title: High total metabolic tumor volume in PET/CT predicts worse prognosis in diffuse large B cell lymphoma patients with bone marrow involvement in rituximab era.
abstract: Bone marrow involvement (BMI) in diffuse large B cell lymphoma (DLBCL) was naively regarded as an adverse clinical factor. However, it has been unknown which factor would separate clinical outcomes in DLBCL patients with BMI. Recently, metabolic tumor volume (MTV) on positron emission tomography/computed tomography (PET/CT) was suggested to predict prognosis in several lymphoma types. Therefore, we investigated whether MTV would separate the outcomes in DLBCL patients with BMI. MTV on PET/CT was defined as an initial tumor burden as target lesion ≥ standard uptake value, 2.5 in 107 patients with BMI. Intramedullary (IM) MTV was defined as extent of BMI and total MTV was as whole tumor burden. 260.5 cm(3) and 601.2 cm(3) were ideal cut-off values for dividing high and low MTV status in the IM and total lymphoma lesions in Receiver Operating Curve analysis. High risk NCCN-IPI (p<0.001, p<0.001), bulky disease (p=0.011, p=0.005), concordant subtype (p=0.025, p=0.029), high IM MTV status (p<0.001, p<0.001), high total MTV status (p<0.001, p<0.001), and ≥ 2CAs in BM (p=0.037, p=0.033) were significantly associated with progression-free survival (PFS) and overall survival (OS) than other groups. In multivariate analysis, high risk NCCN-IPI (PFS, p=0.006; OS, p=0.013), concordant subtype (PFS, p=0.005; OS, p=0.007), and high total MTV status (PFS, p<0.001; OS, p<0.001) had independent clinical impacts. MTV had prognostic significances for survivals in DLBCL with BMI.
authors: Department of Hematology-Oncology, Pusan National University Yangsan Hospital Medical Research Institute, Yangsan, Republic of Korea.
authors: Moo-Kon
authors: MK
authors: Song
authors: Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea. Electronic address: drydh1685@hotmail.com.
authors: Deok-Hwan
authors: DH
authors: Yang
authors: Department of Hematology, Gyeong-Sang National University Hospital, school of medicine, Gyeong-Sang National University Jinju, Republic of Korea.
authors: Gyeong-Won
authors: GW
authors: Lee
authors: Department of Hematology, Busan Haeundae Paik Hospital, Busan, Republic of Korea.
authors: Sung-Nam
authors: SN
authors: Lim
authors: Department of Nuclear medicine, Pusan National University Hospital, Busan, Republic of Korea.
authors: Seunghyeon
authors: S
authors: Shin
authors: Department of Nuclear medicine, Pusan National University Hospital, Busan, Republic of Korea.
authors: Kyoung June
authors: KJ
authors: Pak
authors: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea.
authors: Seong Young
authors: SY
authors: Kwon
authors: Department of Nuclear Medicine, Busan Haeundae Paik Hospital, Busan, Republic of Korea.
authors: Hye Kyung
authors: HK
authors: Shim
authors: Department of Nuclear Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
authors: Bong-Hoi
authors: BH
authors: Choi
authors: Department of Laboratory medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
authors: In-Suk
authors: IS
authors: Kim
authors: Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
authors: Dong-Hoon
authors: DH
authors: Shin
authors: Department of Hematology-Oncology, Pusan National University Yangsan Hospital Medical Research Institute, Yangsan, Republic of Korea.
authors: Seong-Geun
authors: SG
authors: Kim
authors: Department of Hematology-Oncology, Pusan National University Yangsan Hospital Medical Research Institute, Yangsan, Republic of Korea.
authors: So-Yeon
authors: SY
authors: Oh
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D019540:Area Under Curve; D001853:Bone Marrow / Q000473:pathology*; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000378:metabolism* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D000069283:Rituximab / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Bone marrow involvement; Diffuse large B cell lymphoma; Positron emission tomography