Bone marrow infiltration in diffuse large B-cell lymphoma: impact of 18FDG-PET/CT in detection and prediction of therapy outcome | ||||
| Zagazig University Medical Journal | ||||
| Articles in Press, Accepted Manuscript, Available Online from 23 April 2024 | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/zumj.2024.274282.3229 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Ibrahim NASR1; DALIA HAMOUDA ELSAYED  2; omnia talaat3; Mohamed Abdel Tawab4; Mohammed Fathy5; Ismail Ali6
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| 1Clinical Oncology and Nuclear Medicine Department Faculty of Medicine, Zagazig University | ||||
| 2MEDICAL ONCOLOGY FACULTY OF MEDICINE ZAGAZIG UNIVERSITY | ||||
| 3Nuclear Medicine Unit, Radiation Oncology Department, National Cancer Institute, Cairo University | ||||
| 4Radiology Department, Faculty of Human Medicine, Alazhar University | ||||
| 5Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Zagazig University | ||||
| 6Radiology Department, Faculty of Human Medicine, Zagazig University | ||||
| Abstract | ||||
| Abstract: Objective: to assess the utility of 18FDG-PET/CT in the detection of bone marrow (BM) infiltration and the prediction of therapy outcomes in patients with diffuse large B-cell lymphoma (DLBCL). Method: This retrospective study included 111 patients with pathologically confirmed DLBCL. They underwent 18FDG-PET/CT imaging twice at initial staging and 2 to 12 months following completion of the recommended therapy. Results: 18FDG-PET/CT is more accurate than BMB for the identification of BM infiltration and exhibited 100% sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy for BM infiltration detection. Patients with avid 18FDG BM uptake has a bad prognosis compared to those with no BM FDG uptake, as it is significantly associated with lower rates of complete metabolic response (CMR) (66% vs. 85.9%; p = 0.019), a higher relapse rate (38.7% vs. 9.1%; p = 0.001), lower four-year relapse-free survival (RFS) (37.4% vs. 90.3%; p = 0.001), a lower five-year overall survival (OS) rate (0% vs. 77.1%; p = 0.034), and a higher death rate (21.3% vs. 6.2%; p = 0.018). Also, patients with axial, multifocal, and diffuse FDG BM uptake have a bad prognosis and lower RFS and OS rates. Conclusion: 18FDG PET/CT imaging provides whole-body mapping for detecting BM infiltration with high SN, SP, and accuracy; it can replace routine BMB in the staging of DLBCL. Avid 18FDG BM uptake is a poor prognostic sign associated with a higher relapse rate and lower rates of CMR and OS. | ||||
| Keywords | ||||
| DLBCL; Bone marrow infiltration; Bone marrow biopsy; and 18FDG-PET/CT | ||||
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