¹⁸F-fluorodeoxyglucose positron emission tomography in the staging and prognosis of T cell lymphoma

Abstract

We previously reported that 18F-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 [(n = 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 [(n = 50) (interim restaging cohort)]. The frequency of specific T cell histologies included in this analysis were: PTCL not otherwise specified (NOS) (n = 35); angioimmunoblastic T cell lymphoma (AITL) (n = 17); anaplastic large cell lymphoma (ALCL), ALK-1+ (n = 11) and ALK-1− (n = 12); adult T cell lymphoma/leukemia (ATLL) (n = 7); NK/T cell lymphoma (NKTCL) (n = 10); and enteropathy-associated T cell lymphoma (EATL) (n = 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 (n = 24); bone (n = 10); skin (n = 8); nasopharynx (n = 4); spleen (n = 3); and lung (n = 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 (n = 19); CHOP/ifosfamide, carboplatin and etoposide (ICE) (n = 26); and other (n = 7). Subsequently, 29 patients were consolidated with either autologous (n = 22) or allogeneic (n = 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 (p = 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.

Survival in patients with limited-stage peripheral T-cell lymphomas

“…Staging evaluations in this cohort were largely performed with computerized tomography (CT) imaging. In contrast to 18 F-fluorodeoxyglucose positron emission tomography (PET) imaging, the use of CT imaging for disease staging likely underestimates the extent of disease involvement in approximately 50% of patients (15). Therefore, it is likely that many of the patients included in this cohort may have had more extensive disease.…”

Imaging of Non-Hodgkin Lymphomas: Diagnosis and Response-Adapted Strategies

“…While the cutaneous T-cell lymphomas have low or no FDG uptake, most nodal PTCLs are FDG-avid albeit with lower FDG uptake than the corresponding B-cell lymphomas [13,34,35]. PET/CT identifies additional disease sites in non-cutaneous PTCLs in almost 50 % of the patients, but only changes disease stage in 5 % [35]. Since most nodal PTCLs are disseminated at the time of diagnosis, the additional diagnostic information by PET/CT is less likely to impact overall stage.…”

A rare case of anaplastic large T-cell lymphoma of the lung evaluated by 18F-FDG PET/CT

“…This lymphoma is associated with a patognomonic chromosomal translocation resulting in ALK overexpression and constitutive tyrosine kinase activity. 3 In our case we described a patient with a rare pulmonary ALCL in whom 18 F-FDG PET/CT has been useful for a correct staging. Chemotherapy is the mainstay of treatment and the long-term overall survival is >70%.…”