title: Correlation between FDG/PET, histology, characteristics, and survival in 332 patients with chronic lymphoid leukemia.
abstract: Richter syndrome (RS) is associated with poor outcome. The prognosis of patients with histologically aggressive chronic lymphocytic leukemia (CLL), or HAC, has not been studied. We aimed to correlate 2-deoxy-2-[(18)F]fluoroglucose/positron emission tomography (FDG/PET) data, histological diagnosis, clinical characteristics, and survival in patients with CLL. A total of 332 patients with CLL were histologically classified as: 95 RS, 117 HAC, and 120 histologically indolent CLL (HIC). HAC and RS patients had higher maximum standardized uptake value (SUVmax), more frequent constitutional symptoms, poorer performance status (PS), lower hemoglobin and platelets, and higher lactate dehydrogenase and β-2-microglobulin. An SUVmax ≥10 strongly correlated with mortality (overall survival [OS], 56.7 vs 6.9 months in patients with SUVmax <10 vs ≥10). Survival of patients with RS and HAC was similar among patients with SUVmax <10 or ≥10. SUVmax ≥10, PS ≥2, bulky disease, and age ≥65 were independently associated with shorter OS. In patients undergoing both fine-needle aspiration and biopsy, the former proved diagnostically inadequate in 23%, 29%, and 53% of HIC, HAC, and RS, respectively. FDG/PET is a useful diagnostic tool in patients with CLL and suspected transformation. Patients with HAC show different characteristics and worse prognosis compared with those with HIC. Patients with different CLL phases, but similar SUVmax have similar outcome. Tissue biopsy should be preferred for diagnosing RS.
authors.affiliation: Department of Leukemia.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Falchi
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Keating
authors.forename: Edith M
authors.initials: EM
authors.lastname: Marom
authors.forename: Mylene T
authors.initials: MT
authors.lastname: Truong
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Schlette
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Sargent
authors.forename: Long
authors.initials: L
authors.lastname: Trinh
authors.forename: Xuemei
authors.initials: X
authors.lastname: Wang
authors.forename: Susan C
authors.initials: SC
authors.lastname: Smith
authors.forename: Nitin
authors.initials: N
authors.lastname: Jain
authors.forename: Zeev
authors.initials: Z
authors.lastname: Estrov
authors.forename: Susan
authors.initials: S
authors.lastname: O'Brien
authors.forename: William G
authors.initials: WG
authors.lastname: Wierda
authors.forename: Susan
authors.initials: S
authors.lastname: Lerner
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ferrajoli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D016896:Treatment Outcome
chemical_list: D019788:Fluorodeoxyglucose F18