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The Role of 2-[18F]-FDG PET/CT in Detecting Richter Transformation in Chronic Lymphocytic Leukemia: A Systematic Review. RADIATION 2021. [DOI: 10.3390/radiation1010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Richter transformation (RT) is a condition wherein B cell chronic lymphocytic leukemia (CLL) transforms into a more aggressive lymphoma variant. The incidence and the significance of RT detected by 2-[18F]-FDG PET/CT is a clinical challenge and it is not widely investigated in the literature. The aim of this systematic review was to analyze published data about the potential role of 2-[18F]-FDG PET/CT in detecting RT. A comprehensive computer literature search of the PubMed/MEDLINE, Embase and Cochrane library databases was conducted up to December 2020. Thirteen studies (1336 patients with CLL) were selected. The maximum standardized uptake value (SUVmax) was the most common metabolic parameter used to detect RT. An SUVmax of 5 had an average overall sensitivity of 87% (range: 71–96%), an average overall specificity of 49% (range: 4–80%), an average positive predictive value of 41% (range: 16–53%) and an average negative predictive value of 84% (range: 33–97%). Other metabolic variables were only marginally investigated, with promising results. 2-[18F]-FDG PET/CT imaging may play an important role in the detection of RT in CLL, based on the high metabolic activity of the nodal lesions that transformed into aggressive lymphomas. 2-[18F]-FDG PET/CT has high negative predictive value for evaluating RT.
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Ziemba B, Sikorska H, Jander M, Kuncman W, Danilewicz M, Appelhans D, Bryszewska M, Borowiec M, Franiak-Pietryga I. Anti-Tumour Activity of Glycodendrimer Nanoparticles in a Subcutaneous MEC-1 Xenograft Model of Human Chronic Lymphocytic Leukemia. Anticancer Agents Med Chem 2021; 20:325-334. [PMID: 31738155 DOI: 10.2174/1871520619666191019093558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/04/2019] [Accepted: 07/01/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Chronic Lymphocytic Leukaemia (CLL) is an indolent disorder, which mainly affects older adults. Since the advent of chemoimmunotherapy, great progress has been made in its treatment. However, some patients develop a more aggressive form of the disease and are included in the group of high-risk CLL patients with a dismal prognosis and a need for new therapies. OBJECTIVE Maltotriose-modified poly(propylene imine) dendrimers were presented as potential agents in targeted therapy for CLL in the murine xenograft model. METHODS Tumour, brain and internal organs resected from NOD scid gamma mice were subjected to gross and histopathological evaluation. RESULTS The results of ex vivo tissue examination indicated that open-shell glycodendrimers prevented/inhibited the spread of CLL into the brain and internal organs and its transformation into a more aggressive form. CONCLUSION The results of the study have a potentially important impact on the design of future personalized therapies as well as clinical trials.
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Affiliation(s)
- Barbara Ziemba
- GeneaMed LTD, Lodz, Poland.,Department of Clinical and Laboratory Genetics, Medical University of Lodz, Lodz, Poland
| | | | | | - Wojciech Kuncman
- Department of Pathomorphology, Medical University of Lodz, Lodz, Poland
| | - Marian Danilewicz
- Department of Pathomorphology, Medical University of Lodz, Lodz, Poland
| | | | - Maria Bryszewska
- Department of General Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Maciej Borowiec
- Department of Clinical and Laboratory Genetics, Medical University of Lodz, Lodz, Poland
| | - Ida Franiak-Pietryga
- GeneaMed LTD, Lodz, Poland.,Department of Clinical and Laboratory Genetics, Medical University of Lodz, Lodz, Poland.,Moores Cancer Center, University of California, San Diego, CA, United States
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Zhao Z, Hu Y, Li J, Zhou Y, Zhang B, Deng S. Applications of PET in Diagnosis and Prognosis of Leukemia. Technol Cancer Res Treat 2020; 19:1533033820956993. [PMID: 32875963 PMCID: PMC7476341 DOI: 10.1177/1533033820956993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
As a malignant hematopoietic stem cell disease, leukemia remains life-threatening due to its increasing incidence rate and mortality rate. Therefore, its early diagnosis and treatment play a very important role. In the present work, we systematically reviewed the current applications and future directions of positron emission tomography (PET) in patients with leukemia, especially 18F-FDG PET/CT. As a useful imaging approach, PET significantly contributes to the diagnosis and treatment of different types of leukemia, especially in the evaluation of extramedullary infiltration, monitoring of leukemia relapse, detection of Richter’s transformation (RT), and assessment of the inflammatory activity associated with acute graft versus host disease. Future investigations should be focused on the potential of PET/CT in the prediction of clinical outcomes in patients with leukemia and the utility of novel radiotracers.
