Effect of steroid treatment on the diagnostic yield of baseline 18f-fluorodeoxyglucose positron emission tomography in aggressive B cell lymphoma

Abstract

Aggressive B cell lymphoma often requires prompt steroid treatment, even before baseline 18f-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and definitive treatment, to alleviate symptoms or prevent organ damage. Since lymphoma is a steroid-sensitive malignancy, there are concerns that steroids might affect the results of FDG PET/CT and decrease its diagnostic yield. The aim of the current study was to evaluate the effect of steroids administered before baseline PET/CT on the maximum standardized uptake value (SUVmax) and additional PET/CT parameters. Retrospective review of the database in a tertiary medical center yielded 178 patients newly diagnosed with aggressive B cell lymphoma between January 2017 and May 2020 who had an available baseline FDG PET/CT scan. The cohort was divided into patients who received steroids before PET/CT (n = 47) and those who did not (n = 131), and the groups were compared for SUVmax and additional PET/CT parameters. The steroid-treated group had a higher disease stage and lactate dehydrogenase level compared to the steroid-naïve group, with a trend toward a higher international prognostic index. There was no significant between-group difference in SUVmax (P = 0.61). This finding remained consistent across steroid treatment durations and dosage regimens. Further evaluation revealed a significantly larger mean tumor volume and a trend toward a higher tumor metabolic burden in the steroid-treated group, yet no between-group difference in SUV mean or other PET/CT parameters. In this retrospective analysis of patients with aggressive B cell lymphoma, steroid prophase prior to baseline PET/CT did not decrease the diagnostic yield of the scan. However, further studies are required to fully appreciate the impact of steroids on PET CT parameters.

Characterizing influence of rCHOP treatment on diffuse large B-cell lymphoma microenvironment through in vitro microfluidic spheroid model

“…Gal-1 has been correlated to increased metastasis and immune evasion, while CD83 is known to decrease NK cell activation [ 58 , 59 ]. These changes may be influenced by the anti-inflammatory activity of prednisone in the CHOP [ 13 ]. This data is collected from a single timepoint, however, and may be heavily influenced by cell cycle.…”

“…We utilized primary human DLBCL combined with primary NK cells, and treated these with Rituximab, CHOP chemotherapy, or the combination of both to make our model as clinically relevant as possible. Adding a cytotoxic immune cell to the model is necessary for a relevant response from the added treatments, as rCHOP treatment is primarily an immune-modulating therapy [ 13 – 15 ]. NK cells were chosen due to their ability to function independently of antigen-presenting cells, and because they are the most prominent immune cell in the DLBCL microenvironment [ 16 ].…”