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Ródenas Quiñonero I, Marco-Ayala J, Chen-Liang TH, de la Cruz-Vicente F, Baumann T, Navarro JT, Martín García-Sancho A, Martin-Santos T, López-Jiménez J, Andreu R, Parra E, Usas A, Alonso D, Fernández-González M, Palomo Rumschisky P, Frutos L, Navarro JL, Alvarez-Perez RM, Sarandeses P, Cortes M, Tamayo P, Uña J, Martínez-Lorca A, Ruiz C, Lozano ML, Ortuño FJ. The Value of Bone Marrow Assessment by FDG PET/CT, Biopsy and Aspirate in the Upfront Evaluation of Mantle Cell Lymphoma: A Nationwide Cohort Study. Cancers (Basel) 2024; 16:4189. [PMID: 39766089 PMCID: PMC11674780 DOI: 10.3390/cancers16244189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 11/27/2024] [Accepted: 12/13/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Assessment of bone marrow infiltration (BMI) is part of the initial staging of mantle cell lymphoma (MCL), although BMI evaluated by biopsy (BMB) is not considered significant in the MIPI scales, and standardized recommendations remain lacking. OBJECTIVES To evaluate the accuracy and prognostic impact of BMI assessed by PET/CT and BMB in a large series of MCL patients. METHODS We deconstructed the IPI-NCCN, MIPI, and MIPI-c indices and considered BMI as positive if indicated by a BMB, PET/CT scan, or a combination of both. RESULTS In the total cohort (n = 148), 110 patients had BMI detected by BMB and 33 by PET/CT. The sensitivity of BMB was higher than that of PET/CT (94.8% vs. 28.4%), as were its negative predictive value (84.2% vs. 27.8%) and accuracy (95.9% vs. 43.9%). In the total cohort, BMI detected by PET/CT showed a significant predictive value for PFS (p = 0.027), while BMB demonstrated independent prognostic value only in combination with PET/CT (p = 0.025). Among intensively treated patients (n = 128), PET/CT had significant clinical impact on PFS (p = 0.030), and when combined with BMB, it provided independent prognostic value for both PFS and OS (p = 0.026 and p = 0.033, respectively). Based on these findings, we propose a prognostic model (MCL-PET-I) that incorporates BMI by PET/CT, allowing for the identification of three groups with distinct clinical outcomes (p < 0.0001 for PFS and p = 0.00025 for OS). CONCLUSIONS In the upfront work of MCL, PET/CT-based BMI has greater prognostic impact, while BMB remains essential for staging. We propose the MCL-PET-I prognostic index, which effectively differentiates between clinical risk groups.
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Affiliation(s)
- Isabel Ródenas Quiñonero
- Servicio de Hematología, Hospital José María Morales Meseguer, IMIB-Pascual Parrilla, Centro de Investigación Biomédica en Red. Enfermedades Raras (CIBERER), 30008 Murcia, Spain; (I.R.Q.); (T.-H.C.-L.); (M.L.L.); (F.J.O.)
| | - Javier Marco-Ayala
- Servicio de Hematología, Hospital José María Morales Meseguer, IMIB-Pascual Parrilla, Centro de Investigación Biomédica en Red. Enfermedades Raras (CIBERER), 30008 Murcia, Spain; (I.R.Q.); (T.-H.C.-L.); (M.L.L.); (F.J.O.)
- Department of Medicine, University of Murcia, 30100 Murcia, Spain
| | - Tzu-Hua Chen-Liang
- Servicio de Hematología, Hospital José María Morales Meseguer, IMIB-Pascual Parrilla, Centro de Investigación Biomédica en Red. Enfermedades Raras (CIBERER), 30008 Murcia, Spain; (I.R.Q.); (T.-H.C.-L.); (M.L.L.); (F.J.O.)
| | - Fátima de la Cruz-Vicente
- Servicio de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/Consejo Superior de Investigaciones Científicas (CSIC)/Universidad de Sevilla, 41013 Sevilla, Spain;
| | - Tycho Baumann
- Servicio de Hematología, Hospital 12 de Octubre, 28041 Madrid, Spain; (T.B.); (E.P.)
| | - José-Tomás Navarro
- Lymphoid Neoplasms Group, Josep Carreras Leukaemia Research Institute (IJC), Department of Hematology, ICO-Hospital Germans Trias i Pujol Hospital, 08916 Badalona, Spain; (J.-T.N.); (A.U.)
| | - Alejandro Martín García-Sancho
- Servicio de Hematología, Hospital Universitario Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación Biomédica en Red. Cáncer (CIBERONC), University of Salamanca, 37008 Salamanca, Spain; (A.M.G.-S.); (D.A.)
