diagnosis was established by histopathological analysis or clinical follow-up greater than 8 months. RESULTS A total of 199 explorations belonging to 106 patients with lymphoma were included. Of these patients, 59 had Hodgkin's lymphoma and 47 non-Hodgkin's lymphoma. There was suspicion of relapse from the metabolic point of view in 27 of the PET/CT scans. Of these, 14 (10 patients) were false positive (FP), and 13 (8 patients) true positive. The remaining studies were true negative, no false negatives being detected. The pattern most frequently related to recurrence was infradiaphragmatic lymph node involvement while most of the FP had isolated supradiaphragmatic involvement. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of PET/CT parameters for the study were 100%, 92%, 48%, 100% and 93%, respectively. CONCLUSION (18)F-FDG-PET/CT is a sensitive technique in the detection of asymptomatic recurrences in patients with lymphoma during their follow-up. Multiple character and infradiaphragmatic locations were the patterns that best correlated to the diagnosis of recurrence.
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Lopci E, Burnelli R, Guerra L, Cistaro A, Piccardo A, Zucchetta P, Derenzini E, Todesco A, Garaventa A, Schumacher F, Farruggia P, Buffardi S, Sala A, Casale F, Indolfi P, Biondi S, Pession A, Fanti S. Postchemotherapy PET evaluation correlates with patient outcome in paediatric Hodgkin’s disease. Eur J Nucl Med Mol Imaging 2011; 38:1620-7. [DOI: 10.1007/s00259-011-1836-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 04/14/2011] [Indexed: 11/29/2022]
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El-Galaly T, Prakash V, Christiansen I, Madsen J, Johansen P, Boegsted M, Johnsen HE, Bukh A. Efficacy of routine surveillance with positron emission tomography/computed tomography in aggressive non-Hodgkin lymphoma in complete remission: status in a single center. Leuk Lymphoma 2011; 52:597-603. [DOI: 10.3109/10428194.2010.547642] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kumar R, Shandal V, Shamim SA, Halanaik D, Malhotra A. Clinical applications of PET and PET/CT in pediatric malignancies. Expert Rev Anticancer Ther 2011; 10:755-68. [PMID: 20470007 DOI: 10.1586/era.10.12] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The common childhood cancers are leukemia, CNS tumors, lymphomas, soft-tissue tumors (such as rhabdomyosarcoma and fibrosarcoma), neuroblastoma, malignant bone tumors, germ cell tumors with neoplasms of gonads and hepatic tumors. Usually the conventional imaging modalities, such as x-ray, ultrasound, computed tomography (CT) and MRI, are being routinely used for the management of these pediatric malignancies. However, most of these modalities provide structural information and are lacking in functional/metabolic status of these malignancies. Recently, PET and PET/CT have emerged as a functional diagnostic imaging modality for the management of various cancers in adult population. Up to now most of the data published in the literature are on PET alone. PET used in conjunction with CT is useful as it provides an enhanced view of the anatomical details and the malignant focus then can be located with highest accuracy. PET and PET/CT has been found to be useful in, for example, CNS tumors, lymphomas, soft-tissue tumors, neuroblastoma, malignant bone tumors and germ cell tumors. PET/CT has a limited role in early diagnosis, however, it plays an important role in initial staging, treatment response evaluation and detection of metastatic disease in these cancers. Despite the fact that PET/CT has better diagnostic value when compared with conventional imaging, such as CT and MRI, in the management of many pediatric cancers, there are certain limitations. PET/CT has a limited role in detection of lesions smaller than 5 mm, well-differentiated tumors and tumors with low metabolic rate. Many infections and inflammation can lead to false-positive PET/CT results. In the present review we will discuss the various clinical indications of PET and PET/CT in pediatric cancers.
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Affiliation(s)
- Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari nagar, New Delhi, 110029, India.