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Affiliation(s)
- Zixuan Zhao
- Department of Nuclear Medicine, 74566The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yanwen Hu
- Department of Nuclear Medicine, 74566The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jihui Li
- Department of Nuclear Medicine, 74566The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yeye Zhou
- Department of Nuclear Medicine, 74566The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bin Zhang
- Department of Nuclear Medicine, 74566The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shengming Deng
- Department of Nuclear Medicine, 74566The First Affiliated Hospital of Soochow University, Suzhou, China
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Mato AR, Wierda WG, Davids MS, Cheson BD, Coutre SE, Choi M, Furman RR, Heffner L, Barr PM, Eradat H, Ford SM, Zhou L, Verdugo M, Humerickhouse RA, Potluri J, Byrd JC. Utility of positron emission tomography-computed tomography in patients with chronic lymphocytic leukemia following B-cell receptor pathway inhibitor therapy. Haematologica 2019; 104:2258-2264. [PMID: 30923097 PMCID: PMC6821597 DOI: 10.3324/haematol.2018.207068] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/20/2019] [Indexed: 12/17/2022] Open
Abstract
The utility of positron emission tomography-computed tomography (PET-CT) in distinguishing Richter’s transformation versus chronic lymphocytic leukemia (CLL) progression after ibrutinib and/or idelalisib was assessed in a post hoc analysis of a phase II study of venetoclax. Patients underwent PET-CT at screening and were not enrolled/treated if Richter’s transformation was confirmed pathologically. Of 167 patients screened, 57 met criteria for biopsy after PET-CT. Of 35 patients who underwent biopsy, eight had Richter’s transformation, two had another malignancy, and 25 had CLL. A PET-CT maximum standardized uptake value (SUVmax) ≥10 had 71% sensitivity and 50% specificity for detecting Richter’s transformation [Odds Ratio (OR): 2.5, 95%CI: 0.4-15; P=0.318]. Response rate to venetoclax was similar for screening SUVmax <10 versus ≥10 (65% vs. 62%) (n=127 enrolled), though median progression-free survival was longer at <10 months (24.7 vs. 15.4 months; P=0.0335). Six patients developed Richter’s transformation on venetoclax, of whom two had screening biopsy demonstrating CLL (others did not have a biopsy) and five had screening SUVmax <10. We have defined the test characteristics for PET-CT to distinguish progression of CLL as compared to Richter’s transformation when biopsied in patients treated with B-cell receptor signaling pathway inhibitors. Overall diminished sensitivity and specificity as compared to prior reports of patients treated with chemotherapy/chemoimmunotherapy suggest it has diminished ability to discriminate these two diagnoses using a SUVmax ≥10 cutoff. This cutoff did not identify venetoclax-treated patients with an inferior response but may be predictive of inferior progression-free survival. (Registered at clinicaltrials.gov identifier: 02141282)
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Affiliation(s)
- Anthony R Mato
- CLL Program, Leukemia Service, Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Steven E Coutre
- Stanford Cancer Center, Stanford University School of Medicine, Stanford, CA
| | | | | | | | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | | | | | - John C Byrd
- The Ohio State University, Columbus, OH, USA
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Lymphomatoid Granulomatosis in a Patient with Chronic Lymphocytic Leukemia and Rapidly Progressing Peribronchovascular Pulmonary Infiltrates. Case Rep Pulmonol 2019; 2019:9870494. [PMID: 30805241 PMCID: PMC6363242 DOI: 10.1155/2019/9870494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/04/2019] [Accepted: 01/09/2019] [Indexed: 12/18/2022] Open
Abstract