| | - Taida Martin-Santos
- Servicio de Hematología, Hospital Universitario de Canarias, 38320 La Laguna, Spain; (T.M.-S.); (M.F.-G.)
| | - Javier López-Jiménez
- Servicio de Hematología, Hospital Ramón y Cajal, 28034 Madrid, Spain; (J.L.-J.); (P.P.R.)
| | - Rafael Andreu
- Servicio de Hematología, Hospital La Fe, 46026 Valencia, Spain;
| | - Ester Parra
- Servicio de Hematología, Hospital 12 de Octubre, 28041 Madrid, Spain; (T.B.); (E.P.)
| | - Andrea Usas
- Lymphoid Neoplasms Group, Josep Carreras Leukaemia Research Institute (IJC), Department of Hematology, ICO-Hospital Germans Trias i Pujol Hospital, 08916 Badalona, Spain; (J.-T.N.); (A.U.)
| | - David Alonso
- Servicio de Hematología, Hospital Universitario Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación Biomédica en Red. Cáncer (CIBERONC), University of Salamanca, 37008 Salamanca, Spain; (A.M.G.-S.); (D.A.)
| | - Marta Fernández-González
- Servicio de Hematología, Hospital Universitario de Canarias, 38320 La Laguna, Spain; (T.M.-S.); (M.F.-G.)
| | | | - Laura Frutos
- Servicio de Medicina Nuclear, Hospital Virgen de la Arrixaca, 30120 Murcia, Spain; (L.F.); (J.L.N.)
| | - José Luis Navarro
- Servicio de Medicina Nuclear, Hospital Virgen de la Arrixaca, 30120 Murcia, Spain; (L.F.); (J.L.N.)
| | | | - Pilar Sarandeses
- Servicio de Medicina Nuclear, Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Montserrat Cortes
- Servicio de Medicina Nuclear, Hospital Universitari de Bellvitge-IDIBELL, 08908 Barcelona, Spain;
| | - Pilar Tamayo
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca/IBSAL, 37007 Salamanca, Spain;
| | - Jon Uña
- Servicio de Medicina Nuclear, Hospital Universitario de Canarias, 38320 La Laguna, Spain;
| | | | - Cristina Ruiz
- Servicio de Medicina Nuclear, Hospital La Fe, 46026 Valencia, Spain;
| | - María Luisa Lozano
- Servicio de Hematología, Hospital José María Morales Meseguer, IMIB-Pascual Parrilla, Centro de Investigación Biomédica en Red. Enfermedades Raras (CIBERER), 30008 Murcia, Spain; (I.R.Q.); (T.-H.C.-L.); (M.L.L.); (F.J.O.)
- Department of Medicine, University of Murcia, 30100 Murcia, Spain
| | - Francisco José Ortuño
- Servicio de Hematología, Hospital José María Morales Meseguer, IMIB-Pascual Parrilla, Centro de Investigación Biomédica en Red. Enfermedades Raras (CIBERER), 30008 Murcia, Spain; (I.R.Q.); (T.-H.C.-L.); (M.L.L.); (F.J.O.)
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FDG PET/CT versus Bone Marrow Biopsy for Diagnosis of Bone Marrow Involvement in Non-Hodgkin Lymphoma: A Systematic Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The management of non-Hodgkin lymphoma (NHL) patients requires the identification of bone marrow involvement (BMI) using a bone marrow biopsy (BMB), as recommended by international guidelines. Multiple studies have shown that [18F]FDG positron emission tomography, combined with computed tomography (PET/CT), may provide important information and may detect BMI, but there is still an ongoing debate as to whether it is sensitive enough for NHL patients in order to replace or be used as a complimentary method to BMB. The objective of this article is to systematically review published studies on the performance of [18F]FDG PET/CT in detecting BMI compared to the BMB for NHL patients. A population, intervention, comparison, and outcome (PICO) search in PubMed and Scopus databases (until 1 November 2021) was performed. A total of 41 studies, comprising 6147 NHL patients, were found to be eligible and were included in the analysis conducted in this systematic review. The sensitivity and specificity for identifying BMI in NHL patients were 73% and 90% for [18F]FDG PET/CT and 56% and 100% for BMB. For aggressive NHL, the sensitivity and specificity to assess the BMI for the [18F]FDG PET/CT was 77% and 94%, while for the BMB it was 58% and 100%. However, sensitivity and specificity to assess the BMI for indolent NHL for the [18F]FDG PET/CT was 59% and 85%, while for the BMB it was superior, and equal to 94% and 100%. With regard to NHL, a [18F]FDG PET/CT scan can only replace BMB if it is found to be positive and if patients can be categorized as having advanced staged NHL with high certainty. [18F]FDG PET/CT might recover tumors missed by BMB, and is recommended for use as a complimentary method, even in indolent histologic subtypes of NHL.
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