18F-fluorodeoxyglucose positron emission tomography in the staging and prognosis of T cell lymphoma. Issue 10 (October 2013)

• Record Type: Journal Article
• Authors: Casulo, Carla; Schöder, Heiko; Feeney, John; Lim, Remy; Maragulia, Jocelyn; Zelenetz, Andrew D.; Horwitz, Steven
• Is Part Of: Leukemia & lymphoma. Volume 54:Issue 10(2013:Oct.)
• Page Start: 2163
• Page End: 2167
• Publication Date: 2013-10
• Subjects: Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.3109/10428194.2013.767901
• Languages: English
• ISSNs: 1042-8194

Abstract

<abstract> <title>Abstract</title> <p>We previously reported that <sup>18</sup>F-fluorodeoxyglucose positron emission tomography scan (FDG-PET) is almost universally positive in patients with T cell lymphoma. In the present analysis we examined the impact of FDG-PET on the initial staging of peripheral T cell lymphomas (PTCLs), and the prognostic value of interim FDG-PET. This retrospective analysis identified patients with mature T or natural killer (NK) lymphomas who had PET scans as part of initial staging or staging at relapse [(<italic>n</italic> = 95) (staging cohort)] in the PTCL database at Memorial Sloan-Kettering Cancer Center. A subset of these patients had repeat PET for interim restaging during initial therapy with curative intent [(<italic>n</italic> = 50) (interim restaging cohort)]. The frequency of specific T cell histologies included in this analysis were: PTCL not otherwise specified (NOS) (<italic>n</italic> = 35); angioimmunoblastic T cell lymphoma (AITL) (<italic>n</italic> = 17); anaplastic large cell lymphoma (ALCL), ALK-1+ (<italic>n</italic> = 11) and ALK-1− (<italic>n</italic> = 12); adult T cell lymphoma/leukemia (ATLL) (<italic>n</italic> = 7); NK/T cell lymphoma (NKTCL) (<italic>n</italic> = 10); and enteropathy-associated T cell lymphoma (EATL) (<italic>n</italic> = 3). In the staging cohort, 77 patients were newly diagnosed, and 18 had relapsed disease. Pretreatment FDG-PET was positive in 96% of patients. PET identified additional disease sites in 47/95 patients (50%) when added to conventional staging. Most frequently identified additional sites were: other nodal (<italic>n</italic> = 24); bone (<italic>n</italic> = 10); skin (<italic>n</italic> = 8); nasopharynx (<italic>n</italic> = 4); spleen (<italic>n</italic> = 3); and lung (<italic>n</italic> = 2). However, FDG-PET modified computed tomography (CT)-based staging in only 5/95 patients (5.2%): two patients were upstaged and three patients were downstaged. FDG-PET-based staging did not alter planned treatment for any patient. Interim restaging with PET was performed after a median of 4 cycles of chemotherapy. In this cohort, treatment regimens included cyclophosphamide, doxorubicin, vincristine and prednisone CHOP (<italic>n</italic> = 19); CHOP/ifosfamide, carboplatin and etoposide (ICE) (<italic>n</italic> = 26); and other (<italic>n</italic> = 7). Subsequently, 29 patients were consolidated with either autologous (<italic>n</italic> = 22) or allogeneic (<italic>n</italic> = 7) stem cell transplant. After a median follow-up of 3.4 years for surviving patients, those with negative interim PET had superior progression-free survival (PFS) compared to patients with positive interim PET (<italic>p</italic> = 0.03). There were no differences in overall survival (OS). In PTCL, FDG-PET commonly identifies additional sites of disease but infrequently impacts CT-based staging and does not influence therapy. Interim FDG-PET may predict for PFS. FDG-PET should be integrated into prospective trials to confirm these findings.</p> </abstract>