title: Combined PET and biopsy evidence of marrow involvement improves prognostic prediction in diffuse large B-cell lymphoma.
abstract: 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.
  
  
  CONCLUSIONS
  This large study demonstrates that positive iliac crest biopsy histology only confers poor prognosis for patients who also have abnormal marrow (18)F-FDG uptake identified on the staging PET scan. Abnormal (18)F-FDG uptake in marrow, when iliac crest biopsy histology is normal, has no adverse effect on outcomes.
authors.affiliation: Quanta Diagnóstico e Terapia, Curitiba, Brazil cercijuliano@hotmail.com.
authors.forename: Juliano J
authors.initials: JJ
authors.lastname: Cerci
authors.affiliation: ScanoMed Medical Diagnostic Ltd., Budapest, Hungary Department of Nuclear Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Györke
authors.affiliation: Policlinico S. Orsola Malpighi, Universita de Bologna, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
authors.affiliation: Division of Human Health, Department of Nuclear Sciences and Application, International Atomic Energy Agency (IAEA), Vienna, Austria.
authors.forename: Diana
authors.initials: D
authors.lastname: Paez
authors.affiliation: Hospital de Clinicas, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: José Cláudio
authors.initials: JC
authors.lastname: Meneghetti
authors.affiliation: Oncologic Clinic, Fundación Arturo Lopez Perez, Santiago, Chile.
authors.forename: Francisca
authors.initials: F
authors.lastname: Redondo
authors.affiliation: Policlinico S. Orsola Malpighi, Universita de Bologna, Bologna, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Celli
authors.affiliation: Chulabhorn Cancer Centre and Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
authors.forename: Chirayu
authors.initials: C
authors.lastname: Auewarakul
authors.affiliation: Departments of Nuclear Medicine and Pathology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Rangarajan
authors.affiliation: Departments of Nuclear Medicine and Pathology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Gujral
authors.affiliation: St. Luke's Medical Center, Quezon City, Manila, Philippines.
authors.forename: Charity
authors.initials: C
authors.lastname: Gorospe
authors.affiliation: St. Luke's Medical Center, Quezon City, Manila, Philippines.
authors.forename: Maejoy V
authors.initials: MV
authors.lastname: Campo
authors.affiliation: Seoul National University Hospital, Seoul, South Korea.
authors.forename: June-Key
authors.initials: JK
authors.lastname: Chung
authors.affiliation: MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, United Kingdom; and.
authors.forename: Tim P
authors.initials: TP
authors.lastname: Morris
authors.affiliation: Policlinico S. Orsola Malpighi, Universita de Bologna, Bologna, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Dondi
authors.affiliation: Department of Haematology, Guy's and St Thomas' Hospital, London, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Carr
mesh_terms: D000328:Adult; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology; D001854:Bone Marrow Cells / Q000166:cytology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: International Prognostic Index; bone marrow; diffuse large B-cell lymphoma; positron emission tomography