Prognostic Value and Clinical Impact of 18FDG-PET in the Management of Children with Burkitt Lymphoma after Induction Chemotherapy

Abstract

Objective: Burkitt lymphoma (BL) is a rare and aggressive form of B-cell lymphoma that is curable using intensive chemotherapy. Obtaining a complete response (CR) at the end of induction chemotherapy is a major prognostic factor. This study retrospectively evaluates the potential impact of 18FDG-PET in the management of children with BL after induction chemotherapy, and the prognostic performance of the Deauville criteria.Methods: Nineteen children with BL treated according to the French LMB2001 protocol between 2005 and 2012 were included. 18FDG-PET and conventional imaging (CI) were performed after induction chemotherapy to confirm CR. 18FDG-PET was interpreted according to Deauville criteria with follow-up and/or histology as the gold standard.Results: 18FDG-PET was negative in 15 cases, in agreement with CI in 9/15 cases. The six discordant cases confirmed to be negative by histology, were considered as true negative for 18FDG-PET. Negative predictive value (NPV) of CI and 18FDG-PET were 73 and 93%, respectively. The 5-year progression-free survival (PFS) was significantly higher in patients with negative 18FDG-PET than those with positive 18FDG-PET (p = 0.011).Conclusion: 18FDG-PET interpreted using Deauville criteria can help confirm CR at the end of induction chemotherapy, with a prognostic impact on 5-year PFS. Its high NPV could limit the use of residual mass biopsy. Given the small size of our population, these results need to be confirmed by future prospective studies on a larger population.

Prognosis estimation under the light of metabolic tumor parameters on initial FDG-PET/CT in patients with primary extranodal lymphoma

“…It is the most frequent NHL in childhood (30–40%), presenting almost always as a rapidly growing tumoral mass in the abdomen (60–80%, typically in the ileocecal region). 24 Our patients with Burkitt lymphoma had high FDG uptake and their prognosis was bad. T cell lymphomas (PTCL) are a heterogeneous group of generally aggressive neoplasms that constitute less than 15% of all NHLs in adults.…”

Can FDG‐PET replace biopsy for the evaluation of residual tumor in pediatric mature B‐cell non‐Hodgkin lymphoma?

“…A biopsy of these residual masses is recommended by most of the treatment protocols, but it is sometimes invasive and only has a value if positive. 8 The aim of the current study is to evaluate the role of 18 FDG-PET scan in detection of viable residual tumor cells, using the biopsy and clinical outcome as reference. to be an inadequate response to avoid undertreatment.…”

“…Similar results have been reported with an NPV of 80% to 100%, 10,11 making it a very good negative test and a reliable indicator of CR, 13,14 and suggesting the possibility to avoid biopsy from a residual mass if it is negative. 8,9,[15][16][17] FN results varied among different studies and ranged from 0% to 5%. It was 5.2% in our study, similar to Bailly et al, which was 4.7% 8 and Riad et al, which was 5.1%.…”

“…8,9,[15][16][17] FN results varied among different studies and ranged from 0% to 5%. It was 5.2% in our study, similar to Bailly et al, which was 4.7% 8 and Riad et al, which was 5.1%. 9 Common causes of FN are inadequate patient preparation and raised serum blood glucose, 17 hence the importance of evaluation of the CT component as it can provide additional diagnostic information.…”

“…FP scan is relatively common in clinical practice, with reported rates between 25% and 75% in pediatric NHL. 2,8,9,19 Causes of FP results include tumor necrosis, postther-apeutic inflammation, 20 rebound thymic hyperplasia, accumulation in normal tissues, discomfort, anxiety, injection artifacts, 21 and brown fat uptake. 22,23 Moreover, the pattern in the GIT is highly variable.…”