Diffuse large B-cell lymphoma involving osseous sites: Utility of response assessment by PET/CT and good long-term outcomes Journal Article
| Authors: | Ghione, P.; Ahsanuddin, S.; Luttwak, E.; Varela, S. B.; Nakajima, R.; Michaud, L.; Gupta, K.; Navitski, A.; Straus, D.; Palomba, M. L.; Moskowitz, A.; Noy, A.; Hamlin, P.; Matasar, M.; Kumar, A.; Falchi, L.; Yahalom, J.; Horwitz, S.; Zelenetz, A.; Younes, A.; Salles, G.; Schöder, H.; Joffe, E. |
| Article Title: | Diffuse large B-cell lymphoma involving osseous sites: Utility of response assessment by PET/CT and good long-term outcomes |
| Abstract: | Osseous involvement by diffuse large B-cell lymphoma (DLBCL-bone) is a heterogeneous disease. There is limited data regarding response assessment by positron emission tomography with fluorodeoxyglucose, which may demonstrate residual avidity despite a complete response. We analyzed clinical data of patients with newly diagnosed DLBCL and identified all cases with DLBCL-bone. End of treatment scans were reviewed by two independent experts classifying osseous lesions into Deauville (DV) ≤3; DV ≥4, or reactive uptake in the bone marrow (M), site of fracture (F) or surgery (S). We compared outcomes of DLBCL-bone to other extranodal sites (EN) matched on International Prognotic Index features and regimen. Of 1,860 patients with DLBCL (bone 16%; EN 45%; nodal 39%), 41% had localized disease and 59% advanced. Only 9% (n=27) of patients with initial bone involvement had residual fluorodeoxyglucose avidity at the osseous site. In half of these cases, the uptake was attributed to F/S/M, and of the remaining 13, only two were truly refractory (both with persistent disease at other sites). Overall survival and progression-free survival (PFS) were found to be similar for early-stage nodal DLBCL and DLBCL-bone, but inferior in EN-DLBCL. Advanced-stage disease involving the bone had a similar 5-year PFS to nodal disease and EN-DLBCL. After matching for International Prognotic Index and treatment regiments, PFS between bone and other EN sites was similar. Osseous involvement in DLBCL does not portend a worse prognosis. End of treatment DV ≥4 can be expected in 5-10% of cases, but in the absence of other signs of refractory disease, may be followed expectantly. ©2024 Ferrata Storti Foundation. |
| Keywords: | adult; aged; middle aged; retrospective studies; major clinical study; overall survival; positron emission tomography; follow up; carboplatin; progression free survival; multiple cycle treatment; etoposide; diagnostic imaging; retrospective study; histology; ifosfamide; minimal residual disease; fluorodeoxyglucose f 18; fluorodeoxyglucose f18; positron-emission tomography; lactate dehydrogenase; lymphoma, large b-cell, diffuse; fluorodeoxyglucose; standardized uptake value; international prognostic index; procedures; overall response rate; diffuse large b cell lymphoma; refractory disease; humans; prognosis; human; male; female; article; positron emission tomography-computed tomography; positron emission tomography computed tomography; cyclophosphamide plus doxorubicin plus prednisolone plus rituximab plus vincristine; ecog performance status |
| Journal Title: | Haematologica |
| Volume: | 109 |
| Issue: | 1 |
| ISSN: | 0390-6078 |
| Publisher: | Ferrata Storti Foundation |
| Date Published: | 2024-01-01 |
| Start Page: | 200 |
| End Page: | 208 |
| Language: | English |
| DOI: | 10.3324/haematol.2022.282643 |
| PUBMED: | 37646672 |
| PROVIDER: | scopus |
| PMCID: | PMC10772505 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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