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Chen Z, Li X, Li F, Ouyang Q, Yu T. Evolving role of 18F-FDG-PET/CT for the body tumor and metastases in pediatrics. Eur J Radiol 2010; 75:329-35. [DOI: 10.1016/j.ejrad.2010.05.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 04/23/2010] [Indexed: 10/19/2022]
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Lopci E, Burnelli R, Ambrosini V, Nanni C, Castellucci P, Biassoni L, Rubello D, Fanti S. (18)F-FDG PET in Pediatric Lymphomas: A Comparison with Conventional Imaging. Cancer Biother Radiopharm 2010; 23:681-90. [PMID: 19111053 DOI: 10.1089/cbr.2008.0519] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study reports on our experience with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in pediatric patients affected by Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). We studied 20 pediatric subjects (12 males, 8 females; mean age, 10 years; range, 6 months to 14 years) with malignant lymphoma (9 HD, 11 NHL) for a 4-year period of time. Overall, 45 PET scans were performed: 7 at disease presentation and 38 for evaluation of response to therapy or follow-up study. All PET results were compared with conventional imaging (CI), mainly computed tomography (CT) and/or magnetic resonance imaging (MRI), and supported by clinical follow-up and/or histologic data. In 18 of 20 patients, PET findings correctly identified the status of disease. Two (2) subjects (respectively, 1 HD and 1 NHL, both at follow-up) resulted falsely positive: 1 due to prominent thymic uptake, and the other due to nonspecific inflammation. Of 45 scans, PET findings were consistent with clinical follow-up and other CI data in 43 cases (16 true-positive and 27 true-negative results) and resulted falsely positive in the remaining 2 scans. On a lesion-by-lesion basis (overall, 153 lesions: 84 nodal and 69 extranodal), we found a concordance between CI and PET findings in 25 nodal (29.8%) and in 22 extranodal sites (32%). PET was more accurate than CI, as it identified active disease in 1 patient negative at CI and excluded relapse in 6 patients with inconclusive CI and in 2 patients with a falsely positive CI. Overall, PET sensitivity and specificity was 100% and 93% versus 94% sensitivity and 72.4% specificity for CI. This comparative study shows FDG PET to be more accurate than CI in evaluating children with lymphoma. Our data also confirms that (18)F-FDG PET may show false-positive findings.
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Affiliation(s)
- Egesta Lopci
- Department of Nuclear Medicine, Policlinico "S. Orsola-Malpighi," Bologna, Italy
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The role of routine imaging procedures in the detection of relapse of patients with Hodgkin lymphoma and aggressive non-Hodgkin lymphoma. Ann Hematol 2010; 90:165-71. [DOI: 10.1007/s00277-010-1044-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 08/02/2010] [Indexed: 10/19/2022]
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Mocikova H, Obrtlikova P, Vackova B, Trneny M. Positron emission tomography at the end of first-line therapy and during follow-up in patients with Hodgkin lymphoma: a retrospective study. Ann Oncol 2010; 21:1222-1227. [DOI: 10.1093/annonc/mdp522] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lee AI, Zuckerman DS, Van den Abbeele AD, Aquino SL, Crowley D, Toomey C, Lacasce AS, Feng Y, Neuberg DS, Hochberg EP. Surveillance imaging of Hodgkin lymphoma patients in first remission. Cancer 2010; 116:3835-42. [PMID: 20564135 DOI: 10.1002/cncr.25240] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alfred Ian Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02114, USA
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Furth C, Steffen IG, Amthauer H, Ruf J, Misch D, Schönberger S, Kobe C, Denecke T, Stöver B, Hautzel H, Henze G, Hundsdoerfer P. Early and late therapy response assessment with [18F]fluorodeoxyglucose positron emission tomography in pediatric Hodgkin's lymphoma: analysis of a prospective multicenter trial. J Clin Oncol 2009; 27:4385-91. [PMID: 19667276 DOI: 10.1200/jco.2008.19.7814] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In adult Hodgkin's lymphoma (HL) risk stratification after early therapy response assessment with [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) seems to allow tailoring therapy with less toxicity for patients with adequate metabolic response. This study delivers the first prospective data on the potential of FDG-PET for response assessment in pediatric HL. PATIENTS AND METHODS FDG-PET was performed in 40 pediatric HL patients before polychemotherapy (PET-1), after two cycles of polychemotherapy (PET-2), and after completion of polychemotherapy (PET-3). Mean follow-up was 46 months (range, 26 to 72 months). RESULTS At early and late response assessment, the proportion of PET-negative patients was significantly higher compared with those patients with negative findings in conventional imaging methods (CIMs; PET-2, 26 of 40 v CIM-2, one of 40; P < .001; PET-3, 21 of 29 v CIM-3, four of 29; P < .001). Sensitivity and negative predictive value were 100% for early and late therapy response assessment by PET. Both patients suffering a relapse during follow-up were identified by PET-2/3, whereas one of these patients was not detected by CIM-3. PET was superior to CIMs with regard to specificity in early and late therapy response assessment (68% v 3%, and 78% v 11%, respectively; both P < .001). Specificity of early therapy response assessment by PET was improved to 97% by quantitative analysis of maximal standardized uptake value reduction using a cutoff value of 58%. CONCLUSION Pediatric HL patients with a negative PET in response assessment have an excellent prognosis while PET-positive patients have an increased risk for relapse.
