Abstract 5204

Backgrounds:

As a bone marrow bopsy (BMB) is a painful and invasive procedure with a restrictive reliability as only a limited area of the bone marrow (BM) can be evaluated, role of FDG-PET/CT to demonstrate lymphomatous BM involvement as an alternative or at least a complementary to BMB is an area of interest. Several previous studies exist but most of them included heterogeneous types of lymphomas with various treatments.

Patients and methods:

To evaluate the role of FDG-PET/CT in detecting BM involvement, pre-treatment bilateral BMBs and FDG-PET/CT scans of 89 patients with diffuse large B-cell lymphoma (DLBCL) treated with standard immunochemotherapy, rituximab-CHOP were reviewed and analyzed. Uptake more than liver parenchyma intensity on FDG-PET/CT was interpreted as 'with a possibility' of involvement. The final interpretation on the possibility of BM involvement in each patient was reported after discussion among three nuclear medicine physicians and results of BMB were blinded at the time of FDG-PET/CT review. Fourteen patients (15.7%) had lymphomatous involvement based on BMB (BMB+) and 17 patients (19.1%) had the possibility of BM involvement on FDG-PET/CT (FDG-PET/CT+). Seventy-two patients (80.8%) had concordant results between BMB and FDG-PET/CT (7 patients were positive for both and 65 patients were negative for both), but 17 patients (19.2%) had a discordant interpretation (7 patients were BMB+ and FDG-PET/CT-, and 10 for BMB- and FDG-PET/CT+; table 1). Although BMB+ patients had an inferior 2-year EFS (37.0% vs. 79.8%, p < 0.001) and OS (36.3% vs. 81.0%, p < 0.001) compared to BMB- patients, no differences in EFS (62.6% vs. 72.7%, p = 0.185) and OS (59.4% vs. 78.0%, p = 0.146) were shown between FDG-PET/CT+ and FDG-PET/CT- patients. Six of 7 patients with BMB+ and FDG-PET/CT+ had a diffuse involvement on FDG-PET/CT whereas 9 of 10 patients with BMB- and FDG-PET/CT+ had a focal BM involvement on FDG-PET/CT (table 2). Six of 7 patients with diffuse involvement on FDG-PET/CT were BMB+ whereas only 1 of 10 patients with focal BM involvement on FDG-PET/CT were BMB+ (table 2). It is likely therefore that patients with diffuse BM involvement on FDG-PET/CT had higher probability for BMB+ and they might have poorer survival than those with focal BM involvement.

Table 1.
FDG-PET/CT-FDG-PET/CT+Total
BMB- 65 10 75 
BMB+ 7 7 14 
Total 72 17 89 
FDG-PET/CT-FDG-PET/CT+Total
BMB- 65 10 75 
BMB+ 7 7 14 
Total 72 17 89 
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Table 2.
BMB result (side)FDG-PET/CT result, pattern (lesion)Revised IPI
BMB+and FDG-PET/CT+    
Patient 1 + (right only) +, focal (right humerus, rib) Poor 
Patient 2 + (left only) +, diffuse Poor 
Patient 3 + (bilateral) +, diffuse Poor 
Patient 4 + (bilateral) +, diffuse Poor 
Patient 5 + (left only) +, diffuse Poor 
Patient 6 + (left only) +, diffuse Good 
Patient 7 + (bilateral) +, diffuse Good 
BMB+ and FDG-PET/CT-    
Patient 8 + (bilateral) – Poor 
Patient 9 + (right only) – Poor 
Patient 10 + (bilateral) – Poor 
Patient 11 + (bilateral) – Poor 
Patient 12 + (bilateral) – Poor 
Patient 13 + (bilateral) – Good 
Patient 14 + (left only) – Good 
BMB- and FDG-PET/CT+    
Patient 15 – +, focal (sternum) Poor 
Patient 16 – +, focal (thoracic spine) Poor 
Patient 17 – +, focal (right humerus, pelvis) Poor 
Patient 18 – +, focal (left femur) Poor 
Patient 19 – +, diffuse Good 
Patient 20 – +, focal (thoracic spine) Good 
Patient 21 – +, focal (left femur) Good 
Patient 22 – +, focal (left femur, pelvis) Good 
Patient 23 – +, focal (lumbar spine) Very good 
Patient 24 – +, focal (pelvis) Very good 
BMB result (side)FDG-PET/CT result, pattern (lesion)Revised IPI
BMB+and FDG-PET/CT+    
Patient 1 + (right only) +, focal (right humerus, rib) Poor 
Patient 2 + (left only) +, diffuse Poor 
Patient 3 + (bilateral) +, diffuse Poor 
Patient 4 + (bilateral) +, diffuse Poor 
Patient 5 + (left only) +, diffuse Poor 
Patient 6 + (left only) +, diffuse Good 
Patient 7 + (bilateral) +, diffuse Good 
BMB+ and FDG-PET/CT-    
Patient 8 + (bilateral) – Poor 
Patient 9 + (right only) – Poor 
Patient 10 + (bilateral) – Poor 
Patient 11 + (bilateral) – Poor 
Patient 12 + (bilateral) – Poor 
Patient 13 + (bilateral) – Good 
Patient 14 + (left only) – Good 
BMB- and FDG-PET/CT+    
Patient 15 – +, focal (sternum) Poor 
Patient 16 – +, focal (thoracic spine) Poor 
Patient 17 – +, focal (right humerus, pelvis) Poor 
Patient 18 – +, focal (left femur) Poor 
Patient 19 – +, diffuse Good 
Patient 20 – +, focal (thoracic spine) Good 
Patient 21 – +, focal (left femur) Good 
Patient 22 – +, focal (left femur, pelvis) Good 
Patient 23 – +, focal (lumbar spine) Very good 
Patient 24 – +, focal (pelvis) Very good 
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Conclusion:

The results suggest that FDG-PET/CT had a limited value to detect BM involvement in patients with DLBCL. It may not be justified to upgrade patient's Ann Arbor stage to IV according to focal hypermetabolic BM lesion on FDG-PET/CT. Until additional results on the role of FDG-PET/CT in detecting BM involvement available, FDG-PET/CT should be used as an adjuvant rather than an alternative in detecting BM involvement in patients with newly diagnosed DLBCL.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
bone marrow involvement, diffuse large b-cell lymphoma, fluorodeoxyglucose positron emission tomography, computed tomography, immunologic adjuvants, lymphoma, nuclear medicine procedure, pain, pharmaceutical adjuvants, r-chop

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2011 by The American Society of Hematology
2011
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