Lymphomatoid granulomatosis (LG) is an EBV-associated angiodestructive lymphoproliferative disease with multiorgan involvement that predominantly affects the lungs. We present a case of a 72-year-old man with a history of chronic lymphocytic leukemia who presented with upper respiratory symptoms and multiple erythematous skin papules. Chest CT showed ill-defined, irregular solid pulmonary nodules with peripheral ground-glass opacities in a peribronchovascular distribution. The differential for this pattern of lung disease is vast which includes but is not limited to infection, vasculitis, sarcoidosis, lymphoma, and Kaposi sarcoma. Subsequent PET/CT showed rapid progression of lung opacities and marked FDG uptake of pulmonary opacities and skin nodules, which raised the question of Richter syndrome. Wedge biopsy under video-assisted thoracoscopic surgery was performed. Pathology showed an extensive lymphoid infiltrate involving lymphatic and bronchovascular bundles and consisting of a mixture of large lymphocytes and inflammatory cells. Special stains showed that the large lymphocytes expressed B-cell markers and EBV virus. Overall, the findings were consistent with LG.
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Gosangi B, Davids M, Somarouthu B, Alessandrino F, Giardino A, Ramaiya N, Krajewski K. Review of targeted therapy in chronic lymphocytic leukemia: what a radiologist needs to know about CT interpretation. Cancer Imaging 2018; 18:13. [PMID: 29669600 PMCID: PMC5907417 DOI: 10.1186/s40644-018-0146-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/06/2018] [Indexed: 01/22/2023] Open
Abstract
The last 5 years have been marked by profound innovation in the targeted treatment of chronic lymphocytic leukemia (CLL) and indolent lymphomas. Using CLL as a case study, we present a timeline and overview of the current treatment landscape for the radiologist, including an overview of clinical and radiological features of CLL, discussion of the targeted agents themselves, and the role of imaging in response and toxicity assessment. The goal is to familiarize the radiologist with multiple Food and Drug Administration (FDA)-approved targeted agents used in this setting and associated adverse events which are commonly observed in this patient population.
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MESH Headings
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnostic imaging
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Radiographic Image Interpretation, Computer-Assisted/methods
- Radiographic Image Interpretation, Computer-Assisted/standards
- Tomography, X-Ray Computed/methods
- Tomography, X-Ray Computed/standards
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Affiliation(s)
- Babina Gosangi
- Thoracic Radiology, Brigham and Women’s Hospital, 45 Francis Street, Boston, MA 02115 USA
| | - Matthew Davids
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
- Chronic Lymphocytic Leukemia, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, 02284 USA
| | | | - Francesco Alessandrino
- Emergency Radiology, Brigham and Women’s Hospital, 45 Francis Street, Boston, MA 02115 USA
| | - Angela Giardino
- Department of Radiology, Dana Farber Cancer Institute, Boston, MA 02284 USA
| | - Nikhil Ramaiya
- Department of Radiology, Dana Farber Cancer Institute, Boston, MA 02284 USA
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Marini C, Bruno S, Fiz F, Campi C, Piva R, Cutrona G, Matis S, Nieri A, Miglino M, Ibatici A, Maria Orengo A, Maria Massone A, Neumaier CE, Totero DD, Giannoni P, Bauckneht M, Pennone M, Tenca C, Gugiatti E, Bellini A, Borra A, Tedone E, Efetürk H, Rosa F, Emionite L, Cilli M, Bagnara D, Brucato V, Bruzzi P, Piana M, Fais F, Sambuceti G. Functional Activation of Osteoclast Commitment in Chronic Lymphocytic Leukaemia: a Possible Role for RANK/RANKL Pathway. Sci Rep 2017; 7:14159. [PMID: 29074954 PMCID: PMC5658396 DOI: 10.1038/s41598-017-12761-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/14/2017] [Indexed: 01/18/2023] Open
Abstract
