RT Journal Article
SR Electronic
T1 Combined PET and Biopsy Evidence of Marrow Involvement Improves Prognostic Prediction in Diffuse Large B-Cell Lymphoma
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1591
OP 1597
DO 10.2967/jnumed.113.134486
VO 55
IS 10
A1 Cerci, Juliano J.
A1 Györke, Tamás
A1 Fanti, Stefano
A1 Paez, Diana
A1 Meneghetti, José Cláudio
A1 Redondo, Francisca
A1 Celli, Monica
A1 Auewarakul, Chirayu
A1 Rangarajan, Venkatesh
A1 Gujral, Sumeet
A1 Gorospe, Charity
A1 Campo, Maejoy V.
A1 Chung, June-Key
A1 Morris, Tim P.
A1 Dondi, Maurizio
A1 Carr, Robert
YR 2014
UL http://jnm.snmjournals.org/content/55/10/1591.abstract
AB Bone marrow is an important extranodal site in diffuse large B-cell lymphoma (DLBCL), and marrow histology has been incorporated into the new National Comprehensive Cancer Network international prognostic index. Marrow involvement demonstrated histologically confers poor prognosis but is identified by staging PET in more cases. How information from staging PET and biopsy should be combined to optimize outcome prediction remains unclear. Methods: The International Atomic Energy Agency sponsored a prospective international cohort study to better define the use of PET in DLBCL. As a planned subsidiary analysis, we examined the interplay of marrow involvement identified by PET and biopsy on clinical outcomes. Results: Eight countries contributed 327 cases with a median follow-up of 35 mo. The 2-y outcomes of cases with no evidence of marrow involvement (n = 231) were 81% (95% confidence interval [CI], 76%–86%) for event-free survival (EFS) and 88% (83%–91%) for overall survival (OS); cases identified only on PET (n = 61), 81% (69%–89%) for EFS and 88% (77%–94%) for OS; cases indentified only on biopsy (n = 10), 80% (41%–95%) for EFS and 100% for OS; or cases identified by both PET and biopsy (n = 25), 45% (25%–64%) for EFS and 55% (32%–73%) for OS. The hazard ratios for PET-negative/biopsy-negative cases versus PET-positive/biopsy-positive cases were 2.67 (95% CI, 1.48–4.79) for EFS and 3.94 (1.93–8.06) for OS. Conclusion: This large study demonstrates that positive iliac crest biopsy histology only confers poor prognosis for patients who also have abnormal marrow 18F-FDG uptake identified on the staging PET scan. Abnormal 18F-FDG uptake in marrow, when iliac crest biopsy histology is normal, has no adverse effect on outcomes.