title: Use of positron emission tomography-computed tomography in the management of patients with chronic lymphocytic leukemia/small lymphocytic lymphoma.
abstract: Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) cells typically have low 2-deoxy-2-[(18)F]fluoro-d-glucose (FDG) avidity, and patients with CLL have an increased risk of developing FDG-avid aggressive lymphomas, second malignancies and infections. We hypothesized that FDG positron emission tomography-computed tomography (PET-CT) of the trunk is a sensitive method of detecting these complications in patients with CLL. Of the of 2299 patients with CLL seen in the Division of Hematology at Mayo Clinic Rochester between 1 January 2006 and 31 December 2011, 272 (11.8%) had 526 PET-CT scans and 472 (89.7%) of these were reported as abnormal. Among the 293 (55.7%) PET-CT scans used for routine evaluation of CLL, the PET component was of clinical value in only one instance. In contrast, in 83 (30.5%) patients, PET-CT scans used to evaluate new clinical complications localized high FDG-avidity lesions for biopsies. This resulted in clinically relevant new diagnoses in 32 patients, including those with more aggressive lymphoma (n = 16), non-hematological malignancies (n = 8) and opportunistic infections (n = 3). Twenty-seven patients had high FDG-avidity CLL, which was associated with prominent lymph node proliferation centers, an increased frequency of poor prognostic factors (17p13 deletion, unmutated immunoglobulin heavy chain variable gene [IGHV], expression of ZAP-70 and CD38) and a shorter overall survival. We conclude that FDG PET scans should not be used for routine surveillance of patients with CLL. However PET-CT scans are sensitive, but not specific, for detection of aggressive lymphomas, other cancers and systemic infections in patients with CLL.
authors.affiliation: Division of Hematology, Mayo Clinic , Rochester, MN , USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Conte
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Bowen
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Wiseman
authors.forename: Kari G
authors.initials: KG
authors.lastname: Rabe
authors.forename: Susan L
authors.initials: SL
authors.lastname: Slager
authors.forename: Susan M
authors.initials: SM
authors.lastname: Schwager
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Call
authors.forename: David S
authors.initials: DS
authors.lastname: Viswanatha
authors.forename: Clive S
authors.initials: CS
authors.lastname: Zent
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002869:Chromosome Aberrations; D019468:Disease Management; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D016130:Immunophenotyping; D007239:Infections / Q000175:diagnosis* / Q000209:etiology*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000175:diagnosis / Q000235:genetics; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000209:etiology*; D049268:Positron-Emission Tomography; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D007143:Immunoglobulin Heavy Chains; D019788:Fluorodeoxyglucose F18
keywords: CT; Chronic lymphocytic leukemia; PET; imaging; small lymphocytic lymphoma