nach oben

Erschienen in:

09.10.2023 | Nuclear Medicine

The prognostic value of bone marrow retention index and bone marrow-to-liver ratio of baseline 18F-FDG PET/CT in diffuse large B-cell lymphoma

verfasst von: Ahmed El-Azony, Mohammad Abd Alkhalik Basha, Yassir Edrees Almalki, Bader Abdelmaksoud, Nabila Hefzi, Ahmed A. Alnagar, Sheren Mahdey, Ismail Mohamed Ali, Ibrahim Nasr, Ahmed A. El-Hamid M. Abdalla, Hala Y. Yousef, Mohamed M. A. Zaitoun, Saeed Bakry Elsayed, Mohamad Gamal Nada, Mohamed I. Amin, Rania Mostafa Hassan, Susan Adil Ali, Tamer Mahmoud Dawoud, Sameh Abdelaziz Aly, Youssef H. Algazzar, Heba Abdelhamed

Erschienen in: European Radiology | Ausgabe 4/2024

Einloggen, um Zugang zu erhalten

Abstract

Objective

To determine prognostic value of bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) measured on baseline dual-phase ¹⁸F-FDG PET/CT in a series of newly diagnosed patients with diffuse large B-cell lymphoma (DLBCL) treated homogeneously with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy.

Patients and methods

This prospective study enrolled 135 patients with newly diagnosed DLBCL. All patients underwent dual-phase ¹⁸F-FDG PET/CT. The following PET parameters were calculated for both tumor and bone marrow: maximum standardized uptake value (SUVmax) at both time points (SUVmax early and SUVmax delayed), SUVmax increment (SUVinc), RI, and BLR. Patients were treated with R-CHOP regimen and response at end of treatment was assessed.

Results

The final analysis included 98 patients with complete remission. At a median follow-up of 22 months, 57 patients showed no relapse, 74 survived, and 24 died. The 2-year relapse-free survival (RFS) values for patients with higher and lower RI-bm were 20% and 65.1%, respectively (p < 0.001), and for patients with higher and lower BLR were 30.2% and 69.6%, respectively (p < 0.001). The 2-year overall survival (OS) values for patients with higher and lower RI-bm were 60% and 76.3%, respectively (p = 0.023), and for patients with higher and lower BLR were 57.3% and 78.6%, respectively (p = 0.035). Univariate analysis revealed that RI-bm and BLR were independent significant prognostic factors for both RFS and OS (hazard ratio [HR] = 4.02, p < 0.001, and HR = 3.23, p < 0.001, respectively) and (HR = 2.83, p = 0.030 and HR = 2.38, p = 0.041, respectively).

Conclusion

Baseline RI-bm and BLR were strong independent prognostic factors in DLBCL patients.

Clinical relevance statement

Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) could represent suitable and noninvasive positron emission tomography/computed tomography (PET/CT) parameters for predicting pretreatment risk in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy.

Key Points

• Bone marrow retention index (RI-bm) and bone marrow-to-liver ratio (BLR) are powerful prognostic variables in diffuse large B-cell lymphoma (DLBCL) patients.

• High BLR and RI-bm are significantly associated with poor overall survival (OS) and relapse-free survival (RFS).

• RI-bm and BLR represent suitable and noninvasive risk indicators in DLBCL patients.

Sehn LH, Salles G (2021) Diffuse large B-cell lymphoma. N Engl J Med 384:842–858CrossRef

Sehn LH, Donaldson J, Chhanabhai M et al (2005) Introduction of combined CHOP plus rituximab therapy dramatically improved outcome of diffuse large B-cell lymphoma in British Columbia. J Clin Oncol 23:5027–5033CrossRefPubMed

Candelaria M, Dueñas-Gonzalez A (2021) Rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in diffuse large B-cell lymphoma. Ther Adv Hematol 12:2040620721989579CrossRefPubMedPubMedCentral

Pfreundschuh M, Kuhnt E, Trümper L et al (2011) CHOP-like chemotherapy with or without rituximab in young patients with good-prognosis diffuse large-B-cell lymphoma: 6-year results of an open-label randomised study of the MabThera international trial [MInT] group. Lancet Oncol 12:1013–1022CrossRefPubMed

Gisselbrecht C, Glass B, Mounier N et al (2010) Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era. J Clin Oncol 28:4184–4190CrossRefPubMedPubMedCentral

The International Non-Hodgkin’s Lymphoma Prognostic Factors Project. (1993) A predictive model for aggressive non-Hodgkin’s lymphoma. N Engl J Med 329:987–994

Bari A, Marcheselli L, Sacchi S et al (2010) Prognostic models for diffuse large B-cell lymphoma in the rituximab era: a never-ending story. Ann Oncol 21:1486–1491CrossRefPubMed

Gutierrez A, Bento L, Diaz-Lopez A et al (2020) Evaluation of the MD Anderson tumor score for diffuse large B-cell lymphoma in the rituximab era. Eur J Haematol 104:400–408CrossRefPubMedPubMedCentral

Tilly H, Gomes da Silva M, Vitolo U et al (2015) Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 26:v116–v125CrossRefPubMed

10.

