Bone marrow infiltration in diffuse large B-cell lymphoma: impact of 18FDG-PET/CT in detection and prediction of therapy outcome

NASR, Ibrahim; ELSAYED, DALIA HAMOUDA; Talaat, Omnia; Abdel Tawab, Mohamed; Fathy, Mohammed; Ali, Ismail

doi:10.21608/zumj.2024.274282.3229

Bone marrow infiltration in diffuse large B-cell lymphoma: impact of 18FDG-PET/CT in detection and prediction of therapy outcome

Document Type : Original Article

Authors

¹ Clinical Oncology and Nuclear Medicine Department Faculty of Medicine, Zagazig University

² MEDICAL ONCOLOGY FACULTY OF MEDICINE ZAGAZIG UNIVERSITY

³ Nuclear Medicine Unit, Radiation Oncology Department, National Cancer Institute, Cairo University

⁴ Radiology Department, Faculty of Human Medicine, Alazhar University

⁵ Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Zagazig University

⁶ Radiology Department, Faculty of Human Medicine, Zagazig University

10.21608/zumj.2024.274282.3229

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.

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