Skeletal erosion has been found to represent an independent prognostic indicator in patients with advanced stages of chronic lymphocytic leukaemia (CLL). Whether this phenomenon also occurs in early CLL phases and its underlying mechanisms have yet to be fully elucidated. In this study, we prospectively enrolled 36 consecutive treatment-naïve patients to analyse skeletal structure and bone marrow distribution using a computational approach to PET/CT images. This evaluation was combined with the analysis of RANK/RANKL loop activation in the leukemic clone, given recent reports on its role in CLL progression. Bone erosion was particularly evident in long bone shafts, progressively increased from Binet stage A to Binet stage C, and was correlated with both local expansion of metabolically active bone marrow documented by FDG uptake and with the number of RANKL + cells present in the circulating blood. In immune-deficient NOD/Shi-scid, γcnull (NSG) mice, administration of CLL cells caused an appreciable compact bone erosion that was prevented by Denosumab. CLL cell proliferation in vitro correlated with RANK expression and was impaired by Denosumab-mediated disruption of the RANK/RANKL loop. This study suggests an interaction between CLL cells and stromal elements able to simultaneously impair bone structure and increase proliferating potential of leukemic clone.
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Affiliation(s)
- Cecilia Marini
- CNR Institute of Bioimages and Molecular Physiology, Milan, Italy.
- Nuclear Medicine IRCCS AOU San Martino-IST, Genoa, Italy.
- Nuclear Medicine, Department of Health Science, University of Genova, Genoa, Italy.
| | - Silvia Bruno
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Francesco Fiz
- Nuclear Medicine, Department of Health Science, University of Genova, Genoa, Italy
- Nuclear Medicine Unit, Department of Radiology, Uni-Klinikum Tuebingen, Germany
| | | | - Roberta Piva
- Nuclear Medicine, Department of Health Science, University of Genova, Genoa, Italy
| | | | - Serena Matis
- Molecular Pathology, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Alberto Nieri
- Nuclear Medicine, Department of Health Science, University of Genova, Genoa, Italy
| | - Maurizio Miglino
- Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | | | | | | | - Paolo Giannoni
- Stem Cell Laboratory, Department of Experimental Medicine, University of Genova, Genoa, Italy
| | - Matteo Bauckneht
- Nuclear Medicine, Department of Health Science, University of Genova, Genoa, Italy
| | | | - Claudya Tenca
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Elena Gugiatti
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Alessandro Bellini
- Nuclear Medicine, Department of Health Science, University of Genova, Genoa, Italy
| | - Anna Borra
- Nuclear Medicine, Department of Health Science, University of Genova, Genoa, Italy
| | | | - Hülya Efetürk
- Nuclear Medicine IRCCS AOU San Martino-IST, Genoa, Italy
- Nuclear Medicine, Department of Health Science, University of Genova, Genoa, Italy
| | | | - Laura Emionite
- Animal Facility, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Michele Cilli
- Animal Facility, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Davide Bagnara
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
- Karches Center for Oncology Research, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Valerio Brucato
- Department of Civil, Environmental, Aerospace, Materials Engineering, Aten Center, CHAB pole, University of Palermo, Viale delle Scienze, 6, Palermo, 90128, Italy
| | - Paolo Bruzzi
- Epidemiology and Clinical trial Service, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Michele Piana
- SPIN Institute, CNR, Genoa, Italy
- Department of Mathematics (DIMA), University of Genoa, Genoa, Italy
| | - Franco Fais
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
- Molecular Pathology, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine IRCCS AOU San Martino-IST, Genoa, Italy
- Nuclear Medicine, Department of Health Science, University of Genova, Genoa, Italy
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