Huang H, Xiao F, Han X et al (2016) Correlation of pretreatment 18F-FDG uptake with clinicopathological factors and prognosis in patients with newly diagnosed diffuse large B-cell lymphoma. Nucl Med Commun 37:689–698CrossRefPubMedPubMedCentral

11.

Yonezawa N, Minamikawa T, Kitajima K et al (2017) The maximum standardized uptake value increment calculated by dual-time-point 18F-fluorodeoxyglucose positron emission tomography predicts survival in patients with oral tongue squamous cell carcinoma. Nagoya J Med Sci 79:189–198PubMedPubMedCentral

12.

Nakajo M, Jinguji M, Aoki M, Tani A, Sato M, Yoshiura T (2020) The clinical value of texture analysis of dual-time-point 18F-FDG-PET/CT imaging to differentiate between 18F-FDG-avid benign and malignant pulmonary lesions. Eur Radiol 30:1759–1769CrossRefPubMed

13.

Grisanti F, Zulueta J, Rosales JJ et al (2021) Diagnostic accuracy of visual analysis versus dual time-point imaging with 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules with low uptake. Rev Esp Med Nucl Imagen Mol (Engl Ed) 40:155–160PubMed

14.

Shimizu K, Okita R, Saisho S et al (2015) Clinical significance of dual-time-point 18F-FDG PET imaging in resectable non-small cell lung cancer. Ann Nucl Med 29:854–860CrossRefPubMedPubMedCentral

15.

Gormsen LC, Vendelbo MH, Pedersen MA et al (2019) A comparative study of standardized quantitative and visual assessment for predicting tumor volume and outcome in newly diagnosed diffuse large B-cell lymphoma staged with 18F-FDG PET/CT. EJNMMI Res 9:36CrossRefPubMedPubMedCentral

16.

Lee JK, Min K, So KA et al (2014) The effectiveness of dual-phase ¹⁸F-FDG PET/CT in the detection of epithelial ovarian carcinoma: a pilot study. J Ovarian Res 7:1–6CrossRef

17.

Lee SC, Kim HJ, Lee SM, Lee JW (2017) Prognostic value of bone marrow 18F-FDG uptake on PET/CT in lymphoma patients with negative bone marrow involvement. Hell J Nucl Med 20:17–25PubMed

18.

Frood R, Burton C, Tsoumpas C et al (2021) Baseline PET/CT imaging parameters for prediction of treatment outcome in Hodgkin and diffuse large B cell lymphoma: a systematic review. Eur J Nucl Med Mol Imaging 48:3198–3220CrossRefPubMedPubMedCentral

19.

Cheson BD, Fisher RI, Barrington SF et al (2014) Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol 32:3059–3068CrossRefPubMedPubMedCentral

20.

Zhou M, Chen Y, Huang H, Zhou X, Liu J, Huang G (2016) Prognostic value of total lesion glycolysis of baseline 18F-fluorodeoxyglucose positron emission tomography/computed tomography in diffuse large B-cell lymphoma. Oncotarget 7:83544CrossRefPubMedPubMedCentral

21.

Shagera QA, Cheon GJ, Koh Y et al (2019) Prognostic value of metabolic tumour volume on baseline 18F-FDG PET/CT in addition to NCCN-IPI in patients with diffuse large B-cell lymphoma: further stratification of the group with a high-risk NCCN-IPI. Eur J Nucl Med Mol Imaging 46:1417–1427CrossRefPubMed

22.

Zhou Y, Zhao Z, Li J et al (2019) Prognostic values of baseline, interim and end-of therapy 18F-FDG PET/CT in patients with follicular lymphoma. Cancer Manag Res 11:6871CrossRef

23.

Chang CC, Cho SF, Chuang YW (2017) Prognostic significance of total metabolic tumor volume on 18F-fluorodeoxyglucose positron emission tomography/ computed tomography in patients with diffuse large B-cell lymphoma receiving rituximab-containing chemotherapy. Oncotarget 8:99587–99600CrossRefPubMedPubMedCentral

24.

Chen S, He K, Feng F et al (2019) Metabolic tumor burden on baseline 18F-FDG PET/CT improves risk stratification in pediatric patients with mature B-cell lymphoma. Eur J Nucl Med Mol Imaging 46:1830–1839CrossRefPubMed

25.

Xie M, Zhai W, Cheng S, Zhang H, Xie Y, He W (2016) Predictive value of F-18 FDG PET/CT quantization parameters for progression-free survival in patients with diffuse large B-cell lymphoma. Hematology 21:99–105CrossRefPubMed

26.

