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FDG PET/CT to detect bone marrow involvement in the initial staging of patients with aggressive non-Hodgkin lymphoma: results from the prospective, multicenter PETAL and OPTIMAL>60 trials.


ABSTRACT:

Purpose

Fluorine-18 fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG PET/CT) is the standard for staging aggressive non-Hodgkin lymphoma (NHL). Limited data from prospective studies is available to determine whether initial staging by FDG PET/CT provides treatment-relevant information of bone marrow (BM) involvement (BMI) and thus could spare BM biopsy (BMB).

Methods

Patients from PETAL (NCT00554164) and OPTIMAL>60 (NCT01478542) with aggressive B-cell NHL initially staged by FDG PET/CT and BMB were included in this pooled analysis. The reference standard to confirm BMI included a positive BMB and/or FDG PET/CT confirmed by targeted biopsy, complementary imaging (CT or magnetic resonance imaging), or concurrent disappearance of focal FDG-avid BM lesions with other lymphoma manifestations during immunochemotherapy.

Results

Among 930 patients, BMI was detected by BMB in 85 (prevalence 9%) and by FDG PET/CT in 185 (20%) cases, for a total of 221 cases (24%). All 185 PET-positive cases were true positive, and 709 of 745 PET-negative cases were true negative. For BMB and FDG PET/CT, sensitivity was 38% (95% confidence interval [CI]: 32-45%) and 84% (CI: 78-88%), specificity 100% (CI: 99-100%) and 100% (CI: 99-100%), positive predictive value 100% (CI: 96-100%) and 100% (CI: 98-100%), and negative predictive value 84% (CI: 81-86%) and 95% (CI: 93-97%), respectively. In all of the 36 PET-negative cases with confirmed BMI patients had other adverse factors according to IPI that precluded a change of standard treatment. Thus, the BMB would not have influenced the patient management.

Conclusion

In patients with aggressive B-cell NHL, routine BMB provides no critical staging information compared to FDG PET/CT and could therefore be omitted.

Trial registration

NCT00554164 and NCT01478542.

SUBMITTER: Kaddu-Mulindwa D 

PROVIDER: S-EPMC8440256 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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Publications

FDG PET/CT to detect bone marrow involvement in the initial staging of patients with aggressive non-Hodgkin lymphoma: results from the prospective, multicenter PETAL and OPTIMAL>60 trials.

Kaddu-Mulindwa Dominic D   Altmann Bettina B   Held Gerhard G   Angel Stephanie S   Stilgenbauer Stephan S   Thurner Lorenz L   Bewarder Moritz M   Schwier Maren M   Pfreundschuh Michael M   Löffler Markus M   Menhart Karin K   Grosse Jirka J   Ziepert Marita M   Herrmann Ken K   Dührsen Ulrich U   Hüttmann Andreas A   Barbato Francesco F   Poeschel Viola V   Hellwig Dirk D  

European journal of nuclear medicine and molecular imaging 20210429 11


<h4>Purpose</h4>Fluorine-18 fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG PET/CT) is the standard for staging aggressive non-Hodgkin lymphoma (NHL). Limited data from prospective studies is available to determine whether initial staging by FDG PET/CT provides treatment-relevant information of bone marrow (BM) involvement (BMI) and thus could spare BM biopsy (BMB).<h4>Methods</h4>Patients from PETAL (NCT00554164) and OPTIMAL>60 (NCT01478542) with aggressiv  ...[more]

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