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Song GY, Jung SH, Ahn SY, Kim M, Ahn JS, Lee JJ, Kim HJ, Moon JB, Yoo SW, Kwon SY, Min JJ, Bom HS, Kang SR, Yang DH. Prognostic Significance Of Sequential 18f-fdg Pet/Ct During Frontline Treatment Of Peripheral T Cell Lymphomas. Korean J Intern Med 2024; 39:327-337. [PMID: 38268194 PMCID: PMC10918377 DOI: 10.3904/kjim.2023.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/03/2023] [Accepted: 10/19/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND/AIMS The prognostic significance of 18F-fluorodeoxyglucose (FDG)-positron emission tomography-computed tomography (PET/CT) in peripheral T-cell lymphomas (PTCLs) are controversial. We explored the prognostic impact of sequential 18F-FDG PET/CT during frontline chemotherapy of patients with PTCLs. METHODS In total, 143 patients with newly diagnosed PTCLs were included. Sequential 18F-FDG PET/CTs were performed at the time of diagnosis, during chemotherapy, and at the end of chemotherapy. The baseline total metabolic tumor volume (TMTV) was calculated using the the standard uptake value with a threshold method of 2.5. RESULTS A baseline TMTV of 457.0 cm3 was used to categorize patients into high and low TMTV groups. Patients with a requirehigh TMTV had shorter progression-free survival (PFS) and overall survival (OS) than those with a low TMTV (PFS, 9.8 vs. 26.5 mo, p = 0.043; OS, 18.9 vs. 71.2 mo, p = 0.004). The interim 18F-FDG PET/CT response score was recorded as 1, 2-3, and 4-5 according to the Deauville criteria. The PFS and OS showed significant differences according to the interim 18F-FDG PET/CT response score (PFS, 120.7 vs. 34.1 vs. 5.1 mo, p < 0.001; OS, not reached vs. 61.1 mo vs. 12.1 mo, p < 0.001). CONCLUSION The interim PET/CT response based on visual assessment predicts disease progression and survival outcome in PTCLs. A high baseline TMTV is associated with a poor response to anthracycline-based chemotherapy in PTCLs. However, TMTV was not an independent predictor for PFS in the multivariate analysis.
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Affiliation(s)
- Ga-Young Song
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Seo-Yeon Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Mihee Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Jae-Sook Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Hyeoung-Joon Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Jang Bae Moon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Su Woong Yoo
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
| | - Deok-Hwan Yang
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun,
Korea
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Hu L, Luo N, Li L, Qiu D, Hu X. A preliminary investigation of the relationship between 18F-FDG PET/CT metabolic parameters and prognosis in angioimmunoblastic T-cell lymphoma. Front Oncol 2023; 13:1171048. [PMID: 37397396 PMCID: PMC10311063 DOI: 10.3389/fonc.2023.1171048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose The goal of the study was to determine the prognostic significance of metabolic parameters in baseline 18F-FDG PET/CT images obtained from patients with angioimmunoblastic T-cell lymphoma (AITL). Methods Forty patients with pathologically diagnosed AITL who had baseline 18F-FDG PET/CT between May 2014 and May 2021 were assessed as part of this study. Maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), and total metabolic tumor volume (TMTV) were obtained and analyzed. In addition, many relevant features were evaluated, including sex, age, staging, International Prognostic Index (IPI), prediction index for T-cell lymphoma (PIT), Ki-67, and so on. Estimates of progression-free survival (PFS) and overall survival (OS) were determined using the log-rank test and Kaplan-Meier. Results The median follow-up was 30.2 months (interquartile range 9.82-43.03). Throughout the follow-up period, 29 (72.5%) deaths occurred and 22 (55.0%) patients made progress. The rates for 2- and 3-year PFS were 43.6% and 26.4%, respectively. The 3- and 5-year OS were 42.6% and 21.5%. For TMTV, TLG, and SUVmax, the cut-off values were 87.0 cm3, 711.1, and 15.8, respectively. Poorer PFS and OS were substantially correlated with high SUVmax and TLG. An increased TMTV suggested a shorter OS. TLG performed independently as OS predictors in multivariate analysis. The risk score for predicting the prognosis of AITL includes the TMTV, TLG, SUVmax, and IPI scores, with 4.5 for TMTV, 2 for TLG, 1.5 for IPI scores, and 1 for SUVmax. Three risk categories of patients with AITL had 3-year OS rates of 100.0%, 43.3%, and 25.0%, respectively. Conclusion Baseline TLG was a strong predictor of OS. Here a new prognostic scoring system for AITL based on the clinical indicators and PET/CT metabolic parameters was constructed, which might make stratification of prognosis easy and also help to individualize treatment.