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Affiliation(s)
- Christian Furth
- Klinik für Radiologie und Nuklearmedizin, Otto-von-Guericke Universität, Universitätsklinikum Magdeburg A.ö.R., Leipziger Strasse 44, 39120 Magdeburg, Germany.
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Cheng G, Servaes S, Alavi A, Zhuang H. FDG PET and PET/CT in the Management of Pediatric Lymphoma Patients. PET Clin 2009; 3:621-34. [PMID: 27156825 DOI: 10.1016/j.cpet.2009.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fluorodeoxyglucose (FDG) PET has an ever-increasing role in the management of Hodgkin's and non-Hodgkin's lymphomas, which has been demonstrated in numerous studies in the adult population. In children and adolescents, however, only a limited number of studies have investigated the role of FDG PET in lymphoma. This article reviews the currently available literature on the clinical application of FDG PET in the management of childhood lymphoma. The authors believe that FDG PET (and especially PET/CT) is a valuable imaging modality in the initial diagnosis, response assessment, and post-therapy residual evaluation of Hodgkin's and FDG-avid non-Hodgkin's lymphomas in children and adolescents, and will have a significant impact on the clinical management of pediatric lymphoma.
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Affiliation(s)
- Gang Cheng
- Department of Radiology, Division of Nuclear Medicine, Children's Hospital of Pennsylvania, 34th and Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Sabah Servaes
- Department of Radiology, Division of Nuclear Medicine, Children's Hospital of Pennsylvania, 34th and Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Division of Nuclear Medicine, Children's Hospital of Pennsylvania, 34th and Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Hongming Zhuang
- Department of Radiology, Division of Nuclear Medicine, Children's Hospital of Pennsylvania, 34th and Civic Center Blvd, Philadelphia, PA 19104, USA.
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Crocchiolo R, Fallanca F, Giovacchini G, Ferreri AJM, Assanelli A, Verona C, Pescarollo A, Bregni M, Ponzoni M, Gianolli L, Fazio F, Ciceri F. Role of 18FDG-PET/CT in detecting relapse during follow-up of patients with Hodgkin's lymphoma. Ann Hematol 2009; 88:1229-36. [PMID: 19468730 DOI: 10.1007/s00277-009-0752-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 04/30/2009] [Indexed: 12/16/2022]
Abstract
The role of 18FDG-PET/CT during follow-up of patients affected by Hodgkin's lymphoma (HL) in complete remission after treatment is not fully elucidated, since a wide use of 18F fluorodeoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT) in this setting could be limited by a relative high rate of false-positive results. Herein, we summarize a retrospective analysis of 27 patients with Hodgkin's lymphoma in complete remission after the first-line (n = 20) or salvage (n = 7) therapy receiving serial 18FDG-PET/CT scans during follow-up. Out of 165 scans, 13 were suspected for relapse, which was confirmed in seven patients. All relapses were correctly identified by 18FDG-PET/CT positivity, with a 100% sensitivity; false-positive rate was 46% and negative predictive value was 100%. True-positive findings were mostly associated with multiple sites, subdiaphragmatic involvement, and/or previous sites of disease. According to our results, we conclude that performing routine PET/CT scan during follow-up of those patients who are at high risk of relapse would be advisable, although caution must be adopted when interpreting PET/CT results due to the relatively high rate of false-positive findings. If FDG abnormal uptake is present at multiple nodal sites, subdiaphragmatic lymph nodes, or previous sites of disease, histological verification of PET abnormal findings is warranted.
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Affiliation(s)
- R Crocchiolo
- Hematology and BMT Unit, San Raffaele Scientific Institute, Milan, Italy.
