title: Prognostic Value of Bone Marrow Tracer Uptake Pattern in Baseline PET Scans in Hodgkin Lymphoma: Results from an International Collaborative Study.
abstract: PET/CT-ascertained bone marrow involvement (BMI) constitutes the single most important reason for upstaging by PET/CT in Hodgkin lymphoma (HL). However, BMI assessment in PET/CT can be challenging. This study analyzed the clinicopathologic correlations and prognostic meaning of different patterns of bone marrow (BM)18F-FDG uptake in HL.Methods:One hundred eighty newly diagnosed early unfavorable and advanced-stage HL patients, all scanned at baseline and after 2 adriamycin-bleomycin-vinblastine-dacarbazine (ABVD) courses with18F-FDG PET, enrolled in 2 international studies aimed at assessing the role of interim PET scanning in HL, were retrospectively included. Patients were treated with ABVD × 4-6 cycles and involved-field radiation when needed, and no treatment adaptation on interim PET scanning was allowed. Two masked reviewers independently reported the scans.Results:Thirty-eight patients (21.1%) had focal lesions (fPET+), 10 of them with a single (unifocal) and 28 with multiple (multifocal) BM lesions. Fifty-three patients (29.4%) had pure strong (>liver) diffuse uptake (dPET+) and 89 (48.4%) showed no or faint (≤liver) BM uptake (nPET+). BM biopsy was positive in 6 of 38 patients (15.7%) for fPET+, in 1 of 53 (1.9%) for dPET+, and in 5 of 89 (5.6%) for nPET+dPET+was correlated with younger age, higher frequency of bulky disease, lower hemoglobin levels, higher leukocyte counts, and similar diffuse uptake in the spleen. Patients with pure dPET+had a 3-y progression-free survival identical to patients without any18F-FDG uptake (82.9% and 82.2%, respectively,P= 0.918). However, patients with fPET+ (either unifocal or multifocal) had a 3-y progression-free survival significantly inferior to patients with dPET+ and nPET+ (66.7% and 82.5%, respectively,P =0.03). The κ values for interobserver agreement were 0.84 for focal uptake and 0.78 for diffuse uptake.Conclusion:We confirmed that18F-FDG PET scanning is a reliable tool for BMI assessment in HL, and BM biopsy is no longer needed for routine staging. Moreover, the interobserver agreement for BMI in this study proved excellent and only focal18F-FDG BM uptake should be considered as a harbinger of HL.
authors.affiliation: Nuclear Medicine Department, A. Lacassagne Cancer Center, Nice, France.
authors.forename: Colette
authors.initials: C
authors.lastname: Zwarthoed
authors.affiliation: Hematology Department, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Tarec Cristoffer
authors.initials: TC
authors.lastname: El-Galaly
authors.affiliation: Hematology Department, S. Croce Hospital, Cuneo, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Canepari
authors.affiliation: Nuclear Medicine Department, A. Lacassagne Cancer Center, Nice, France.
authors.forename: Matthieu John
authors.initials: MJ
authors.lastname: Ouvrier
authors.affiliation: Research, Innovation and Statistics Department, A. Lacassagne Cancer Center, Nice, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Viotti
authors.affiliation: Research, Innovation and Statistics Department, A. Lacassagne Cancer Center, Nice, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Ettaiche
authors.affiliation: Hematology Department and Paediatric Onco-Haematology, National Tumour Institute, Milan, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Viviani
authors.affiliation: Hematology Chair University of Florence, Policlinico Careggi, Florence, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Rigacci
authors.affiliation: Hematology Section, Department of Medicine, Padua University, Padua, Italy.
authors.forename: Livio
authors.initials: L
authors.lastname: Trentin
authors.affiliation: Hematology Department, Ca-Granda Niguarda Hospital, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Rusconi
authors.affiliation: Hematology Department, Modena and Reggio Emilia University, Reggio Emilia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Luminari
authors.affiliation: Hematology Department, Tor Vergata University, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Cantonetti
authors.affiliation: Hematology Department, San Gerardo Hospital, Monza, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bolis
authors.affiliation: Hematology Department, S. Croce Hospital, Cuneo, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Borra
authors.affiliation: Nuclear Medicine Department, A. Lacassagne Cancer Center, Nice, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Darcourt
authors.affiliation: Hematology Department, S. Antonio and Biagio Hospital, Alessandria, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Salvi
authors.affiliation: Hematology Department, Military Institute of Medicine, Warszawa, Poland.
authors.forename: Edyta
authors.initials: E
authors.lastname: Subocz
authors.affiliation: Lymphoproliferative Disease Department, Maria Sklodowska-Curie Memorial Institute, Warszawa, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Tajer
authors.affiliation: Hematology Department, Interior Ministry Hospital, Warmia and Mazury Medical University, Olsztyn, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Kulikowski
authors.affiliation: Nuclear Medicine Department, Oncology Center, Bydgoszcz, Poland; and.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Malkowski
authors.affiliation: Gdynia Oncology Center and Department of Oncological Propaedeutic, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Jan Maciej
authors.initials: JM
authors.lastname: Zaucha
authors.affiliation: Research, Innovation and Statistics Department, A. Lacassagne Cancer Center, Nice, France andreagallamini@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallamini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001692:Biological Transport; D001853:Bone Marrow / Q000000981:diagnostic imaging / Q000378:metabolism*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011379:Prognosis; D011849:Radioactive Tracers; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D011849:Radioactive Tracers; D019788:Fluorodeoxyglucose F18
keywords: Hodgkin; PET/CT; bone marrow involvement; inflammation