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Affiliation(s)
| | | | | | | | - Xiaoyan Hu
- *Correspondence: Dasheng Qiu, ; Xiaoyan Hu,
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3
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McDonald EO, Amanullah AA, Park PSU, Song W, Werner TJ, Alavi A, Revheim ME. The role of 18F-FDG PET/CT in primary cutaneous lymphoma: an educational review. Ann Nucl Med 2023; 37:328-348. [PMID: 37095393 DOI: 10.1007/s12149-023-01830-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/05/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Primary cutaneous lymphoma (PCL) is a cutaneous non-Hodgkin's lymphoma that originates in the skin and lacks extracutaneous spread upon initial diagnosis. The clinical management of secondary cutaneous lymphomas is different from that of PCLs, and earlier detection is associated with better prognosis. Accurate staging is necessary to determine the extent of disease and to choose the appropriate treatment. The aim of this review is to investigate the current and potential roles of 18F- fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) in the diagnosis, staging, and monitoring of PCLs. METHODS A focused review of the scientific literature was performed using inclusion criteria to filter results pertaining to human clinical studies performed between 2015 and 2021 that analyzed cutaneous PCL lesions on 18F PET/CT imaging. RESULTS & CONCLUSION A review of 9 clinical studies published after 2015 concluded that 18F-FDG PET/CT is highly sensitive and specific for aggressive PCLs and proved valuable for identifying extracutaneous disease. These studies found 18F-FDG PET/CT highly useful for guiding lymph node biopsy and that imaging results influenced therapeutic decision in many cases. These studies also predominantly concluded that 18F-FDG PET/CT is more sensitive than computed tomography (CT) alone for detection of subcutaneous PCL lesions. Routine revision of nonattenuation-corrected (NAC) PET images may improve the sensitivity of 18F-FDG PET/CT for detection of indolent cutaneous lesions and may expand the potential uses of 18F-FDG PET/CT in the clinic. Furthermore, calculating a global disease score from 18F-FDG PET/CT at every follow-up visit may simplify assessment of disease progression in the early clinical stages, as well as predict the prognosis of disease in patients with PCL.
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Affiliation(s)
| | - Amir A Amanullah
- Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Peter Sang Uk Park
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - William Song
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas J Werner
- Department of Radiology, University of Pennsylvania Hospital, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania Hospital, Philadelphia, PA, USA
| | - Mona-Elisabeth Revheim
- The Intervention Center, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway.
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Xie Y, Teng Y, Jiang C, Ding C, Zhou Z. Prognostic value of 18F-FDG lesion dissemination features in patients with peripheral T-cell lymphoma (PTCL). Jpn J Radiol 2023:10.1007/s11604-023-01398-y. [PMID: 36752954 DOI: 10.1007/s11604-023-01398-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE To explore the prognostic value of the distance between the two lesions that were farthest apart (Dmax) on baseline 18F-FDG PET/CT in peripheral T lymphoma (PTCL) and establish a new prognostic model for predicting the survival outcomes of patients with PTCL. METHODS In this study, a retrospective analysis of 95 patients with PTCL who underwent baseline 18F-FDG PET/CT was performed to assess the predictive value of Dmax. The total metabolic tumour volume (TMTV), total lesion glycolysis (TLG), standardized uptake value (SUV), and Dmax were calculated with LIFEx software. Progression-free survival (PFS) and overall survival (OS) were used as endpoints. The prognostic model was developed based on the results of the multivariate analysis. The time-dependent area under the ROC curve (tdAUC), calibration curves, Harrell C-index, and decision curve analysis (DCA) were used to assess the model. RESULTS Patients were followed up for a median of 17.0 months. Multivariate analysis showed that bone marrow biopsy (BMB) and Dmax were independent predictors of PFS (HR: 1.889, P = 0.039; HR: 1.965, P = 0.047) and OS (HR: 1.923, P = 0.031; HR: 1.982, P = 0.034). The model consisting of Dmax, TMTV, and BMB had substantial prognostic value for survival outcomes of PTCL and could successfully identify four groups of patients with significantly different prognoses (χ2 = 13.731, P = 0.003 for PFS; χ2 = 11.841, P = 0.008 for OS). The tdAUC, C-index, calibration curves, and DCA supported that the model was superior to the prognostic index for T-cell lymphoma (PIT) and International Prognostic Index (IPI) scores. CONCLUSION BMB and Dmax were independent predictors of PTCL in our study. Moreover, a prognostic model based on the Dmax, TMTV, and BMB could be useful for predicting the survival outcomes of patients with PTCL.
