The role of ¹⁸F‐FDG PET/CT imaging in Waldenstrom macroglobulinemia

Abstract

Disease assessment in WM is dependent on the quantification of the IgM monoclonal protein and percent involvement of the bone marrow. There is a need for imaging studies that objectively measure tumor load in these patients. In this study, we sought to examine the role of combined FDG-PET/CT imaging in the detection of tumor load and in the assessment of response to therapy. Thirty-five patients were enrolled on a prospective study using bortezomib and rituximab therapy and were included in this study because they completed a pre-and post-treatment FDG-PET/CT imaging at one facility (12 newly diagnosed and 23 relapsed/refractory). The use of combined FDG-PET/CT imaging showed positive findings in 83% of patients with WM, unlike prior studies using conventional imaging that indicate that only 20% of patients have lymphadenopathy or hepatosplenomegaly. Moreover, 43% of patients had abnormal bone marrow uptake on FDG-PET imaging that can potentially help in the assessment of their tumor load, especially with heterogenous sampling of the bone marrow. There was no statistical correlation between EORTC response criteria for FDG-PET/CT and response by monoclonal protein. This is the first study to examine the role of FDG-PET/CT imaging in WM. Future studies should examine the role of FDG-PET/CT in conjunction with monoclonal protein response in the assessment of progression-free survival in patients with WM. Am. J. Hematol. 86:567-572, 2011. V

Waldenström macroglobulinemia: What a hematologist needs to know

“…1D). The role of combined [18F]-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging has been examined in a small prospective study of 35 patients (12 previously untreated and 23 relapsed/refractory patients) that demonstrated positive findings in over 80% of patients at baseline, indicating higher sensitivity than seen with either modality alone [65].…”

18F-FDG PET/CT: a review of diagnostic and prognostic features in multiple myeloma and related disorders

“…So far, there is limited information as to the possible role of 18 FDG PET/CT in the assessment of disease extension, tumor load, and response to therapy in patients with WM [77]. Based on large series of patients, including our own cohort of 121 patients [78], it has in fact been shown that the clinical presentation of WM is rather heterogeneous, including lymphadenopathy, hepato-splenomegaly, and polyneuropathy in percentages ranging from 20 to 25 %, signs, and symptoms related to the physical, chemical, and immunologic properties of the IgM monoclonal component, and bone marrow clonal cell expansion of variable extent [79].…”

“…Banwait et al [77] have reported a study on 35 WM patients enrolled on a prospective study and treated with the bortezomib plus rituximab combination. All patients underwent FDG PET/CT before and after therapy.…”

Baby, it's cold outside!

“…Older studies that depended on bone marrow histology for the finding of clonal low-grade lymphoma infiltration could easily overlook small numbers of clonal cells. With the advent of immunohistochemistry, flow and PET scanning, 6 looking for nodal uptake of fluorodeoxyglucose, a For personal use only. on May 9, 2018. by guest www.bloodjournal.org From higher proportion of patients can be recognized as having a low-grade lymphoma with low tumor burden.…”

“…5 In an earlier report on FHL5 patients, Meeths et al evaluated 11 patients with STXBP2 mutations and showed that stimulation of the lymphocytes with IL-2 rescued the national killer cell functional defects. 6 Their patients presented from 2 months to 17 years. Four of their patients had a splice site mutation in exon 15.…”