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Luigi Zinzani P, Stefoni V, Tani M, Fanti S, Musuraca G, Castellucci P, Marchi E, Fina M, Ambrosini V, Pellegrini C, Alinari L, Derenzini E, Montini G, Broccoli A, Bacci F, Pileri S, Baccarani M. Role of [18F]Fluorodeoxyglucose Positron Emission Tomography Scan in the Follow-Up of Lymphoma. J Clin Oncol 2009; 27:1781-7. [DOI: 10.1200/jco.2008.16.1513] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose In lymphoma, [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) is routinely used for initial staging, early evaluation of treatment response, and identification of disease relapse. However, there are no prospective studies investigating the value of serial FDG-PET over time in patients in complete remission. Patients and Methods All patients with lymphoma who achieved the first complete remission were prospectively enrolled onto the study and scheduled for serial FDG-PET scans at 6, 12, 18, and 24 months; further scans were then carried out on an annual basis. Overall, the population included 421 patients (160 patients with Hodgkin's lymphoma [HL], 183 patients with aggressive non-Hodgkin's lymphoma [NHL], and 78 patients with indolent follicular NHL). All patients had a regular follow-up evaluation, including complete clinical and laboratory evaluation, and final assessment of any suspect FDG-PET findings using other imaging procedures (computed tomography [CT] scan) and/or biopsy and/or clinical evolution. FDG-PET findings were reported as positive for relapse, inconclusive (when equivocal), or negative for relapse. Results PET enabled documentation of lymphoma relapse in 41 cases at 6 months, in 30 cases at 12 months, in 26 cases at 18 months, in 10 cases at 24 months, and in 11 cases at more than 36 months. All 36 patients with inconclusive positive PET underwent biopsy; only 12 (33%) of 36 patients had a concomitant suggestion of positivity on CT. A lymphoma relapse was diagnosed in 24 (66%) of 36 patients. Conclusion Our results confirm FDG-PET as a valid tool for follow-up of patients with HL and NHL. In patients with inconclusive positive results, histologic confirmation plays an important role in identifying true relapse.
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Affiliation(s)
- Pier Luigi Zinzani
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vittorio Stefoni
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Monica Tani
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Fanti
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gerardo Musuraca
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Paolo Castellucci
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Enrica Marchi
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Mariapaola Fina
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Valentina Ambrosini
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Cinzia Pellegrini
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Lapo Alinari
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Enrico Derenzini
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giancarlo Montini
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Alessandro Broccoli
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesco Bacci
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Pileri
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Michele Baccarani
- From the Institute of Hematology and Medical Oncology “L. & A. Seràgnoli,” University of Bologna; and Department of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
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Corapcioglu F, Oncel S, Berberoğlu K, Klç SC, Aydoğan A, Doğan S. False positivity of FDG-PET during hemophagocytic lymphohistiocytosis in a child with Hodgkin lymphoma in remission. J Pediatr Hematol Oncol 2009; 31:74-5. [PMID: 19125095 DOI: 10.1097/mph.0b013e31818bba1b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18F-FDG PET in Pediatric Lymphomas: A Comparison with Conventional Imaging. Cancer Biother Radiopharm 2008. [DOI: 10.1089/cbr.2007.0519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) represent 10% to 15% of all malignancies occurring in children younger than 20 years of age. Advances in cross-sectional imaging and the availability of positron emission tomography (PET) and PET-CT have had a major impact on imaging and management of pediatric patients. This article reviews the clinical features of lymphoma, focusing on the spectrum of imaging findings seen in diagnosis, staging, and follow-up of HL and NHL. Pediatric NHL has four major histologic subtypes: Burkitt lymphoma, diffuse large B-cell lymphoma, anaplastic large cell lymphoma, and lymphoblastic lymphoma. The most important subtype of HL is nodular sclerosis.