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Affiliation(s)
- Yiting Xie
- Nanjing Drum Tower Hospital, Clinical College of Jiangsu University, Nanjing, China
| | - Yue Teng
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210000, China
| | - Chong Jiang
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210000, China
| | - Chongyang Ding
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, Clinical College of Jiangsu University, Nanjing, China.
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5
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Gong H, Tang B, Li T, Li J, Tang L, Ding C. The added prognostic values of baseline PET dissemination parameter in patients with angioimmunoblastic T-cell lymphoma. EJHAEM 2023; 4:67-77. [PMID: 36819177 PMCID: PMC9928789 DOI: 10.1002/jha2.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/30/2022]
Abstract
To explore the prognostic values of baseline 2-deoxy-2-[18F] fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) dissemination parameter in angioimmunoblastic T-cell lymphoma (AITL) and its added values to total metabolic tumour volume (TMTV). Eighty-one AITL patients with at least two FDG-avid lesions in baseline PET/CT were retrospectively included. PET parameters including TMTV and the distance between the two lesions that are the furthest apart (Dmax) were obtained. Univariate Cox analysis showed that both Dmax and TMTV were risk factors for progression-free survival (PFS) and overall survival (OS). Multivariate Cox analysis models of different combinations showed that high Dmax (> 65.7 cm) could independently predict both PFS and OS, while high TMTV (>456.6 cm3) was only significant for OS. A concise PET model based on TMTV and Dmax can effectively risk-stratify patients. PFS and OS rates were significantly lower in patients with high Dmax and high TMTV than in patients with low Dmax and low TMTV (3-year PFS rate: 15.0% vs. 48.7%, p = 0.001; 3-year OS rate: 27.6% vs. 79.0%, p < 0.001). Dmax can directly reflect the disease dissemination characteristic and has a significant prognostic value for FDG-avid AITL patients. It has the potential to be introduced into new risk stratification models for tailored treatment.
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Affiliation(s)
- Huanyu Gong
- Department of Nuclear MedicineJiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Bo Tang
- Department of RadiologyShuyang Hospital of Traditional Chinese MedicineSuqianChina
| | - Tiannv Li
- Department of Nuclear MedicineJiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jianyong Li
- Department of HematologyJiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Lijun Tang
- Department of Nuclear MedicineJiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Chongyang Ding
- Department of Nuclear MedicineJiangsu Province HospitalThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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Jemaa S, Paulson JN, Hutchings M, Kostakoglu L, Trotman J, Tracy S, de Crespigny A, Carano RAD, El-Galaly TC, Nielsen TG, Bengtsson T. Full automation of total metabolic tumor volume from FDG-PET/CT in DLBCL for baseline risk assessments. Cancer Imaging 2022; 22:39. [PMID: 35962459 PMCID: PMC9373298 DOI: 10.1186/s40644-022-00476-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background Current radiological assessments of 18fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging data in diffuse large B-cell lymphoma (DLBCL) can be time consuming, do not yield real-time information regarding disease burden and organ involvement, and hinder the use of FDG-PET to potentially limit the reliance on invasive procedures (e.g. bone marrow biopsy) for risk assessment. Methods Our aim is to enable real-time assessment of imaging-based risk factors at a large scale and we propose a fully automatic artificial intelligence (AI)-based tool to rapidly extract FDG-PET imaging metrics in DLBCL. On availability of a scan, in combination with clinical data, our approach generates clinically informative risk scores with minimal resource requirements. Overall, 1268 patients with previously untreated DLBCL from the phase III GOYA trial (NCT01287741) were included in the analysis (training: n = 846; hold-out: n = 422). Results Our AI-based model comprising imaging and clinical variables yielded a tangible prognostic improvement compared to clinical models without imaging metrics. We observed a risk increase for progression-free survival (PFS) with hazard ratios [HR] of 1.87 (95% CI: 1.31–2.67) vs 1.38 (95% CI: 0.98–1.96) (C-index: 0.59 vs 0.55), and a risk increase for overall survival (OS) (HR: 2.16 (95% CI: 1.37–3.40) vs 1.40 (95% CI: 0.90–2.17); C-index: 0.59 vs 0.55). The combined model defined a high-risk population with 35% and 42% increased odds of a 4-year PFS and OS event, respectively, versus the International Prognostic Index components alone. The method also identified a subpopulation with a 2-year Central Nervous System (CNS)-relapse probability of 17.1%. Conclusion Our tool enables an enhanced risk stratification compared with IPI, and the results indicate that imaging can be used to improve the prediction of central nervous system relapse in DLBCL. These findings support integration of clinically informative AI-generated imaging metrics into clinical workflows to improve identification of high-risk DLBCL patients. Trial Registration Registered clinicaltrials.gov number: NCT01287741. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00476-0.