Mikhaeel NG, Smith D, Dunn JT et al (2016) Combination of baseline metabolic tumour volume and early response on PET/CT improves progression-free survival prediction in DLBCL. Eur J Nucl Med Mol Imaging 43:1209–1219CrossRefPubMedPubMedCentral

27.

Cottereau AS, Lanic H, Mareschal S et al (2016) Molecular profile and FDGPET/CT total metabolic tumor volume improve risk classification at diagnosis for patients with diffuse large B-cell lymphoma. Clin Cancer Res 22:3801–3809CrossRefPubMed

28.

Esfahani SA, Heidari P, Halpern EF, Hochberg EP, Palmer EL, Mahmood U (2013) Baseline total lesion glycolysis measured with (18)F-FDG PET/CT as a predictor of progression-free survival in diffuse large B-cell lymphoma: a pilot study. Am J Nucl Med Mol Imaging 3:272–281PubMedPubMedCentral

29.

Kim TM, Paeng JC, Chun IK et al (2013) Total lesion glycolysis in positron emission tomography is a better predictor of outcome than the International Prognostic Index for patients with diffuse large B cell lymphoma. Cancer 119:1195–1202CrossRefPubMed

30.

Adams HJ, de Klerk JM, Fijnheer R et al (2015) Prognostic superiority of the National Comprehensive Cancer Network International Prognostic Index over pretreatment whole body volumetric-metabolic FDG-PET/CT metrics in diffuse large B-cell lymphoma. Eur J Haematol 94:532–539CrossRefPubMed

31.

Gallicchio R, Mansueto G, Simeon V et al (2014) F-18 FDG PET/CT quantization parameters as predictors of outcome in patients with diffuse large B-cell lymphoma. Eur J Haematol 92:382–389CrossRefPubMed

32.

Schoder H, Zelenetz AD, Hamlin P et al (2016) Prospective study of 3’-deoxy-3’-18F-fluorothymidine PET for early interim response assessment in advanced-stage B-cell lymphoma. J Nucl Med 57:728–734CrossRefPubMed

33.

Chang CC, Cho SF, Chuang YW, Lin CY, Huang YF, Tyan YC (2018) Prognostic significance of retention index of bone marrow on dual-phase 18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with diffuse large B-cell lymphoma. Medicine (Baltimore) 97:e9513CrossRefPubMedPubMedCentral

34.

Lim DH, Lee JH (2017) Relationship between dual time point FDG PET/CT and clinical prognostic indexes in patients with high grade lymphoma: a pilot study. Nucl Med Mol Imaging 51:323–330CrossRefPubMedPubMedCentral

35.

Lin S, Zhang X, Huang G et al (2021) Myeloid-derived suppressor cells promote lung cancer metastasis by CCL11 to activate ERK and AKT signaling and induce epithelial-mesenchymal transition in tumor cells. Oncogene 40:1476–1489CrossRefPubMed

36.

Zhang S, Che D, Yang F et al (2020) Correction: Tumor-associated macrophages promote tumor metastasis via the TGF-β/SOX9 axis in non-small cell lung cancer. Oncotarget 11:4845CrossRefPubMedPubMedCentral

37.

Baldassarri M, Fallerini C, Cetta F et al (2018) Omic approach in non-smoker female with lung squamous cell carcinoma pinpoints to germline susceptibility and personalized medicine. Cancer Res Treat 50:356–365CrossRefPubMed

38.

Inoue K, Goto R, Okada K, Kinomura S, Fukuda H (2009) A bone marrow F-FDG uptake exceeding the liver uptake may indicate bone marrow hyperactivity. Ann Nucl Med 23:643–649CrossRefPubMed

Titel: The prognostic value of bone marrow retention index and bone marrow-to-liver ratio of baseline 18F-FDG PET/CT in diffuse large B-cell lymphoma
verfasst von: Ahmed El-Azony
Mohammad Abd Alkhalik Basha
Yassir Edrees Almalki
Bader Abdelmaksoud
Nabila Hefzi
Ahmed A. Alnagar
Sheren Mahdey
Ismail Mohamed Ali
Ibrahim Nasr
Ahmed A. El-Hamid M. Abdalla
Hala Y. Yousef
Mohamed M. A. Zaitoun
Saeed Bakry Elsayed
Mohamad Gamal Nada
Mohamed I. Amin
Rania Mostafa Hassan
Susan Adil Ali
Tamer Mahmoud Dawoud
Sameh Abdelaziz Aly
Youssef H. Algazzar
Heba Abdelhamed
Publikationsdatum: 09.10.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 4/2024
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-023-10150-z

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

The prognostic value of bone marrow retention index and bone marrow-to-liver ratio of baseline 18F-FDG PET/CT in diffuse large B-cell lymphoma