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Zeppa P, Picardi M, Cozzolino I, Troncone G, Lucariello A, De Renzo A, Pane F, Rotoli B, Vetrani A, Palombini L. Fine-needle aspiration cytology in the follow-up of Hodgkin lymphoma. Diagn Cytopathol 2008; 36:467-72. [PMID: 18528892 DOI: 10.1002/dc.20844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hodgkin lymphoma (HL) is characterized by long survival and risk of relapse and second neoplasm. The aim of this study is to evaluate the possibility of improving the accuracy of fine-needle cytology (FNC) in HL follow-up using Power Doppler ultrasound (US) assistance and immediate microscopic evaluation (ICE). The study was performed in two consecutive groups of 200 FNC in HL patients. In the first group FNC of palpable lymph-nodes or extra lymph-nodal masses were performed without US assistance except for impalpable and/or deep located masses (nonassisted group); In the second group, all the FNC were performed under Power Doppler US assistance with ICE and immediately repeated in inadequate cases (assisted group). Cytological diagnoses were controlled by histology (61) or clinical follow-up (69); sensitivity and specificity were calculated in the two groups and to evaluate the effect of Power Doppler alone, adequate cases were compared with the total number of FNC in each of the two groups.FNC identified 90 negative cases, 3 false negatives, 70 HL relapse, 16 inadequate and 14 suspicious; second neoplasia were diagnosed in 12 cases and all histologically confirmed. Sensitivity and specificity were 64 and 84% in the nonassisted group and 86 and 94% in the assisted group and there were significant differences between the number of adequate cases v.s. the total number of FNC in each of the two groups. Sensitivity and specificity in assisted FNC are higher than in nonassisted ones. The main advantage of assisted FNC in the follow-up of HL is to produce accurate diagnoses avoiding invasive biopsies.
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Affiliation(s)
- Pio Zeppa
- Dipartimento di Scienze Biomorfologiche e Funzionali, Facoltà di Medicina e Chirurgia, Università di Napoli Federico II, Napoli, Italia.
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Hines-Thomas M, Kaste SC, Hudson MM, Howard SC, Liu WA, Wu J, Kun LE, Shulkin BL, Krasin MJ, Metzger ML. Comparison of gallium and PET scans at diagnosis and follow-up of pediatric patients with Hodgkin lymphoma. Pediatr Blood Cancer 2008; 51:198-203. [PMID: 18428430 DOI: 10.1002/pbc.21574] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Positron emission tomography (PET) and gallium scans facilitate diagnosis and staging, evaluation of response to therapy, and monitoring for relapse in Hodgkin lymphoma (HL), but have not been compared in pediatric HL. PROCEDURE We performed concurrent PET and gallium scans on 44 pediatric HL patients at diagnosis, early response, off chemotherapy, and off-therapy evaluations. PET and gallium scans were compared to each other and to computed tomography (CT) alone to determine whether either modality led to a change in stage or modified the results of the early response evaluation, which was used to determine the radiation dose. RESULTS PET upstaged four patients at diagnosis (2 from stage I to II, one II to III, and one III to IV), but did not lead to a change in therapy in any of them. It changed response category in two patients at early response evaluation, leading to a change in radiation dose for 1 patient (25.5 Gy instead of 15 Gy to the spleen). Gallium did not change the stage of treatment for any patient. The negative predictive values for eventual lymphoma relapse of PET and gallium scans at off therapy were 89% and 83%, respectively; the positive predictive value of PET at off therapy is 29%. CONCLUSION PET appears to be superior to gallium in pediatric HL; future studies will determine the optimal timing of PET to assess early response and the utility of quantitative interpretation of the avidity of specific nodal sites.
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Early prediction of response to therapy: the clinical implications in Hodgkin’s and non-Hodgkin’s lymphoma. Eur J Nucl Med Mol Imaging 2008; 35:1413-20. [DOI: 10.1007/s00259-008-0787-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW The prognostic utility of midtreatment fluorine-18 fluorodeoxyglucose positron emission tomography (F-FDG PET) has become widely appreciated in aggressive B-cell non-Hodgkin's lymphoma and, more recently, in Hodgkin's lymphoma. Outcomes based on midtreatment FDG PET performed during primary and salvage therapy are reviewed and management strategies considered, with a focus on treatment intensification for poor-risk disease as identified by metabolic imaging. RECENT FINDINGS PET, when performed after as few as two cycles of primary chemotherapy, is strongly prognostic in certain aggressive lymphomas and provides information independently from validated prognostic indices. What constitutes a positive or negative scan is not always clear, particularly if there is minimal tracer uptake, and the causes of false positive and false negative scans must be considered. How to tailor therapy based on the midtreatment PET result is the focus of current trials and is presently being defined for both Hodgkin's and non-Hodgkin's lymphoma. SUMMARY Early PET has the strong potential to improve clinical outcomes by sparing good-risk patients from overly aggressive treatments, and by more accurately identifying poor-risk patients so as to guide changes in management. Treatment modifications on the basis of midtreatment PET are presently best made in clinical trial settings.
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