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Affiliation(s)
- S Jemaa
- 1PHC Imaging, Genentech, Inc, South San Francisco, CA, USA
| | - J N Paulson
- Biostatistics, Genentech, Inc, South San Francisco, CA, USA
| | - M Hutchings
- Department of HaematologyRigshospitalet, Copenhagen, Denmark
| | - L Kostakoglu
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - J Trotman
- Department of Haematology, Concord Repatriation General Hospital, University of Sydney, Concord, NSW, Australia
| | - S Tracy
- Biostatistics, Genentech, Inc, South San Francisco, CA, USA
| | - A de Crespigny
- Clinical Imaging Group, Genentech, Inc, South San Francisco, CA, USA
| | - R A D Carano
- 1PHC Imaging, Genentech, Inc, South San Francisco, CA, USA
| | - T C El-Galaly
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - T G Nielsen
- Pharmaceutical Development Clinical Oncology, F. Hoffmann-La Roche Ltd, Bldg 1, Grenzarcherstrasse 124m, CH-4070, Basel, Switzerland.
| | - T Bengtsson
- 1PHC Imaging, Genentech, Inc, South San Francisco, CA, USA.,Department of Statistics, University of California-Berkeley, Berkeley, CA, USA
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Baseline 18 F-FDG PET/CT May Portend the Prognosis of Patients With Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphoma After First-Line Treatment. Clin Nucl Med 2022; 47:954-960. [PMID: 35961637 DOI: 10.1097/rlu.0000000000004362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The outcome of patients with Waldenström macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) is variable. We aim to study if baseline 18 F-FDG PET/CT has some prognostic significance in WM/LPL. METHODS Thirty-three patients with newly diagnosed WM/LPL who underwent baseline 18 F-FDG PET/CT and received active treatment thereafter were recruited in this retrospective study. Semiquantitative indices of baseline 18 F-FDG PET/CT were measured as total lesion glycolysis (TLG), metabolic tumor volume (MTV), and SUV max . The patients were followed up for at least 3 years or until reaching the endpoint, which were defined as progression-free survival (PFS) and the time to next treatment (TTNT). RESULTS The overall response rate of the first-line treatment in the recruited patients was 84.8% (28/33). The 3-year PFS and overall survival rates were 56.3% and 89.3%, respectively. Patients with PFS <36 months and TTNT <36 months showed TLG and MTV significantly higher than those with PFS ≥36 months and TTNT ≥36 months ( P < 0.05). SUV max in patients with PFS <36 months was significantly higher than those with PFS ≥36 months ( P = 0.033). Receiver operating characteristic analysis demonstrated that cutoff values of TLG >291.28 SUVbw * mL, MTV >108.78 mL, and SUV max >3.16 were optimal for predicting PFS <36 months. Kaplan-Meier analysis showed that TLG >291.28 SUVbw * mL and MTV >108.78 mL were predictive for shorter PFS ( P = 0.003) and TTNT ( P = 0.002). In multivariate analysis, TLG >291.28 SUVbw * mL and MTV >108.78 mL were independent predictors for shorter PFS (hazard ratio, 3.06; 95% confidence interval, 1.09-8.57; P = 0.033) and TTNT (hazard ratio, 10.01; 95% confidence interval, 2.56-39.22; P = 0.001). CONCLUSIONS The metabolic indices of TLG and MTV in baseline 18 F-FDG PET/CT were independent prognostic factors to predict PFS and TTNT in patients with WM/LPL.
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PET imaging of lymphomas. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00047-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Tari G, Lemonnier F, Morschhauser F. Epigenetic focus on angioimmunoblastic T-cell lymphoma: pathogenesis and treatment. Curr Opin Oncol 2021; 33:400-405. [PMID: 34230442 DOI: 10.1097/cco.0000000000000773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Angioimmunoblastic T-cell lymphoma (AITL) is a frequent peripheral T-cell lymphoma affecting elderly patients with a poor outcome when treated with conventional chemotherapy. Molecular studies revealed a homogenous mutational landscape gathering anomalies in genes regulating the DNA methylation and hydroxymethylation and anomalies in T-cell signalling. RECENT FINDINGS Recent studies indicate that AITL emerges from a TET2 and/or DNMT3A mutated clonal haematopoiesis. This clonal haematopoiesis bearing mutations altering DNA hydroxymethylation can explain the observed coexistence of AITL with myeloid neoplasms. In addition, AITL development requires AITL-specific mutations, such as the RHOAG17V mutations. Combination of TET2 and RHOAG17V alterations results in the development of AITL-like disease in mouse models. The impact of the presence of these mutations on patient outcome seems limited and new biological factor predicting treatment response and survival remains to be determined. At the therapeutic level, therapies targeting epigenetic changes, such as histone deacetylase inhibitors and the hypomethylating 5-azacytidine agent, could have efficacy in this disease and gave promising results. Recent progress in mouse model development should allow development of new treatments. SUMMARY Epigenetic changes are frequent in AITL and could be a promising target.
