Prognostic Value of Bone Marrow Tracer Uptake Pattern in Baseline PET Scans in Hodgkin Lymphoma: Results from an International Collaborative Study

• DOI: 10.2967/jnumed.116.184218
• Publication Date: 2017-01-27T01:11:00Z
• Authors: Colette Zwarthoed; Tarec Cristoffer ...; Maria Canepari; Matthieu John Ouv...; Julien Viotti; Marc Ettaiche; Simonetta Viviani; Luigi Rigacci; Livio Trentin; Chiara Rusconi; Stefano Luminari; Maria Cantonetti; Silvia Bolis; Anna Borra; Jacques Darcourt; Flavia Salvi; Edyta Subocz; Joanna Tajer; Waldemar Kulikowski; Bogdan Malkowski; Jan Maciej Zaucha; Andrea Gallamini
• Keywords: ABVD; Dacarbazine; Stereotactic biopsy

PET/CT-ascertained bone marrow involvement (BMI) constitutes the single most important reason for upstaging by PET/CT in Hodgkin lymphoma (HL). However, BMI assessment can be challenging. This study analyzed clinicopathologic correlations and prognostic meaning of different patterns (BM) ¹⁸F-FDG uptake HL. <b>Methods:</b> One hundred eighty newly diagnosed early unfavorable advanced-stage HL patients, all scanned at baseline after 2 adriamycin-bleomycin-vinblastine-dacarbazine (ABVD) courses with PET, enrolled international studies aimed assessing role interim PET scanning HL, were retrospectively included. Patients treated ABVD × 4–6 cycles involved-field radiation when needed, no treatment adaptation on was allowed. Two masked reviewers independently reported scans. <b>Results:</b> Thirty-eight patients (21.1%) had focal lesions (fPET⁺), 10 them a (unifocal) 28 multiple (multifocal) BM lesions. Fifty-three (29.4%) pure strong (&gt;liver) diffuse (dPET⁺) 89 (48.4%) showed or faint (≤liver) (nPET⁺). biopsy positive 6 38 (15.7%) fPET⁺, 1 53 (1.9%) dPET⁺, 5 (5.6%) nPET⁺. dPET⁺ correlated younger age, higher frequency bulky disease, lower hemoglobin levels, leukocyte counts, similar spleen. 3-y progression-free survival identical to without any (82.9% 82.2%, respectively, <i>P</i> = 0.918). fPET+ (either unifocal multifocal) significantly inferior dPET+ nPET+ (66.7% 82.5%, <i>P =</i> 0.03). The κ values interobserver agreement 0.84 0.78 uptake. <b>Conclusion:</b> We confirmed that is reliable tool longer needed routine staging. Moreover, this proved excellent only should considered as harbinger