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Affiliation(s)
| | - François Lemonnier
- Univ Paris Est Créteil, INSERM, IMRB
- AP-HP, Groupe hospitalo-universitaire Chenevier Mondor, Service Unité Hémopathies Lymphoides, Créteil
| | - Franck Morschhauser
- University Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
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10
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Prognostic value of baseline total metabolic tumour volume of 18F-FDG PET/CT imaging in patients with angioimmunoblastic T-cell lymphoma. EJNMMI Res 2021; 11:64. [PMID: 34264417 PMCID: PMC8282837 DOI: 10.1186/s13550-021-00807-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/24/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose The aim of this study was to explore the prognostic value of baseline metabolic parameters of 18F-FDG PET/CT imaging in patients with angioimmunoblastic T-cell lymphoma (AITL). Materials and methods Fifty-six AITL patients (average age 64.0 ± 1.3 years) diagnosed pathologically from August 2009 to August 2019 were enrolled in this retrospective study. The total metabolic tumour volume (TMTV), total lesion glycolysis (TLG), maximum standardized uptake value (SUVmax), and correlated clinical characteristics were collected and analysed. TMTV was computed with the 41% SUVmax threshold method. The chi-square test or Fisher’s exact probability method was used to compare clinical characteristics. Kaplan–Meier curves were used to describe progression-free survival (PFS) and overall survival (OS). The log-rank test was used to analyse the difference within groups. The statistically significant factors in the univariate regression analysis were incorporated into the Cox risk proportional regression model for multivariate survival analysis. Results The TMTV cut-off value was 514.6 cm3 from the ROC curve analysis. Forty (71.4%) patients progressed and 31 (55.4%) patients died within a median follow-up time of 19.1 (interquartile range 7.8–34.6) months. The 1-year and 3-year PFS rates were 42.9% and 30.1%, and the 3-year and 5-year OS rates were 45.9% and 34.4%, respectively. Univariate survival analysis showed that high TMTV and TLG may be the factors contributing to poor PFS and OS. Multivariate analysis showed that TMTV and prognostic index for T-cell lymphoma (PIT) were independent parameters for PFS and OS in AITL patients. TMTV, combined with PIT, may have better risk stratification performance than TMTV alone. Conclusions Baseline TMTV and PIT were independent prognostic predictors in AITL patients. The combination of TMTV and PIT can facilitate prognostic stratification and contribute to personalized therapy.
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Zafar S, Sharma RK, Cunningham J, Mahalingam P, Attygalle AD, Khan N, Cunningham D, El-Sharkawi D, Iyengar S, Sharma B. Current and future best practice in imaging, staging, and response assessment for Non-Hodgkin's lymphomas: the Specialist Integrated Haematological Malignancy Imaging Reporting (SIHMIR) paradigm shift. Clin Radiol 2021; 76:391.e1-391.e18. [PMID: 33579517 DOI: 10.1016/j.crad.2020.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
Non-Hodgkin's lymphoma (NHL) encompasses over 40 different haematological malignancies, including low and high-grade neoplasms, such as follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) respectively. A key clinical issue in the context of NHL is delayed and inaccurate diagnosis, which contributes adversely to patient morbidity and mortality. This article will address relevant imaging aspects, with particular reference to advancements in NHL imaging, including computed tomography (CT), integrated positron-emission tomography (PET)-CT, and magnetic resonance imaging (MRI). We provide multiparametric (anato-functional) imaging display items, including histological correlation. We will also introduce our original concept of "Specialist Integrated Haematological Malignancy Imaging Reporting" (SIHMIR), a paradigm shift in lymphoma radiology.
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Affiliation(s)
- S Zafar
- Department of Radiology, The Royal Marsden NHS Trust, London, UK.
| | - R K Sharma
- College of Medicine and Health, University of Exeter, UK
| | - J Cunningham
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - P Mahalingam
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - A D Attygalle
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - N Khan
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - D Cunningham
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - D El-Sharkawi
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - S Iyengar
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK; The Institute of Cancer Research, London, UK
| | - B Sharma
- Department of Radiology, The Royal Marsden NHS Trust, London, UK; The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
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